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What Will Medicaid Pay For

  • Synopsis: Published: 2010-06-29 (Revised/Updated 2016-10-08) - Information regarding medical services and products that Medicaid will reimburse or pay for - Disabled World (Disabled World).

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Quote: "Medicare will not pay for long term care if it is not accompanied by the need for skilled care, and so the burden falls on Medicaid to pay for the ongoing costs of custodial care."

Many people often confuse Medicaid for another popular government sponsored program. However, they are very different in what they are designed to do.

Medicare is the national health care assistance program provided by the federal government. It's function is to make sure that affordable health care is available to all seniors and those that are disabled under 65.

On the other hand, Medicaid is a program run by the individual states along with some federal assistance and it varies considerably from one state to another. However, the common function of Medicaid is to provide assistance to those who have very little assets in several areas of daily life. One of those areas that many people need assistance with is health care, and so Medicaid picks up the tab for health care costs that many seniors simply cannot pay for.

Medicaid is a wonderful provision then to make sure that those with little means receive the care they need even when they cannot afford to pay for it themselves. However, Medicaid does have it's limitations, and one area that is draining Medicaid of much of it's precious resources is long term care.

In fact according to the Centers for Medicare and Medicaid Services in 2001, Medicaid paid for almost 40% of the annual long term care bill in this country.

So what is long term care anyway?

It is generally custodial care that is provided when a person needs assistance for activities of daily living including eating, bathing, dressing, continence, toileting, and transferring.

Skilled care on the other hand, which is paid for to some extent by Medicare is for situations where you are expected to get better as a result, such as IVs, changing dressings, physical and speech therapy, and so forth. Once the progress stops though, the care is no longer skilled, and becomes custodial instead.

Medicare will not pay for long term care if it is not accompanied by the need for skilled care, and so the burden falls on Medicaid to pay for the ongoing costs of custodial care.

Although Medicaid will pay for long term care, there are severe restrictions on the qualifications for their assistance. First and foremost, Medicaid is a program designed to help those who are impoverished, and so to qualify for long term care assistance through Medicaid a person must spend practically all of their own assets first to the point that they have very little left before Medicaid will begin to pick up the tab.

Medicaid is also not generally set up to provide care in a home setting.

Usually the care received must be provided in a facility and that means that a person has to give up much of their independence in order to qualify. Much of the ability to control the kind of care received is also lost because the state will determine where and how the care is administered since they are the ones paying for the care.

The skyrocketing costs of long term care is placing many state Medicaid programs under extreme pressure though, and much needs to be done to help make sure that this vital program for those who have little means will be able to continue to serve those who need it most.

As a result, both state and federal governments are encouraging most Americans to take the responsibility for their own future long term care needs, and getting more information on the important issues surrounding long term care and how it affects us all is a good place to start.

Related Information:

  1. Medicaid: U.S. Public Health Care Safety Net - Exactly which medical expenses are covered by Medicaid and for whom varies from state to state - Weiner & McCulloch PLLC
  2. Medicare, Medicaid and the Costs of Residential Care - Article examines ways to help finance residential care costs including insurance policies and personal means - Wendy Taormina-Weiss
  3. Medicaid Wait List: Many Adults With Disabilities Likely to Have Unmet Service Needs - Adults with intellectual and developmental disabilities on Medicaid wait list who are minorities, in poor health or unable to speak are more likely to have unmet service needs - University of Illinois at Urbana-Champaign


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