(800) 562-2734

Understanding Medicaid: The Basics

From Shelley Levitt, Pfizer Get Old

When limited income and assets factor into your health, Medicaid can often be a lifeline.

According to government statistics, more than 4.6 million men and women over the age of 65, who qualify, receive Medicaid benefits. Nearly all are also enrolled in Medicare, the federal health insurance program for seniors, making them what’s known as “dually eligible.”

Medicaid can help pay for Medicare premiums and out-of-pocket medical expenses. It also covers, as the medicaid.gov website notes, services that aren’t fully covered by Medicare.  That includes long-term care in a nursing facility, or home nursing care. In short, for seniors unable to afford some healthcare costs, Medicaid can help cover the gaps that are left by Medicare.

While Medicare is a federal program, Medicaid is a partnership between the federal and state governments. That means Medicaid is called by different names across the country, such as Health First Colorado, MaineCare and MassHealth.  It also means that states have flexibility on how they design their Medicaid programs.

“Medicaid is complicated on many different fronts,” says Patricia D’Agostino, a Boston-based lawyer who specializes in elder law and estate planning. “Eligibility for Medicaid not only differs from state to state, the rules are also different depending upon whether someone is seeking coverage for long-term care in a nursing facility, or for what’s considered a community-based service.” That could be an assisted-living facility, a home health aide or services in the home of a caregiver.

In general, D’Agostino says, in order to receive Medicaid benefits for nursing-care costs, an individual cannot have assets of more than $2,000 beyond their home and car. For couples, the spouse who’s not applying for Medicaid can typically have assets of $123,600. That’s known as the Community Spouse Resource Allowance, or CSRA, for short. Here, too, there is some variance among states. Illinois, for example, has a CSRA maximum of $109,560 and South Caroline caps “well spouse” assets at $66,480.

The Medicaid Planning Assistance website from the American Council on Aging has a breakdown of eligibility by state, as well as a general overview on Medicaid that’s a good starting point on educating yourself.

“In many cases, if you exhaust your Medicare benefits, a nursing home or hospital can help you apply for Medicaid,” D’Agostino notes.

Often, however, you’ll want to do some planning in advance. As D’Agostino points out, it may be important to preserve some assets for the healthy spouse when a husband or wife receives Medicaid to cover long-term nursing care. A consultation with a specialized attorney can help you understand your options. The National Academy of Elder Law Attorneys and The National Elder Law Foundation both have directories of specialists.

Free services on deciphering Medicaid are also available . The federal Medicaid.gov website has a directory of contacts for state Medicaid offices. At AgingCare.com, you’ll find state-by-state listings for a variety of local agencies on aging that can provide assistance.

“There are lots of different pathways to getting information about Medicaid,” says Ruth Linden, Ph.D., founder and president of Tree of Life Health Advocates in San Francisco. “These include social services agencies in your community, legal services agencies and community-based organizations.”

  Keep in mind that Medicaid is both complex and an ever-changing landscape. “It’s difficult to figure out on your own,” says D’Agostino, “so it’s definitely advisable to get some guidance.”




(800) 562-2734
24 Hours, 7 Days A Week

CA License #374700058