Does Medicaid Cover Long-Term Care?

Questions tend to abound if you have a family member who may need some type of long-term care. For example, you may be the adult child of an older person who may have reached a juncture at which some type of long-term care is needed. If that is the case, one of the key questions on your list could be does Medicaid cover the cost of long-term care?

Yes, Medicaid can Cover Long-Term Care

The direct answer to the question of does Medicaid cover long-term care is “yes.” As will be discussed later in this article, in order to obtain Medicaid payment support for long-term care, the individual seeking that assistance must otherwise qualify for this program. A person doesn’t qualify for Medicaid payment simply because long-term care is needed.

Facts and Stats About Medicaid and Long-Term Care

According to a report from Medicaid, the program pays out over $550 billion in benefits annually. Of that amount, over 20 percent was for long-term care services. 

Medicaid has established milestones for its long-term assistance support:

  • Person-driven: The system affords older people, people with disabilities and/or chronic illness the opportunity to decide where and with whom they live, to have control over the services they receive and who provides the services, to work and earn money, and to include friends and support to help them participate in community life.
  • Inclusive: The system encourages and supports people to live where they want to live with access to a full array of quality services and support in the community.
  • Effective and accountable: The system offers high quality services that improve quality of life. Accountability and responsibility is shared between public and private partners and includes personal accountability and planning for long-term care needs, including greater use and awareness of private sources of funding. 
  • Sustainable and efficient: The system achieves economy and efficiency by coordinating and managing a package of services paid that are appropriate for the beneficiary and paid for by the appropriate party.
  • Coordinated and transparent: The system coordinates services from various funding streams to provide a coordinated, seamless package of supports, and makes effective use of health information technology to provide transparent information to consumers, providers and payers.
  • Culturally competent: The system provides accessible information and services that take into account people’s cultural and linguistic needs.

Money Follows the Person

Medicaid makes it a point to advise that when it comes to benefits through the program, money follows the person. In fact, the agency has established the Money Follows the Person program (or MFB). 

The MFP program has these stated objectives:

  • Increase the use of home and community-based services (HCBS) and reduce the use of institutionally based services
  • Eliminate barriers in state law, state Medicaid plans, and state budgets that restrict the use of Medicaid funds to enable Medicaid-eligible individuals to receive support for appropriate and necessary long-term services and supports in the settings of their choice
  • Strengthen the ability of Medicaid programs to provide HCBS to people who choose to transition out of institutions
  • Put procedures in place to provide quality assurance and improve HCBS

The California Medicaid Program Is Medi-Cal

The Medicaid program in California is called Medi-Cal. In addition to the programming mentioned a moment ago designed to transition people to their homes with supportive assistance, Medi-Cal does provide financial support for people who otherwise qualify for the program and intend to reside in an assisted living community. Medi-Cal does not pay for room and board costs associated with assisted living. However, through what is known as the Assisted Living Waiver Program, Medi-Cal does cover:

  • Assistance with activities of daily living, such as bathing, grooming or toileting, eating, and mobility
  • Assistance with the instrumental activities of daily living, such as transportation and medication administration
  • Health related services, including skilled nursing if necessary
  • Social and recreational activities
  • Prepared meals
  • Housekeeping and laundry
  • Nursing home transition care

Medi-Cal does pay for a good portion of the cost associated with nursing home care.

Qualify for Medi-Cal

If you are under the age of 60, you qualify for Medi-Cal if your total household income is 138 percent of poverty level. This breaks down like this, based on the number of people in a household:

  1. $18,755
  2. $25,268
  3. $31,782
  4. $38,295
  5. $44,809
  6. $51,323

You also can qualify for Medi-Cal if one or another of the following factors exist:

  • 65 or older
  • Blind
  • Disabled
  • Under 21
  • Pregnant
  • In a skilled nursing or intermediate care home
  • On refugee status for a limited time, depending how long you have been in the United States
  • A parent or caretaker relative of an age eligible child
  • Have been screened for breast and/or cervical cancer

Finally, if you enrolled in one of these programs, you also qualify for Medi-Cal:

  • CalFresh
  • CalWorks (AFDC)
  • Refugee Assistance
  • Foster Care or Adoption Assistance Program