Understanding Medicaid: Frequently Asked Questions

What is Medicaid medical assistance?

Medicaid is a joint federal and state funded program, run by the state and local counties, providing medical insurance, home-care services (assisting with all activities of daily living) and nursing home medical assistance to the poor, elderly or disabled.

However, individuals requiring home-care services or nursing home medical assistance, in addition to fi nancial requirements, also will need to have a medical need for these services.

Who can apply for Medicaid?

Medicaid is for anyone who meets the income and resources restrictions.

What services does Medicaid provide?

• Doctors • Hospitals • Prescriptions • Nursing Homes (room & board)

• Home-care Services, such as home attendants, home health aides and nurses

What is an MLTC?

MLTC stands for Managed Long-Term Care. One example: When an applicant has been approved for Medicaid home-care services, the applicant has to choose one MLTC from several approved Medicaid plans. Upon joining an MLTC a coordinator will be assigned and this coordinator will be the point person between the applicant/recipient and the MLTC.

Changes with Community Medicaid eligibility!

Due to Covid-19 once again the new rule regarding transfer of assets for Community Medicaid has been extended from October 1, 2022 to January 1, 2023; however, the earliest date that the state will seek implementation is March 31, 2024.

What does the new regulation mean to the applicant?

Once the new regulation is in place, applicants wishing to apply for community Medicaid and receive homecare services paid for by Medicaid will need to submit two and one-half years of bank statements. If there were any transfers during that period, other than spouse to spouse, the applicant will be disqualified for a period of time. Presently, applicants can transfer any amount of money one month and become financially eligible for Community Medicaid the following month. This window of opportunity is closing in fast. There is no time to procrastinate. The only way to avoid this issue is to apply before the new rule is enforced.

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As for rehab facilities, Park recommends reading the reviews online and contacting the centers for a tour.

A private geriatric care manager, who are typically paid by the hour, can also be used to help research and recommend facilities based on the patient’s specific needs, according to the Family Caregiver Alliance. A social worker can also give advice and support.

Every rehab center is different and caters to different needs, beyond just physical therapy. They can be specialized for a patient with complicated wounds, someone with a lung disease on a BiPap machine, or who needs dialysis.

“If they have any kind of skilled needs, meaning requiring nursing care like wound care, antibiotics, drainage care — after surgery sometimes they have drains put in by the surgical team that need to be monitored so they could heal appropriately — they may not need to be in a hospital anymore, like an acute care facility, but maybe a subacute facility,” said Park.

A subacute facility offers a short-term program of care, which can include one to three hours of rehabilitation per day, at least five days per week, depending on the condition, according to Columbis University.

So rehab facilities no longer just do physical rehab, said Park. “They do complex skilled nursing care ... now insurances are paying for this type of care in the rehab facility.”

That is especially the case as hospital systems have increasingly tigeth requirements to stay in the hospital, she added.

Insurance is a key consideration, then, too.

“What can Medicare provide? What can the managed Medicare provide? Because there are restrictions with managed Medicare. And if they’re eligible for Medicaid too, Medicaid continued on page 10