Long Term Care, Medicaid
What is Medicaid?
By Rick Law of Law Elder Law in Aurora, IL Medicare is a health insurance program that is an entitlement – regardless of an individual’s income or assets. Medicaid is not. Medicaid is jointly funded and administered by the federal government through the Centers for Medicare and Medicaid Services and each state. The responsibility for developing the guidelines for the federal/state cost sharing lies with the U.S. Department of Health and Human Services. This department is also responsible for overall supervision of state and provider participation in Medicaid. Each individual state government has a fairly wide latitude in running their Medicaid Medicaid is considered to be a means-tested program; this means that participants must meet strict income and asset criteria in order to qualify. It is considered the safety net for the impoverished. And, in many cases, Medicaid is the “payer of last resort” for skilled nursing facility benefits. Even though additional benefits may be added by individual states at their own option, all states are required to cover the following long-term care-related services:
- Inpatient hospital services (with the exception of services in institutions for tuberculosis or mental diseases)
- Outpatient hospital services and rural health clinic services, including any ambulatory services that are offered by such clinics and otherwise included in the state’s Medicaid plan
- Other laboratory and X-ray services
- Transportation to medical facilities
- Physicians’ services furnished in the office, the patient’s home, hospital, skilled nursing facility, or elsewhere, or medical and surgical services that are furnished by a dentist where state law permits either doctors or dentists to perform such services
- Skilled nursing facility services, including custodial care, but excluding services in institutions for tuberculosis or mental diseases, for individuals who are 21 years of age or older