Orientation to Medicaid
January 2016 | Leland Kiang, LICSW firstname.lastname@example.org
Medicaid is a free, government funded health program, which people sometimes confuse with Medicare. Medicare provides health insurance to mostly older adults and people with disabilities, regardless of their finances. In contrast, Medicaid pays for health insurance for primarily low-income adults, older adults, and children. It also helps some older adults with Medicare related costs (e.g. premiums and co-pays); and covers long-term care (i.e. residency) in a nursing home. In some states, Medicaid covers long-term care in an assisted living facility, and/or helps with in-home care. While Medicaid is funded by a mix of federal and state dollars, it is managed almost entirely by the states. For this reason, Medicaid’s coverage and eligibility varies somewhat state to state.
Most people think of Medicaid as being one program. It actually is comprised of multiple sub-programs. Community Medicaid (a.k.a. State Plan Medicaid) mainly offers health insurance to low-income individuals. In some states, it also pays for in-home care for those needing help with “personal care” (i.e. bathing, dressing, and grooming). Some state programs also offer help with adult day care and transportation to medical appointments. Separate eligibility requirements (which may include age, income, and asset restrictions) typically exist for older adults, younger adults with disabilities, parents, and children. Those states—which opted for expanded coverage under the ACA (a.k.a. “Obamacare)—also assist other populations. In most states, the income limit for Community Medicaid for older adults falls right around the Federal Poverty Line. To learn more about (or to apply for) your state’s Community Medicaid program, consult with your state Medicaid office.
The Qualified Medicare Beneficiary program (QMB), the Service Limited Medicare Beneficiary program (SLMB), and the Qualified Individual program (QI) are all Medicaid programs (collectively called Medicare Savings Programs) that help with some of the costs associated with Medicare (e.g. premiums and copays). The Medicare Savings Programs do not replace Medicare, nor do they help with in-home care, adult day care, transportation, or long-term care. To be eligible, individuals must have Medicare; and must have low to moderate income and asset levels. Typically, income limits for QMB, SLMB, and QI are higher than those of Community Medicaid. To learn more about the Medicare Savings Programs, see Medicare’s website. To apply, consult with your state Medicaid office.
Some states offer Medicaid Home and Community Based Waiver programs. These programs provide extensive in-home support to older adults and people with disabilities; and may include social services, personal care aid, medication management assistance, and transportation to medical appointments. To be eligible, individuals must need assistance and/or supervision with multiple life skills (a.k.a. Activities of Daily Living and Instrumental Activities of Daily Living), and meet income and asset restrictions. Typically, income and asset restrictions for Home and Community Based Waivers are higher than those for Community Medicaid. To learn if your state offers a Home and Community Based Waiver program (or to apply for a program), consult with your state Medicaid office.
In all states, Medicaid provides long-term care (i.e. residency) coverage in a nursing home, under the sub-program, Institutional Long-Term Care Medicaid (a.k.a. Long-Term Care Medicaid). A few states also pay for costs associated with assisted living facilities. To be eligible, individuals must need a nursing home level of care (meaning that the care needed requires a nursing home), and meet income and asset restrictions. To learn more (or apply for) your state’s Institutional Long-Term Care Medicaid program, contact your state Medicaid office.
For more information about any of Medicaid’s programs, contact your state Medicaid office. Additional free assistance for older adults also may be available from your State Health Insurance Assistance Program, or from your local Area Agency on Aging.