Working with Seniors: Health, Financial, and Social Issues

Chapter 20: Medicaid and Seniors

Sammy moved into a nursing home three years ago at the age of 88. At that time, after six years of paying for around-the-clock home health aids, his original portfolio of $20,000 had dwindled to $500,000. The monthly fee for the nursing home was $4,745, so it took only four months until he reached his state’s asset limit of $2,000 and could apply for Medicaid.

Sammy’s diabetes has gotten better since he moved into the home, where he eats a healthy diet, takes his medications regularly, and enjoys daily walks. Sammy, who worked for the same printing company for over 40 years says, “ I never expected to outlive my money. Where would I be without Medicaid?”

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Evy is part of a new trend in long-term care provided through Medicaid, called home and community-based services. She receives home-based service instead of nursing home care because the state she lives in, Florida, has a “Medicaid waiver.” The waiver allows Evy to live with her son, daughter-in-law, and eight-year-old granddaughter and receive personal care from them. Without the waiver program, she would have to live in a nursing home.

Medicaid also covers Evy’s Medicare premiums and pays for her walker and prescription drugs. At age 85, she says the greatest gift is being able to live with her granddaughter, who plays Chinese checkers with her many evenings.

Introduction

Medicaid is the United States’ health care safety net. It is important for you to know about Medicaid for a number of reasons:

• Today, many seniors live age 80 or 90, and some, like Sammy, outlive their assets. Medicaid can provide them with the health care they would otherwise not receive.

• Spending down to qualify for Medicaid is a controversial and complicated issue important to the financial well-being of many seniors. Failure to understand how the system works can have financially devastating consequences. In addition, many seniors have questions about spending down, and you may be the best source of answers for them. Understanding the system and requirements will work to your benefit.

• Medicaid can help pay for Medicare premiums and other costs not covered by Medicare.

• Medicaid is the biggest financer of long-term care (LTC) services in the United States.

• The Medicaid system is changing dramatically and rapidly. Failure to keep up with these changes could mean that some senior clients will lose out on benefits and services.

This chapter covers the major issues that you should know about Medicaid and its coverage. The chapter includes: a brief history of the Medicaid program, an explanation of the differences between Medicaid and Medicare, a breakdown of Medicaid services, details on Medicaid’s coverage of institutional and community-based services, and the importance of Medicaid in planning for long-term care.