Long-Term Care And Medicaid
What is Medicaid?
Medicaid is an entitlement program for indigent people that covers a whole variety of things that include acute hospitalization, it covers long-term custodial care, it covers medications, durable medical equipment, and home health. It's pretty comprehensive, but you have to have virtually no assets. You have to be indigent in order to qualify for it.
Why is it called Medi-Cal in California?
We call in Medi-Cal in California because we like to be different, but it's basically all the same as any other MedicAid program.
How do I qualify for Medicaid?
To have Medicaid benefits, you essentially have to be indigent and typically have some significant medical needs. So, in other words, if you are just out of work and don't have any money, that doesn't get you Medicaid. I mean, if you're pregnant you automatically get it, and if you're elderly and indigent, you automatically get it, but a young healthy person that just is indigent won't qualify for Medicaid.
Who determines Medicaid eligibility?
Medicaid eligibility is done on a state by state basis, so the criteria are somewhat variable from one state to the next. In some states, I think, just by virtue of having certain conditions you automatically can qualify, if you meet the financial requirements. Other states have different rules, and probably the best way to find out is to call you local Medicaid office.
Is it true Medicaid can recollect the cost of care from a person's estate upon death?
I've heard rumors that Medicaid, in some circumstances, can collect money or create a lien against an estate if they become aware that there were assets available in that person's name that they weren't aware of previously. Also, in situations where, for example, there's a lawsuit against the nursing facility and the family gets a big judgment, both the nursing home and maybe hospitals have the opportunity to try to recoup some of that money. Both Medicare and Medicaid, if they paid out for the person's care and it's found that that care was required because of some form of negligence or something, can also go after an award in that kind of situation.
What does Medicaid cover?
Medicaid covers a whole slew of things. It's a fairly comprehensive program for people who do qualify for it. The one thing that Medicaid covers that nobody else covers, outside of private long-term care insurance, is long-term custodial care in a nursing facility. That can be a very huge amount of money, so if you qualify for Medicaid, it's a very good idea to get it or do whatever it is you need to do to become eligible for it. They cover hospital stays, they cover medications, and they cover some degree of rehabilitation services and at-home health, depending on what your circumstances are.
What does Medicaid NOT cover?
Medicaid doesn't cover care for certain kinds of conditions, and it varies from one state to the next. They also don't cover every single kind of medication known to man. They are pretty strict on some of the home health benefits. It varies, to some degree, from one state to the next, and it varies depending on what a person's medical conditions and needs are. But in general, it's a pretty comprehensive program.
Do all long-term care facilities accept Medicaid?
Not all long-term care facilities accept Medicaid, and obviously assisted-living facilities, independent kinds of settings, can't accept because Medicaid simply doesn't cover care in that setting. As far as nursing homes and nursing facilities, a majority of them do accept Medicaid, but there are a fair number who don't, and those will just take essentially Medicare patients and private-pay patients, or people who have other kinds of insurance that will cover their stays there.
Does Medicaid only pay for certified nursing facilities?
In order to get paid by Medicaid, a facility has to have a certification. You would have to have that certificate in order to accept Medicaid patients and get paid for Medicaid patients. There are facilities who don't have that certificate, and if a Medicaid patient goes in there, they're going to have to be paid through some other avenue.
How can I find out about my state's Medicaid program?
Probably the best way to find out about the Medicaid program in your own area is to contact the local office. Also, a lot of times if you go to the State Department of Health website you can find some good information on the Internet.