Medicaid is a government-run health assistance program for low-income individuals. It is funded jointly by the federal government and the individual states. The program was created in 1965 and currently covers over 80 million individuals as of March 2022.

Preparing early for your loved one’s healthcare expenses is one of the best things you can do for them. Hospital visits and check-ups inevitably become more frequent as they age. Without the proper funds and resources, healthcare costs can be financially draining.

Being well-informed about Medicaid eligibility and policies can make planning for senior care more manageable. With this type of financial assistance, you won’t have to worry about paying for many healthcare-related expenses that aren’t covered by Medicare.

Read on below to learn more about Medicaid, including what the program covers and how to know if you are eligible.

Medicaid Covers a Variety of Ages and Needs

The public health program covers low-income families and individuals. This includes children, pregnant women, people with disabilities, and seniors. The scope of coverage depends on several factors. This includes the state you live in, the services needed, and the duration of service. Medicaid is available in all 50 states but the coverage varies.

Do I Qualify for Medicaid?

To qualify for Medicaid, there are certain non-financial and financial criteria you have to meet. To be eligible, the beneficiary must:

  • Be a U.S. citizen or a non-citizen who meets immigration requirements
  • Be a resident of the state in which they are applying for Medicaid
  • Have a Social Security Number
  • Meet income limits

The financial eligibility requirement differs depending on the state. Income limits vary for different groups and household sizes. You can learn more about the specific requirements by contacting your Area Agency on Aging.

Medicaid Funding: Federal and State

Medicaid costs are shared by the federal government and the states. On average, the federal portion covers two-thirds of the medical cost of Medicaid. Using the Federal Medical Assistance Percentage (FMAP), the federal government matches what the state spends, taking into account the per capita income among the states.

Medicaid can also provide an enhanced matching rate through the Affordable Care Act Medicaid expansion. This allows the federal government to cover nearly all the costs of coverage for those eligible.

Medicaid Benefit to Older Adults

Older adults who meet the eligibility requirements can benefit from Medicaid. The program can pay for long-term care services. This includes custodial nursing home care, home care, and community-based services.

In addition, Medicaid can also help with out-of-pocket medical expenses. In some cases, the program can also pay for Medicare premiums, co-payments, and deductibles.

What is a Medicaid Caseworker?

When you apply for Medicaid, a professional caseworker oversees your application for processing. The caseworker becomes your contact person throughout the application process.

Caseworkers can help you understand the complexities of the program. Their goal is to provide assistance and make the whole application process easier to navigate.

What Does Medicaid Pay For?

Medicaid covers a wide array of health services. States are required to provide the mandatory benefits listed below to beneficiaries. They may also choose to cover the optional benefits listed below.

Some Mandatory Medicaid benefits include:

  • Inpatient hospital services
  • Outpatient hospital services
  • Home Health
  • Long-term Nursing Facility care
  • Physician services
  • Laboratory and x-ray
  • Transportation to medical care

Some Optional Medicaid benefits include:

  • Prescription drugs
  • Physical therapy
  • Occupational therapy
  • Clinic services
  • Respiratory care services
  • Dental services
  • Dentures
  • Prosthetics
  • Eyeglasses
  • Chiropractic services
  • Private duty nurse
  • Personal care
  • Case management
  • Hospice

Does Medicaid Pay for Senior Housing?

Yes, Medicaid pays for some of the costs of long-term care in most states. This includes assisted living communities, residential care homes, adult care homes, and nursing homes. The housing or community must be Medicaid-approved.

Keep in mind that not all senior housing communities accept Medicaid. If you or a loved one has been approved for Medicaid, obtain a list of facilities that have an active Medicaid contract in place. A Medicaid contract does not require a senior care facility to accept new Medicaid residents.

Does Medicaid Pay for Assisted Living?

Yes, Medicaid can help pay for some of the costs of assisted living. The exact coverage will vary depending on the state and program. But, all states offer some degree of coverage for personal care. Some of the services Medicaid can help pay for include homemaker services, case management, and transportation.

Does Medicaid Pay for Memory Care?

Yes, memory care falls under the category of nursing facility services. However, how it is delivered can vary, depending on the state. Some states offer programs that provide stand-alone memory care, while others provide this type of care as part of a nursing facility.

Does Medicaid Pay for Adult Care Homes?

Yes, Medicaid can also pay for adult care homes. The adult care home, also known as adult foster care, should be Medicaid-approved and licensed by the specific state where they are located.

Did you know?
An Adult Care Home is a lesser-known level of senior care that is gaining popularity across the US. Typically located in a single-family home, private owners take care of 5 or more residents in a home-like setting. Home-cooked meals, high staffing ratios, and 24/7 care are a few of the benefits of adult care homes (aka adult foster care).

Does Medicaid Pay for Nursing Homes?

Nursing home facilities are included in Medicaid’s coverage. The program often pays for 100% of nursing home costs. Medicaid will pay a fixed daily rate to the nursing home, covering room and board, meals, and other services.

Does Medicaid Pay for In-Home Care?

Yes, Medicaid can pay for in-home care. Specific in-home care services, the amount covered, and eligibility can vary from state to state. In-home care services could be from a home care agency or a state database of private caregivers.

Differences Between Medicaid and Medicare

It is not uncommon for people to confuse Medicaid and Medicare. They are both government-run programs but have very different policies and financing structures.

Medicaid is a financial assistance program that provides help to low-income individuals, regardless of age.

Medicare is fee-for-service insurance that covers adults 65 years and above. In some cases, Medicare can also help younger adults with disabilities.

You can have both Medicaid and Medicare if you meet the requirements for both programs. Dual-eligible beneficiaries receive benefits from both Medicaid and Medicare, eliminating most out-of-pocket expenses.

Some of the main differences between Medicaid and Medicare are:

  • Medicare is primarily for older adults who are 65 years old and above.
  • Medicaid is for individuals who have limited income and resources.
  • Monthly premiums are collected to help fund Medicare.
  • Expect out-of-pocket expenses with Medicare.
  • There are little or sometimes no out-of-pocket costs with Medicaid.
  • The enrollment period for Medicare starts three months before your 65th birthday.
  • Enrollment for Medicaid is available at any time.

In Summary

Medicaid can provide much-needed financial assistance for families in a variety of areas. However, the program can be complex and difficult to navigate. By understanding the basics of Medicaid eligibility and coverage, you can plan ahead for your loved one’s care and avoid costly surprises down the road.

Have you had any experience with Medicaid? What tips would you add to our list? Let us know in the comments below!

Medicaid Frequently Asked Questions

How are Medicaid and Medicare Different?

Medicaid and Medicare are both health insurance programs. Medicaid eligibility is based on income, while Medicare is based on age. Medicare is federally funded while Medicaid is funded both federally and at the state level.

Can you have Medicaid and Medicare at the same time?

Yes, you can be dually eligible for Medicaid and Medicare if you meet the requirements for both. Those who are eligible for both can enjoy wider coverage and have fewer out-of-pocket expenses.

Does Medicaid pay for Assisted Living?

Yes, the program can help pay for some of the costs of assisted living. The amount covered will vary from state to state. Room and boarding costs are typically not included in the coverage.

What does Medicaid cover?

Medicaid covers a wide range of healthcare services. Some of the services included in its coverage are inpatient and outpatient hospital services, home health services, and nursing homes. Some of the optional Medicaid benefits include physical therapy, dental care, personal care, private-duty nurse, and hospice.

An expert in senior care, Amie has professional and personal experience in senior housing, caregiving, end-of-life care, and more from her 24 years of working with older adults.