Qualifying For Medicaid To Pay For Assisted Living Services in Utah

Jul 31, 2017

For Seniors in Utah who need some help paying for assisted living care or a nursing home, Medicaid can help. Since Medicaid is a joint state and federal program, the states do have more flexibility regarding the eligibility criteria and setting the benefits they provide for those who qualify.

Here are important things Utah residents need to know about Medicaid.

Rules for Long-Term Care

Assisted living services and nursing homes are often considered as forms of long-term care. With long-term care, the services include not only the personal services but also medical services for the people who have an illness or disability. For instance, a person living in a nursing home may need to pay for assistance with dressing and bathing along with medical treatment. With Medicaid, the rules for long-term care are quite different from those of other services.

Payments Made by the State

The federal law directs states to deliver certain services to the recipients of Medicaid. The states are also required to pay for home health care services for all those persons who would ideally qualify for nursing home care, and for nursing facilities for those people who receive Medicaid.

The states also have the option to use Medicaid funding to offer extra long-term care services such as home health aide for people that don’t qualify for assisted living facilities, nursing homes, and adult foster homes. Additionally, this funding can be used for those who might not qualify for in-home services including medication management and housekeeping. If you are still unsure of what your state provides, contact an Ogden Medicaid attorney today.

Not all assisted living facilities, nursing homes, or other services accept payments from Medicaid. However, they can tell you if they accept Medicaid payments or not. Facilities that do accept Medicaid payments will have to be licensed by the state, and be subject to regular inspections to make sure that the facility meets the standards set by the federal law.

Eligibility for Medicaid

Keep in mind that it has to be proven “medically necessary” for the patient before Medicaid pays for a nursing home or other facility. While different states will have different rules to determine the necessary duration of long-term care, all of them require that a doctor certify the patient needs to be in a nursing facility, for them to be covered by Medicaid.

States also have different assets and income guidelines for eligibility for Medicaid. Most of them have rather flexible guidelines for income eligibility and the compensation of long-term care services. Most allow you to pay up to 300% of the SSI (Supplemental Security Income) limit but still qualify for the nursing home only Medicaid option.

The income eligibility guidelines also vary depending on the type of long-term care the person is seeking. For instance, in states where the Medicaid program covers for the in-home care services, there may be lower monthly income limits for these services compared to most nursing homes.

Those who don’t meet the income and resource guideline might still be allowed to qualify for Medicaid, provided they are medically needy. This would mean that your assets and income are above the eligibility levels, but have been reduced to eligible levels due to high medical expenses. In Medicaid jargon, this is called “spending down.”

An Ogden Medicaid attorney can help you determine if you are eligible for Medicaid, and give you the necessary advice to commence your application.

Thanks to our friend and Ogden estate planning attorney, Michael Haslam, for his insight on qualifying for medicaid to pay for assisted living services. Michael is the founding attorney at Voyant Legal. He helps families in Farmington, Ogden, Layton, Bountiful and surrounding Utah areas create estate plans and elder law plans to protect their families and assets.

Guest Blog courtesy of Christee Nabor, Voyant Legal in Farmington, UT

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