Medicaid is an assistance program at the state and federal level that provides health coverage for individuals with very low incomes, regardless of age. Medicaid offerings and requirements vary substantially by state, so it is critical to know your state’s programs and requirements. In addition to general healthcare coverage, Medicaid also covers long-term care in nursing homes. Many states have various programs, often called waivers, that may provide home nursing care and other services to help with caregiving needs.
Medicaid is funded jointly by states and the federal government. Individuals eligible for Medicaid include:
- eligible low-income adults
- pregnant women
- elderly adults
- people with disabilities
Medicaid is administered and operated by states, according to federal requirements. Each state’s program is different depending on the needs and goals of that state. Some states offer Medicaid benefits only through managed care organizations (MCO’s). MCO’s generally contract with a set of providers, and those receiving care will be limited to those providers.
Below are frequently asked questions to help you connect with the appropriate resource to address your health coverage needs.
Does Medicaid cover hospice care?
Hospice services are available in every state through Medicaid and you can find information about those benefits on Medicaid.gov. Additionally, the Centers for Medicare & Medicaid Services has prepared a downloadable PDF with more information on the hospice benefit and patients’ rights.
Does Medicaid cover palliative care?
Some states, such as California, require community-based palliative care to be available to people on Medicaid.
For example, California’s Senate Bill 1004 (SB 1004) requires Medi-Cal managed care plans to cover palliative care for patients suffering from cancer, end-stage liver disease, chronic obstructive pulmonary disease, or congestive heart failure. Patients may continue curative treatments while receiving palliative care.
Other states do not require or offer Medicaid coverage of palliative care services.
Be sure to check your state’s website carefully so you can get all the benefits to which you are entitled.
Does Medicaid pay for care in nursing homes?
In all states, Medicaid pays for care for individuals that reside in nursing homes if the individual meets the state’s financial requirements. This is often referred to as Long Term Care Medicaid, LTC Medicaid, or Institutional Medicaid. Learn more about how Medicaid can cover nursing home costs in our Finding Care Outside of the Home section.
Does Medicaid cover home health care?
Medicaid offers Home and Community Based Services (HCBS), which are programs that provide services to individuals who live outside of nursing homes. Individuals enrolled in a HCBS program reside at home or in their community. Community, in this case, refers to individuals who do not live in their own home, but also do not live in a nursing home. The individual may live:
- in the home of a caregiver
- in the home of a family member
- at a board and care home
- in an assisted living residence
- in an adult foster care home
- or a senior living community.
What is a Medicaid waiver and how does it help cover care?
Medicaid waivers are state-specific Medicaid programs that allow for services to be provided outside of nursing homes. Home and Community Based Services are generally provided via a type of Medicaid waiver. However, some states provide long-term HCBS through their state Medicaid program, and other states provide this type of care through both avenues. Since each state has different policies and offerings, you must research your own state’s structure.
What is the difference between Long Term Medicaid and Medicaid waivers?
A very important distinction between Long Term Care Medicaid and Medicaid waivers is that Long Term Care Medicaid is considered an entitlement program, while waivers are not. Entitlement, in this situation, means that if one meets the eligibility requirements in Long Term Medicaid, they will automatically receive services.
With Medicaid waivers, someone can meet the eligibility requirements but be unable to enroll in the program. This is because waivers limit the number of individuals who can receive services. If the Medicaid waiver program’s enrollment cap has been met in a state, then an otherwise eligible person may be put on a waiting list to receive benefits. In addition, Medicaid waivers may limit services to specific geographic regions within a state, as well as to specific medical diagnoses, such as Alzheimer’s disease.
Does Medicaid pay for home health care by family members?
Long Term Care Medicaid and many states will allow a family member or member of a patient’s inner circle to be paid for their caregiving time and services. This varies wildly state by state though, so be sure to contact the local Medicaid office. (Source: USA.gov)
Does Children’s Health Insurance Program (CHIP) cover hospice care for children?
CHIP provides comprehensive benefits to children in families that may not strictly qualify for Medicaid.
With the enactment of the Affordable Care Act in 2010, Medicaid and CHIP-eligible individuals under age 21 who elect the hospice benefit no longer have to waive services for the cure or treatment of the terminal condition and can receive both curative care and hospice care for the terminal condition. This is important because traditional hospice benefit traditionally requires patients to choose palliative treatments and discontinue curative care when electing to use other services.
States have flexibility to design their own programs within federal guidelines, so benefits vary by state and by the type of CHIP program. States may choose between a Medicaid expansion program, a separate CHIP, or a combination of both types of programs. As always, contact your state’s Medicaid office to answers about care in your area.