Medicaid, unlike Medicare, covers long term care services. Medicaid, unlike Medicare, which is funded federally, is covered by the state so guidelines vary from state to state. To meet the guidelines for Medicaid you must be under a certain income and asset cutoff. The problem facing many family caregivers is Medicaid typically covers nursing home and assisted living care costs but does not fund home health care. More often than not, these benefits go directly to the providers and the beneficiaries do not have much control over where the Medicaid funding goes. Legislation is being passed that gives family caregivers more control over where their Medicaid benefit go- oftern referred to as the “Cash and Counseling” method.
Several states including Arkansas, New Jersey, and Florida are implementing Cash and Counseling demonstrations that give beneficiaries direct control over where they choose to spend their Medicaid benefits. Many beneficiaries choose to pay family members and independent home health aides for care. The program has proven to be extremely successful and is expanding into many other states.
The cost for Nursing Home Care can easily run $55,000 per year with the cost more than doubling in major metropolitan and hard to reach cities. Middle income families are caught in a precarious position because Medicaid is designed for low income families that cannot afford health care insurance. They get no help from Medicare because Medicare doesn’t fund long-term care.
To make Medicaid a more equitable alternative, Congress has passed legislation that allows families to spend down. By “spending down”, Congress means the family can deplete their assets to qualify for Medicaid. In the past, for a couple to spend down enough to qualify for Medicaid, one of the spouses (often the wife) had to reach a point where she did not have enough income to spend on what she needed to live.
After the 2007 changes to the Medicaid guidelines, community spouses are allowed $1,650 to $2,541 a month in income and between $20,328 and $191,640 in assets, in addition to their car, house, and other person belongings, to be eligible for nursing home funding.