With the new healthcare laws, along with annual changes that are typical with both Medicaid and Medicare, there’s a focus on the changes in benefits for those who rely on the programs. It’s easy to become overwhelmed, but getting the foundation in place can eliminate much of the confusion. Remember, it’s always a good idea to discuss any changes – and certainly changes to your estate plan – with your legal advocate to ensure you’re making the most of any Medicaid benefits. Also, remember that these dynamics can and often do change annually. What worked a year ago may no longer be an option today and indeed, laws will vary state to state.
Many Medicaid Benefits
Even though it’s up to each state to administer and police Medicaid coverage, there are compliance issues that each state is required to have in place. After that, each state will decide which, if any, optional benefits it will offer its residents.
These benefits serve as the foundation of the program and include:
- Inpatient and outpatient hospital services
- Home health services
- Rural health clinic services
- Health center services (must have Federal approval)
- Doctors’ services
- Laboratory work and any necessary x-rays
- Other Nursing Facilities
Optional Benefits
States also have the option of including these services:
- Physical therapy
- Occupational therapy
- Hearing and language disorder services
- Diagnostic services
- Optometry services
- Dental services
- Dentures
- Eyeglasses
- Personal-care
- Hospice
Note that this is not an all-inclusive list.
Medicaid Certified Nursing Homes
Many of our clients and their families are concerned about nursing home coverage. Most nursing facility services are covered under Medicaid’s certified nursing homes. Generally, there are three categories. The first is skilled nursing and medical care – including a number of related services which are made available to patients. The second category is rehabilitation and it provides care following injuries, disabilities or other illnesses. Finally, long term care; which is health related care that goes beyond room and board. It’s generally not available within a patient’s community, but is designed for those who need regular care for mental or physical purposes.
There is no boxed definition for Medicaid nursing homes; it’s simply a nursing facility designed to provide care for any number of illnesses or injuries. It might include home and community based services (HCBS) and any other medical services outside of a hospital or institutional setting. If it meets Medicaid’s requirements, it can then move forward provided it stays in compliance.
Once these services have been provided and if the patient requires continued care, those costs are covered by long term care insurance. If that is not available, the patient may have other options available.
Of course, this is a basic outline of a very intricate program. Your Medicaid lawyer can provide more in-depth information that’s tailored for your needs. The important thing to remember is there are typically options available that many elderly are unaware of. Working with your elder care attorney ensures you’re able to take advantage of any of the options available to you.
Ellen LaPlante
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