Many individuals today need skilled nursing services as they age. Their families cannot provide this care at home and must look for other options. Nursing homes are an option. However, if the individual has Medicaid, the family must understand how it impacts their placement.
The family must secure a nursing home placement through Medicaid, as only certain people qualify for coverage. Before the government program will pay for the nursing home, the individual must meet a specific nursing home level of care. Each state determines this measure of care, and most states consider four areas when making this determination.
Nursing Home Placement Criteria
Medicaid programs often look at a person’s ability to complete activities of daily living when determining if skilled nursing care is required. They also look at instrumental activities of daily living. These tasks don’t need to be completed daily but must be handled for a person to live independently. Grocery shopping is an example of an instrumental activity of daily living.
A person’s health issues and medical needs are considered when determining whether a nursing home is necessary, and the program looks at the individual’s cognitive impairment. If a person has impaired judgment, they may be unable to live independently. Behavioral issues, such as those seen in individuals with dementia, also play a role in whether a person needs care in a nursing home.
Assessment Tools
Professionals use assessment tools to determine whether a person meets the Nursing Facility Level of Care. Often, these tools consist of a list of questions regarding the person’s ability to complete activities of daily living and the assistance they need. The questionnaire is then scored to determine if a nursing home is necessary to provide the required level of care. In some states, a physician must also diagnose the individual with a specific medical condition or provide a statement that skilled nursing care is required.
Level of Care and Medicaid Eligibility
Medicaid will only pay for nursing home care if a person meets the state’s Nursing Facility Level of Care requirements. Many families find this problematic because they can no longer provide the care a loved one needs. However, this individual doesn’t qualify for a nursing home paid for by the program, and they also don’t qualify for Medicaid-covered long-term services in the home. Furthermore, the individual must meet income and asset requirements if they want Medicaid to pay for nursing home care.
Applying for a Functional Assessment
When a person applies for Medicaid, federal law states the agency must review the application within 45 days and either approve or deny it. The agency has 90 days to determine disability, but that is the only exception. The functional assessment must be completed before a determination can be made regarding whether the person qualifies for Medicaid. Individuals must understand that their finances will also be assessed to determine eligibility for the government program. Only those individuals with financial and functional needs will qualify for the program. Medicaid pays for the assessment as it is part of the application process.
Redeterminations
Once a person has qualified for Medicaid, they must undergo regular redeterminations. The program will complete a subsequent functional needs reassessment at least once every 12 months. The government agency must ensure the individual still meets all requirements for the program.
Anyone needing skilled nursing care should check their Medicaid eligibility. Many people might be surprised to learn they qualify for this program and can get the help they need. It never hurts to try.
