Long Term Care Flashcards
In a community or residential setting long term care services are provided by ___________ & ______________.
Long term care is not typically provided by nursing homes who usually only provide ____________________.
Adult Day Care
Assisted Living Communities
Institutional Care
What is the average stay in a nursing home?
835 Days
Long term care needs can vary based on the family demographic and type/location of care received. List the highest to lowest cost of LTC options.
Nursing Home - Private Nursing Home - Semi Private Assisted Living Home Health Aide (In-Home) Homemaker/Companion Adult Day Services
What are the 4 common methods for paying for LTC services?
- Medicare
- Medicaid
- Personal Assets and Savings
- Long Term Care Insurance
Is a federal program that pays for healthcare for persons age 65 and over and for people under age 65 with disabilities.
Medicare
Does medicare generally cover long term care services?
No
Medicare will help pay for a short stay in these three places if you meet certain conditions:
1) Skilled Nursing Facility
2) Hospice Care
3) Home Health Care
Medicare will help pay for a short stay in a skilled nursing facility, for hospice care, or for home health care if the recipient meets the following conditions up to 100 days:
- Has had a recent prior hospital stay of at least 3 days
- Is admitted to a Medicare certified nursing facility within 30 days of the prior hospital stay
- Needs skilled care as a result of some medical condition that caused the hospital stay
Entitlement program that pays for medical assistance for certain individuals and families with low incomes and resources.
Medicaid
Provides medical insurance for children under age 19 in families whose income is too high to qualify for medicaid.
(CHIP) Children’s Health Insurance Program
Who funds the Medicaid program?
Federal and State Governments Jointly Fund
This formula has resulted in the Federal Govt. paying a higher percentage to states with lower per capita income and a smaller percentage of states with higher per capita income.
(FMAP) Federal Medical Assistance Percentage
The minimum percentage that states can be required to pay is _______ % of the Medicaid expenses. But, states with lower incomes per capita may receive up to _________% of their Medicaid expenditures from the federal government.
50%
Up to 75%
Consists of medical care provided in the home by trained professionals such as doctors and nurses.
Home Health Services
Personal care provided by family members or paid caregivers.
Home Care
There are both General and Financial requirements to be eligible to receive Medicaid. What are the five general requirement that individuals must meet at least one of?
1) Age 65 or older
2) Have a permanent disability as that term is defined by the social security administration
3) Be blind
4) Be a pregnant woman
5) Be a child, or the parent or caretaker of a child
The amount of income a person can have to be eligible for Medicaid varies by __________ .
State
This is usually the best resource to determine the eligibility requirements for Medicaid within a specific state.
(Each State’s) Medical Assistance Office
Countable income for Medicaid eligibility purposes includes: (7 Sources)
1) Regular benefit payments (SS or SSDI)
2) Veterans Benefits
3) Pensions
4) Salaries
5) Wages
6) Interest from bank accounts and CDs
7) Dividends (from stocks and bonds)
Medicaid generally does not include these sources of funds when determining eligibility:
1) Food Stamps
2) Federal Housing Assistance
3) Home Energy Assistance
What is a common income standard for Medicaid eligibility?
133% of the Federal Poverty Level
When applying for medicaid in most states a person can retain about __________ in countable assets, and married couples still living in the same house can retain ________ in countable assets.
Single $2000
Married $3000
Assets that are usually counted for Medicaid eligibility include:
1) Checking/Savings Accounts
2) Stocks/Bonds
3) CDs
4) Real property other than primary residence
5) Additional Motor Vehicles
6) Retirement Plan assets (IRAs, 401(k)s)
Assets that do not usually get counted for Medicaid eligibility include the following:
1) Primary Residence
2) Personal Property/Household belongings
3) One motor vehicle
4) Life insurance with FV under $1,500
5) Up to $1,500 for burial expenses
6) Assets in trusts
7) Retirement Plan assets that cannot be withdrawn in a lump sum (ie. Pension Plan)
In 2020, the equity limit in excess of $ ______ in a home, Medicaid must deny benefits above this limit.
$595,000
A communtiy spouse that does not need care gets to retain a “community spouse resource allowance.” The couples assets are counted the day that the applicant enters the nursing home and the spouse is entitled to retain what?
1/2 of the couples assets up to $137.400 (2022)
This medicaid law provides special protection to prevent spousal impoverishment should the other spouse have to go into a home.
Community Spouse Resource Allowance
Allowable spend down options to qualify for Medicaid?
1) Paying off debts
2) Purchase of a new exempt asset (car, home)
3) Home Improvements
4) Pre-Payment for burial or funeral expenses
5) Payments for services under caregiver agreements (even when child or sibling is the caregiver)
6) Purchase of certain annuities (Medicaid-compliant annuities)
