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Qualifications for Medicaid
Medicaid is intended to pay for health and long-term care for persons with limited financial resources. Common services include, but are not limited to:

• outpatient hospital services
• inpatient hospital services
• nursing facility services for persons aged 21 or older
• prenatal care
• physician services
• medical and surgical dental services
• home health and community-based care for persons eligible for nursing facility services
• laboratory and x-ray services
• nurse-midwife services
• pediatric and family nurse practitioner services
• family planning services and supplies

Medicaid and Nursing Home Care
Medicaid currently pays for 60% of nursing facility care.

Medicaid and Assisted Living / Home and Community-Based Services
Medicaid pays for only about 10 percent of assisted living services, the majority being paid for with private funds. Several states have adopted Medicaid waiver programs to earmark funds towards assisted living, and this trend is expected to continue as cost containment remains a critical issue for both State and Federal governments.

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Medicare is comprised of two parts, defined as follows:
 

Part A (Hospital Insurance): Provided automatically to individuals 65 and over who are entitled to Social Security, and to disabled persons who have received such benefits for at least 24 months. The health services covered under Part A are:
• Skilled Nursing Facility (SNF) Care: Covered by Part A only if it follows within 30 days of a hospitalization of three or more days, and is certified as medically necessary. Medicare does generally not pay for long-term care in a nursing facility, and the number of SNF days provided for is limited to 100 days, with a co-payment required for days 21 to 100.
• Home Health Agency Care: Can be furnished by a home health agency at the residence of the beneficiary. Part A may also pay for some medical equipment and medical supplies.
• Hospice Care: Provided to terminally ill individuals who have a life expectancy of six months or less, and who choose to forgo standard medical treatment.
• Inpatient Hospital Care: Includes coverage of the costs for most hospital services, including operating room, intensive care, laboratory tests, inpatient prescription drugs, X-rays, rehabilitation, long-term hospitalization,, meals, and semi-private room.

Part B (Supplementary Medical Insurance): Provided to almost all U.S. residents 65 or older, certain aliens 65 or over, and disabled individuals entitled to Part A. Part B coverage requires payment of a monthly premium, and primarily covers physician services. Also covered by Part B are non-physician services, including diagnostic tests, ambulance services, clinical laboratory tests, flu vaccinations, and some therapy services.

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Where can Long-Term Care Insurance be Purchased?
Long-term care policies are sold by private insurance companies (not all insurance firms offer this type), through agents, mail, and various organizations. Another source is employers, who offer this coverage as a benefit to employees and their parents. An insurance company must be licensed in your state to sell long-term care insurance.

How Much do Policies Cost?
Premiums for Long-Term Care Insurance are based on the age of the person at the time of purchase, the benefit amount, the benefit time period, elimination or deductible, and special options (i.e. inflation adjustment, non-forfeiture benefits and spousal discounts).

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In certain circumstances, the SSI payment may be used towards some housing and care needs of the individual.

The SSI program is run by the Social Security Administration (www.ssa.gov), but the SSI is not the same as Social Security. Money for SSI payments comes from the general fund of the U.S. Treasury, and some states add money to the federal payment.

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