Understanding Medicaid

What Does Medicaid Cover?

Medicaid is a joint federal-state government program designed to provide health-care assistance to low income people with limited assets, and it has become the major payer of services for care in skilled nursing facilities across the country. In Pennsylvania, nearly two out of every three skilled nursing facility residents is on Medicaid.

Eligibility:

Medicaid will pay for skilled nursing facility care for those individuals who meet a state-determined poverty level and certain health-related criteria, provided the skilled nursing facility is certified and meets a stringent set of government standards.

Benefits:

Medicaid will pay for care in a skilled nursing facility. The amount paid is determined by each state, and covers room, board, nursing care and social activities.

How to Apply for Medicaid:

Contact your local Area Agency on Aging office or county’s Medical Assistance office for an application. Because Medicaid is based on financial need, you will be asked for extensive information such as residence, family composition, income, real and personal property, banking/investment transactions and medical expenses.

You can also apply for and renew your benefits from the comfort of your home using COMPASS, an online application for Pennsylvanians to apply for many health and human service programs including long-term care.

Risk of Impoverishment:

Spouses of skilled nursing facility residents are protected from what is termed “spousal impoverishment.” This refers to the required depletion of an “at-home” spouse’s financial resources so that the spouse in a skilled nursing facility can qualify for Medicaid. States are required to permit the at-home spouse to retain a “maintenance needs allowance” from the other spouse’s income that is sufficient to bring the at-home spouse’s income to 150 percent of the federal poverty level for a two-person household.

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