What Long-Term Care Services Medicaid Offers
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Unlike Medicare, Medicaid covers long-term care in nursing homes and in the community through home- and community-based waivers (permission from the federal government to spend money that would have gone to nursing homes on community-based services instead) and other approaches.
Federal rules require states to provide a basic set of services to Medicaid recipients, including hospital stays, doctor visits, preventive care, laboratory and X-ray services, transportation to medical care, home health services, and nursing-facility care.
States have the option of adding, among other things, physical and other kinds of therapy, personal care, hospice, and case management. Prescription drug coverage is optional, as are dental and vision services. Many Medicaid services are designed for children and pregnant women.
States can determine the criteria for nursing home care and home-and community-based services, so a person eligible in one state may not be eligible in a neighboring state. Usually some level of functional limitations is required, like being unable to take care of personal basic needs like bathing, dressing, going to the toilet.
Many nursing home residents have cognitive problems like dementia, which limits their ability to function independently.
Because nursing-home care is so expensive, states have moved toward caring for these individuals in the community. Someone with functional limitations can receive care at home that may include personal care, homemaking services, case management, transportation, and other long-term services and supports. Even with these services, which may be limited by funding or workforce shortages, family members often provide some or most of the care.
Most states have a variety of Medicaid services that operate under different waiver programs from the federal government (for example, waivers for programs that include a package of services targeted for people with specific disabilities, such as traumatic brain injury or HIV/AIDS).
A waiver means that the federal government allows a state to use some of its Medicaid funding for specific services that keep people in the community. However, it can be confusing to sort out which services a person may be eligible for and whether there are waiting lists and other barriers such as limits on the duration and types of services.
Some states use Medicaid waivers to allow recipients to enroll in assisted-living facilities. There may be restrictions, however — for example, requiring the recipient to pay for room and board with their own resources, or covering only certain services — and not all assisted-living facilities accept Medicaid.