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The Finances of Proper Elder Care: Medicaid and Nursing Homes

Nursing homes can be a very expensive option for an individual or for his or her family. Where a person requires round the clock assisted living, it is vital not only to find a good long-term care facility that meets federal and state regulations and has a good reputation for excellent care, but your budget must also be considered. For a person or family strapped and unable to afford the full cost of a nursing home, there is the chance that the program called Medicaid may be able to step in to help defray costs. Medicaid is a federally funded program that is facilitated through and administered by states, which often have a strong hand in determining who is eligible for coverage and what they can receive.

Under federal Medicaid rules, states distributing the money must do so for nursing homes as well as home health care services. Services range from skilled nursing, to rehabilitation, and long term care – these include facilities, like nursing homes, as well. States must pay out Medicaid funds for all eligible beneficiaries age 21 and older who meet eligibility requirements. These are provided by both the federal government and state governments, each of which will assert different minimum requirements. In general, persons applying for Medicaid will be eligible if they meet a certain means test, or in other words must demonstrate they do not have the income or any other resources that would enable them to pay for healthcare on their own.

Medicaid Payment Details
Every state in the union participates in Medicaid. On top of this, the Patient Protection and Affordable Care Act, or as it is popularly (or to some, unpopularly) known as “Obamacare,” expanded the scope of Medicaid by increasing funding and opening up eligibility requirements. The law currently mandates that persons with incomes at 133% of the federal poverty line can qualify (in 2014, the federal poverty line for individuals is $14,856 and $30,656 for families, based on 2012 figures). With regard to nursing homes or long term care facilities specifically, many states employ different income thresholds for reimbursement of long term care with Medicaid.

There is somewhat of an added security for patients who stay at nursing homes and long term care facilities that accept Medicaid. Note that not all do, and it is entirely their choice, but Medicaid provides another avenue of revenue for these facilities that many do not want to miss. As we’ve previously discussed, facilities that accept Medicaid money subject themselves to additional rules and regulations under federal law. Thus patients at these facilities can expect that both federal and state authorities will engage in active oversight, often jointly and overlapping, of these nursing homes. While this does not ensure anything automatic, there is an added risk for nursing homes to lose this Medicaid funding by not complying with federal and state regulations. If they fail inspections or complaints lead to investigations that uncover abuse or negligence against patient residents, then these facilities will suffer a major financial hit.

Thus Medicaid offers a financial path for those seeking residency at a long term care facility that accept federal money, and furthermore adds a layer of oversight and enforcement to keep these facilities honest.

See Other Blog Posts:

An Overview of the Regulation and Monitoring of Illinois Nursing Homes

New Example of the Importance of Evaluating a Nursing Home in Illinois