Medicare recipients who qualify for Medicaid services may have several options available to them for long-term care coverage. While Medicare Part A may help cover the costs of care when admitted into a hospital, skilled nursing facility or home health care services, long term custodial care is generally not covered. Dual-eligibles (individuals who qualify for both medicare and Medicaid) should carefully evaluate their needs and discuss their options with loved ones and their health care team.

Common Types of Long-Term Care Providers

The level of care a person requires will help determine what type of long-term care service they need. Providers may classify the types of care they provide by different terms, but most fit within the definition of the following three terms:

  • Skilled nursing. Residents in a skilled nursing facility may be staying for a short recovery after a surgery or they may move into a nursing home facility full-time. These providers are the best choice for residents who have chronic medical needs and require around-the-clock care and medication management. Residents may live in private or companion rooms.
  • Assisted living. Similar to a skilled nursing facility, an assisted living facility can help residents with household needs, such as laundry and cleaning, and daily activities. These providers are not equipped to serve residents who need clinical or personal care. Services that address these needs may be provided through a separate agency.
  • Specialized care. If a resident requires targeted treatment for a chronic condition, such as dementia or Alzheimer’s, a facility specially designed to meet those needs may suit them best. Special needs providers may also be available for those who have other forms of mental illness or developmental delays.
  • In-home assistance. Residents who are able to stay in their own home or in the home of a family member may receive care from a loved one or through an agency who sends aides at scheduled times. Recipients may need a variety of services that encompass both their clinical and personal care needs.

Providers may include temporary care within the scope of their services, such as day or respite care for recipients who live at home but may need extra support when their family is at work or out of town. Hospice care may also be offered on site or at home.

Long-Term Care Coverage for Dual-eligibles

Medicaid can sometimes pay for temporary stays in a skilled nursing facility after a surgery, but there may be limitations related to the length of stay or the type of surgery. Medicaid can also help with costs associated with living in an institutional care facility such as a nursing home, or recipients may be eligible for waivers that allow them to receive home and community-based services while living independently or with family.

Although it is a federal program, Medicaid services are managed and administered by each state according to the state’s own policies. Long-term care services for qualifying dual-eligibles who receive Medicare and Medicaid are determined by both financial and level of care requirements.

Income and resource limits and the defining characteristics of each level of care status can be different in each state. Even though you may qualify for long-term care services through Medicaid in one state, you may not qualify in another. This is important to consider when recipients plan to move if they want to be closer to family while in long-term care.

Recipients of Medicaid should check with their state’s Medicaid office to verify the long-term care services available to them and any requirements for remaining eligible to receive them.

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