Medicaid is a joint federal and state funded medical assistance program designed to provide health coverage for individuals with limited income and resources. Medicaid eligibility is primarily determined by income, household size and other factors. In a long-term care setting, eligibility also requires applicants to be age 65 or older, blind or disabled as determined by the Social Security Administration.
Services Covered by Medicaid in a Long-Term Setting
For approved applicants, Medicaid can help cover medical care in a long-term setting for services like:
- Nursing Home Services
- Physician Services
- Prescriptions
- Medical Supplies and Equipment
- Eyeglasses and Prosthetic Devices
- Physical Therapy
- Occupational Therapy
- Respiratory Therapy
- Speech Therapy
- Podiatry Services
- Dental
Getting Help with Your Application
Some nursing communities have dedicated professionals who can guide applicants through the application process including help with pre-screening, documentation requirements, income verification and other necessary steps required to become covered by Medicaid.
Medicaid Pending Applicants
Some communities may accept residents with the status of “Medicaid Pending,” which means they have not yet been formally approved by Medicaid but expect to be. When long-term care is needed urgently, finding a community that accepts “Medicaid Pending” residents can be very helpful, and is usually a good indication that the community understands the application process well.
Pre-Screening & Other Determinations
Federal law requires that every individual applying for admission to a nursing facility is prescreened to determine whether other services are available in the community which would permit the individual to remain in the community or in a lower cost setting.
A physician must then certify in writing the necessity for admission to a nursing facility and the level of care required. This certification must be completed prior to the time of admission and a recipient remains clinically eligible for nursing facility care as long as the level of care is approved, and he/she continues to meet all financial and other legally established eligibility requirements.
There are also Spousal Impoverishment Protections laws in place that allow the community spouse to keep some of the couple’s income and assets while still qualifying the nursing home spouse for Medicaid. Your admissions representative from your chosen nursing community can help applicants to navigate these determinations as well.
Required Documentation for Applying for Medicaid
To apply for Medicaid you must provide documentation listed below. Your nursing community can serve as a valuable resource to assist you in collecting all the required documentation, or they can provide guidance on the process of obtaining it.
Be prepared to provide:
- Record of marriage
- Social Security number, Medicare claim number, railroad retirement number, Veterans claim number, etc.
- Record of place of birth or, if foreign born, record of naturalization or alien status
- Bank books, record of stock, bonds
- Property deeds on owned property, but which you do not live
- Burial trusts of pre-paid funeral arrangements
- All life and medical insurance policies
- Documentation of all property transferred within the past five years
- Records showing age/ages of dependent children in the home, such as birth certificates, baptismal records and insurance policies
- Records of your income and the income of spouse and dependent children in the home
- SSI benefits – the letter of entitlement:
- Social Security benefits: the check or letter of notification (if within 12 months)
- Veterans’ benefits: the check or letter of notification (if within 12 months)
- Railroad retirement benefits: the check or letter of notification (if within 12 months)
- Unemployment compensation
- Retirement or union benefits check
- Income from rental property
- Earnings: name(s) of employer(s), pay status covering the last three months, verification of work expenses
To learn more about Medicaid, download our Applying to Medicaid brochure here.
If you or a loved one are considering long-term care and require Medicaid coverage, contact a provider near you and ask for the Director of Admissions. Visit ASCCare.com/communities to find an ASC community near you.
