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Medicaid Program: What do I need to know? 

Medicaid program overview: 

You may need to learn about your state's Medicaid program even though your parent or loved one seems to have adequate to resources for the foreseeable future.  The Medicaid program is a government health insurance program for low income people.  Although it may seem that a person has adequate financial resources to last for quite awhile, long-term care is very expensive, and some people, who don't expect to ever need it, may end up having their nursing home care and other medical services paid for under the Medicaid program. 

You may need to learn the rules of the Medicaid program, or better yet, confer with a Medicaid lawyer so your parent or loved one doesn't have to use every available resource needlessly.  In fact, they may actually qualify for Medicaid sooner than they even think they will. 

By reviewing these concerns early on with a Medicaid lawyer, your parent may be able to protect some of their assets before becoming eligible for the Medicaid program.  When an individual uses up their money prior to becoming eligible for Medicaid, it is referred to as a "spend down". 

Unlike Medicare which is fully regulated by the federal government, the Medicaid program is a joint program cosponsored by both the state and the federal governments.  Guidelines are set by the federal government, and then states set up their own rules and programs within these broad guidelines.  The result is that individual states have various rules and programs that are relatively specific to those states. 

Many states have special programs that are specially set up for assisting the elderly that allow them to meet less stringent financial rules if they are in need of long-term care. 

Many elderly people who qualify under the Medicaid program are referred to as "dual eligible" meaning that they are eligible to receive both Medicare (because of their age) and Medicaid (because of their finances).  Any benefits covered under Medicare are usually paid under that program first prior to being paid for under Medicaid. 

The Medicaid program covers the bulk of a person's health care costs including nursing home care as well as some "skilled" care services at home, although sometimes there may be coinsurance amounts to be paid also.  Many doctors and some nursing homes won't accept patients on Medicaid because the reimbursement for services is relatively low.  As a result, Medicaid patients sometimes get health care at clinics where they have to wait for a significant period of time and receive relatively mediocre care.  Or, because it may be difficult to get in one of the better nursing homes, they may have to settle for substandard care in a nursing home of lesser quality. 

Despite these limitations, the Medicaid program is an incredibly important program and is a vital and welcome financial safety net.  You may want to get your parent to talk with the state Medicaid counselor or meet with a Medicaid lawyer who specializes in financial planning for individuals anticipating meeting the eligibility requirements under the Medicaid program because the rules are frequently complicated.  However, you should not expect state counselors to advise you or your loved one on how to protect their assets prior to meeting the eligibility under your state's Medicaid program.

Information from How to Care for Aging Parents 

Additional Information and webpage by Paul Susic MA Licensed Psychologist Ph.D. Candidate                                      

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