Medicaid Long-Term Care FAQ

Medicaid Long-Term Care Lawyers You Can Trust

At Family First Estate Planning Law Center, we advise seniors and families through the everyday challenges they face. For seniors, receiving Medicaid long term care is an important part of the puzzle. As Upland Medicaid attorneys, we can help you every step of the way through the Medicaid process. Qualifying for Medicaid long-term care benefits is not easy without the help of an experienced law firm.

When seeking Medicaid long-term care benefits it is important to prepare yourself and stay educated on all the facts. By providing you with important information, our attorneys hope that your knowledge of Medicaid long-term care will help you feel at ease throughout the process.  For purposes of clarity, the reader should note that in California, Medicaid is known as Medi-Cal, and all references to Medicaid in this article are references to Medi-Cal.

Medicaid Long-Term Care FAQs

What is Long-Term Care and Who Needs It?

Picture of Upland Medicaid Attorneys desk

As the Baby Boomer generation ages, we will need to confront long-term care issues. Even if not for ourselves, we will have to confront these issues for our parents.

Long-term nursing home care is rarely covered by traditional health insurance, and the cost can be staggering. The costs of long-term care are dependent on where you live, and the level of care you require. According to seniorliving.org, in 2019, the average cost of a private nursing home room is $8,365 per month. The average cost of a semi-private room is $7,441 per month.

According to the National Care Planning Council, the average stay in a long-term facility is 835 days. Most seniors will end up paying for

nursing home care with their own assets. Once those assets are depleted, they may qualify for Medicaid benefits.

While no one wants to think of long-term care as it relates to themselves, careful planning can protect your assets while allowing you to receive the benefits you need—and are entitled to receive.
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Does Medicaid Pay for Long-Term Care?

The answer to this question is both yes, and no. You may qualify for Medicaid long-term care, even if you own assets. Yet, there is a limit to the number of assets you may own.

In short, your income and assets must not exceed the levels used by your state. Your state determines eligibility for long-term care through Medicaid. It also determines what level of care you require and whether that level of care qualifies you for nursing home care or home and community-based services.
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Does Medicare Cover Assisted Living or Long-Term Care?

Medicare Part A covers up to 100 days in a skilled nursing facility. Those who require extra days or need long-term care must either:

  • Qualify for Medicaid
  • Have long-term care insurance
  • Own sufficient assets to fully pay for long-term care.

Medicaid is the largest payer of long-term care services. Medicaid will coordinate benefits with Medicare, as they are both federal programs.
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If I Have Medicare, Will I Still Qualify for Medicaid Long-Term Care?

Far too many people believe Medicare will pay for their nursing home care. In fact, Medicare’s nursing home coverage is extremely limited.

Medicare covers only 100 days of skilled nursing care per illness. To qualify for this coverage, you must enter a Medicare-approved skilled nursing facility within 30 days of a hospital stay. This hospital stay must have lasted for at least three days.

The care in the nursing home must be for the same condition as your hospital stay. Medicaid eligibility is based on income and assets, and, when applicable, kicks in when Medicare coverage for nursing home care ends.
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What are the Requirements for Medicaid for Long-Term Care?

The basic criteria for long-term care through Medicaid include:

  • A U.S. citizen (or a qualified non-citizen), and
  • Meeting the residency requirements in California, and
  • One of the following:
    • Age 65 or older
    • Permanent disability
    • Permanent blindness

What happens when your income or countable assets exceed the financial limits set by Medicaid? It is possible, under certain circumstances, to become eligible by spending down income or assets. There are many rules regarding Medicaid spend-down. The income and asset limits for Medicaid are not consistent across the U.S., or even within the same state.
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What is Medicaid Spend-Down?

If your income or asset level is too high to qualify for Medicaid long-term care, you must complete an asset or income spend down. Generally, you must spend that income or assets on healthcare and medical-related costs.

You are also allowed to spend the money on accrued debt, such as a mortgage, your vehicle, or credit card debt.

The allowable health care costs for a spend-down could include:

  • Medical bills both past and current
  • Transportation services to get to your medical services
  • Home improvements that help with medical needs (like a chairlift)
  • Medical expenses like hearing aids or eyeglasses

It is important to understand the precise Medicaid spend-down rules for California before you begin implementing the spend-down process.
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Contact Our Upland Medicaid Attorneys Today

At Family First, we assist seniors and their families when making some of life’s toughest decisions. When planning for long-term care, eligibility for Medi-Cal may make some of those decisions easier. The Medicaid long-term care attorneys at Family First will help you every step of the way. To learn more about all of your options, call us at (714) 790-1827 or fill out our confidential contact form. Our team is ready to assist you in Orange County, San Bernardino County, or Los Angeles County. Call today