Medicaid 101: Coverage & Eligibility

Introduction to Medicaid

While many people have heard of Medicaid, few truly understand it. Beginning today, this blog will feature a comprehensive, multi-part series on the program. Part one is an overview of coverage and eligibility.

What is Medicaid?

Medicaid is a joint effort between the states and federal government. It pays health care costs for qualified individuals. The program covers a broad range of health services. For our purposes, however, we will focus on long-term care in a nursing facility. At minimum, federal law requires the nursing facility benefit to cover the following:

  • Nursing and related services
  • Specialized rehabilitative services
  • Medically-related social services
  • Pharmaceutical services
  • Dietary services individualized to the needs of each resident
  • Professionally directed program of activities to meet the interests and needs for well being of each resident
  • Emergency dental services
  • Room and bed maintenance services
  • Routine personal hygiene items and services (source: Medicaid.gov).

Who is Eligible for Medicaid?

First, the applicant must be over the age of 65 or disabled and in need of long-term care. Next, the individual must meet certain financial requirements. Medicaid considers both the income and assets of a person. States have flexibility to craft their own unique, specific limits. Generally, in Oklahoma, one cannot have assets over $2,000.00 or income exceeding $2,250.00 per month. As we will see in the coming weeks, there are important exceptions and caveats to these figures.

Conclusion

The Medicaid rules and regulations are highly complex. In addition, they differ from state-to-state. What’s more, mistakes in dealing with assets and income can render a person ineligible for care. At best, that’s inconvenient. At worst, it’s life-threatening. Therefore, when a family member or loved one is faced with entering a nursing facility, you should consult a qualified elder law attorney in your area. Next week, we will delve into greater detail regarding the financial requirements. Until then, happy Memorial Day weekend!

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