If you are the caregiver for someone who needs long-term care, Medicaid coverage may help with some or all of the expenses.
But it's important to tread very carefully. First, some basic facts:
Medicaid is run by the states following federal guidelines and is the primary payer nationwide for long-term care services. As of April 2021, more than 75 million people were enrolled in Medicaid, including nearly 11 million who signed up during the COVID-19 pandemic.
Medicaid accounted for $1 of every $6 spent on health care in this country in 2019, the most recent data available.
Many children, low-income people and those with disabilities receive medical coverage from Medicaid. Medicaid also provides services not covered through Medicare or private health insurance, including long-term care in a nursing home or in the community, says Mary Ann Parker, staff attorney with AARP's Legal Counsel for the Elderly program.
Looking for help?
Each state’s individual Medicaid formulas for asset and income limits can be very confusing.
The Centers for Medicare & Medicaid Services has created a list of state Medicaid offices with links to pages that have phone numbers, so you can talk — after navigating the voicemail system — to a real person.
Long-term care services include assistance with such daily activities as bathing, dressing and eating. In some states, these services may also be available in an assisted living facility or in your home through a Medicaid waiver program. Forty-three percent of U.S. long-term care costs in 2019 were paid by Medicaid.
Asset, income levels differ in each state
Medicaid eligibility and application procedures vary from state to state.
The federal-state program was established to pay for health care for those who are unable to afford or obtain health insurance, so all states have asset and income limits that govern who can receive coverage, but it's not one ceiling nationwide.
"Medicaid is often of importance to middle-income Americans because Medicare does not cover the costs of long-term care for illnesses such as Alzheimer's disease or paralysis caused by a stroke. Most people who need such care for extended periods will eventually deplete their assets and become unable to pay the costs of their care,” according to a brochure available online from the National Academy of Elder Law Attorneys (NAELA).
Some assets don't count
Medicaid eligibility is based on a person's monthly income, which may include a pension, Social Security and other payments, plus “countable” assets.