If you or a loved one needs long-term care in Maryland, both Medicare, and the Medicaid Long Term Care Program can provide essential financial assistance. This comprehensive guide covers everything you need to know about qualifying for Medicaid long-term care benefits and navigating the application process.
What is Medicare, and what does it cover?
- Medicare is a federal health insurance program primarily for individuals ages 65 and older. Here’s a quick overview of Medicare and the reasons its nursing home coverage is limited:
- Medicare is a national healthcare program managed by the federal Centers for Medicare & Medicaid Services (CMS).
- It provides health insurance to Americans aged 65 and older, as well as some younger disabled individuals.
- Medicare has different parts – Part A covers hospital/inpatient care, Part B covers medical services, and Part D covers prescription drugs.
- Medicare is funded by payroll taxes, beneficiary premiums, and federal general revenues.
- It serves over 60 million beneficiaries and is a major component of healthcare coverage for seniors.
Why is Nursing Home Coverage Limited?
Medicare was designed to provide acute healthcare coverage, not long-term custodial care. By law, Medicare nursing home benefits are restricted to short-term skilled nursing facility care.
What is Medicare Coverage for Nursing Homes?
To qualify for a Medicare-covered SNF stay, a 3-day minimum hospital admission is required along with a medical need for skilled care.
- Medicare pays 100% for the first 20 days of SNF care, then requires daily coinsurance through day 100, after which coverage ends.
- Custodial long-term care is not covered – Medicare focuses on short rehabilitative services.
- Medicare covers rehabilitation services and skilled nursing care but not long-term custodial care.
- No long-term nursing home care is covered – only up to 100 days per benefit period if certain conditions are met.
- Medicare does not pay for room and board – only direct medical services and supplies.
- Medicare provides only short-term skilled nursing facility coverage after a qualifying 3-day hospital stay.
- Unlike Medicaid, there are no financial requirements to qualify for Medicare – just age and work credits.
By contrast, Medicaid is the primary payer for long-term nursing home care for low-income individuals. Long-term care is not Medicare’s role. When initially enacted, and since that time, consideration was made to expanding nursing home coverage. In each instance, it was determined that further coverage would have significant cost implications for the Medicare program and require legislation beyond that which was originally contemplated.
In summary, Medicare’s nursing home benefits are designed for short-term skilled and rehabilitative care. Long-term custodial services are left to other payers like Medicaid due to Medicare’s acute care focus. Medicaid provides long-term nursing home coverage for those who meet state eligibility criteria, while Medicare only covers short-term skilled care in limited circumstances. The programs serve very different needs.
Medicaid Coverage for Nursing Homes
Medicaid provides long-term coverage for nursing home care. There is no limit on the number of days covered, as long as eligibility criteria continue to be met. Medicaid pays for a basic semi-private room, meals, nursing services, therapies, and some personal care items.
- Individuals must meet financial criteria regarding income and asset limits to qualify for Medicaid nursing home coverage. Spending down excess assets is often required.
- Medicaid eligibility is administered at the state level and coverage varies by state. Financial and functional requirements must be met.
- Income paid to the nursing home is required, with a small personal needs allowance for the individual.
- Medicaid can provide coverage for both skilled nursing care and custodial long-term care.
- .What is the Maryland Medicaid Long-Term Care Program?
The Maryland Medicaid Long Term Care Program helps pay for long-term care services for low-income Maryland seniors and younger adults with disabilities. Medicaid long-term care provides financial support for:
- Nursing home care
- Assisted living facilities
- Home and community-based services
To receive Medicaid coverage for long-term care, individuals must meet eligibility requirements related to their financial situation, health needs, and state residency status.
Am I Eligible for the Maryland Medicaid Long-Term Care Program?
To qualify for Medicaid long-term care benefits in Maryland, you must meet the criteria in these key areas:
- Residency
- You must be a legal resident of Maryland.
- Citizenship
- You must be a U.S. citizen or legal resident.
- Income: Your monthly income must be below 300% of the Supplemental Security Income (SSI) benefit rate. In 2023, that amount is $2,523/month for an individual.
- Assets: Countable assets (like bank accounts and investments) must be under $2,500. Your primary home and car are exempt at the time of application but may be subject to claims from the State
- Functional ability: You must need hands-on assistance with daily living activities. A doctor will assess your capabilities.
- Nursing home level of care: If seeking nursing home care, you must require that high level of care.
How Do I Apply for Medicaid Long-Term Care Benefits in Maryland?
Applying for Medicaid long-term care involves applying with supporting documents to your local Department of Social Services office. Here are the key steps:
- Contact your local DSS office or Area Agency on Aging to get an application. You can also apply online.
- Provide all required information on the application accurately and completely.
- Submit income and asset documentation like bank statements and medical records.
- Complete any requested interviews or assessments.
- Receive an approval or denial letter in the mail. If denied, you can appeal.
- Have benefits renewed annually by confirming your eligibility.
PRACTICE POINTER—Eligibility is determined on both the date of Medicaid application and the date of entry into a nursing home. It is better to plan the application of admission, but if that’s not possible, contact an attorney before applying to determine eligibility, and consider spend-down strategies which may not be available after the application is made.
What Services Does Medicaid Long-Term Care Cover?
If approved, Medicaid can pay for:
- A semi-private room in a Medicaid-certified nursing facility
- Care in select assisted living communities
- In-home health aides, home modifications, medical supplies and more
You must use Medicaid-approved providers.
Does Medicaid Do Estate Recovery for Long-Term Care Costs?
Yes, under federal law Maryland must seek recovery against the estates of certain Medicaid recipients after death. This helps offset program costs. There are exemptions to protect surviving spouses and dependent children.
Get Help Applying for Medicaid Long-Term Care in Maryland
The Medicaid application process can be challenging. Applications can be daunting and once submitted, can’t be re-worked. The best practice is to have an attorney or other experienced advisor review the application before submission. This ensures the highest likelihood of quick acceptance and the least amount of back and forth with the reviewing agency.
Here are some practice pointers on how we, as elder law attorneys often provide value during the Medicaid long-term care application process:
- Review asset ownership and transfer records to identify any red flags that could lead to penalties or delays. Proactively address issues.
- Suggest strategies to convert countable assets into exempt assets to meet eligibility thresholds ethically.
- Help compile all required financial statements and documents in an organized, verifiable fashion. Ensure accuracy.
- Provide guidance on tax returns, pension documents, annuity contracts, and other key income sources to present.
- Assist in evaluating different long-term care options to determine which Medicaid services best meet the applicant’s needs.
- Guide execution of required legal documents like power of attorney forms to simplify the process.
- Support scheduling any required medical assessments or examinations to validate functional disability status.
- Aid in gathering testimonials and evidence of care needs from doctors, nurses, and family members.
- Review the final application prior to submission to identify any missing information or errors to correct.
- Help prepare the applicant and family members for Medicaid interviews by role-playing in advance, and identifying appropriate and inappropriate responses.
- Provide experienced representation during the application appeals process if coverage is denied initially.
- Advise on rules for maintaining eligibility during annual renewals and reporting requirements.
By leveraging an attorney’s technical expertise and familiarity with the Medicaid system, you can make reaching approval much more attainable.
Conclusion:– Meeting Requirements for Medicaid Long-Term Care Coverage in Maryland
Don’t let cost stop you from getting quality long-term care. Tap into support from Maryland’s Medicaid program by confirming your eligibility and submitting a comprehensive application. With proper planning, you can access essential care services.
Navigating the Road to Medicaid Long-Term Care Coverage
When facing long-term care costs, the Medicaid path promises financial relief but contains many tricky turns. Each eligibility requirement and paperwork request threatens a dead-end down the road. Rather than rely on roadside assistance when you break down, consult an experienced Medicaid attorney from the start. Their qualified direction will help you steer clear of potholes and detours.
With an attorney riding shotgun to guide the way, you can feel confident in reaching your destination – Medicaid long-term care coverage approval. They know this route well and will keep you on the most direct path to benefits.
Don’t take on the bumpy Medicaid highway alone. Buckle up with a knowledgeable Montgomery County elder law attorney for a smoother journey to coverage. With their expert help, you will stay on track and cruise right through to eligibility.
