Unlike Medicare, Medicaid funds long term care for people meeting its strict financial cutoffs-although it typically covers nursing homes and other assisted living facilities. Medicaid, unlike Medicare, which is covered federally, is cover by the state. Because of that reason, Medicaid guidelines vary from state to state. Legislation is being reviewed that can actually give people more control over where their Medicaid funds are being spent for personal care- often refereed to as the “Cash and Counseling” model. More often than, not Medicaid funding goes directly to the providers and beneficiaries do not have much control in how the money is spent.
In several states including Florida, Arkansas and New Jersey, Cash and Counseling demonstration projects were conducted providing beneficiaries money directly to decide themselves how the money would be spent. In many cases the beneficiaries paid family members to provide care. This initiative is gaining popularity and several other states are starting to implement these Cash and Counseling programs.
Another initiative that family caregivers should watch is the “Money Follows the Person” program. The program provides funding for people moving from nursing homes to a more community-based setting.
Nursing home care costs $55,000 a year and can be up to twice as much in major metropolitan areas. Because Medicaid is designed for low-income individuals that do not have money to spend on health insurance, middle income families are being caught in the middle with Medicare not able to fund long term care at all and not meeting the financial requirements to qualify for Medicaid. In fact, in an effort to make Medicaid a more equitable solution for middle-income families Congress has established rules to allow families to spend down in order to qualify for Medicaid. “Spending down” means depleting your assets qualifying you for Medicaid. In the past, a couple would spend down to the point where a spouse was left in poverty without enough income or assets to cover his or her needs. After the changes in 2007 to the Medicaid guidelines, community spouses are allowed $1,650 to $2,541 a month in income ad between $20,328 and $191,640 in assets, in addition to their car, house, and other person belongings, and still be eligible nursing home funding.