Medicaid Long Term Care Eligibility

Medicaid Long Term Care Eligibility


I am frequently surprised by how many people do not know that Medicare, the federal health program for persons 65 and older, does not cover long term care. Long term care is assisted living and other care rendered in a nursing home or other institution, or, in some cases, in the community. It is estimated that one in 4 Americans will spend some of their final years in a nursing home. The per person cost of such care in today’s dollars is staggeringly high. As of July 2014, the average monthly cost of long term care in the state of Colorado was $7,161.00 per month or nearly $85,000 per year. Few families have the resources to pay these kinds of costs for long, yet what are the options for families with an elderly loved one who is disabled and unable to care for themselves?

If families have not purchased long term care insurance (and I highly recommend that individuals 55 or over seriously consider making the payment of premiums for such coverage a spending priority), the only option left might be applying for Medical Assistance under the state’s Medicaid program. Medicaid, a partnership program funded with both state and federal dollars will provide long term care insurance for persons who are eligible. Medicaid eligibility involves an assessment of a person’s ability to perform the activities of daily living (ADL) independently, as well as a demonstration that the applicant is impoverished and without means to pay for nursing home or other long term care.

Eligibility for Medicaid long term care in a nursing home is based on three eligibility requirements: categorical, income, and resources.

Categorical: An applicant must have medical conditions requiring institutionalization and in fact must have been admitted to a hospital or nursing home for 30 consecutive days.