Medicaid to the Rescue for Majority of Nursing Home Residents

Medicaid has been in the news frequently, but it can be confusing to understand what it is precisely because it does so many things for the health of our communities.

Medicaid is a lifeline for many nursing home residents. In fact, two-thirds of all nursing home residents are covered by Medicaid. While elderly people and people with disabilities make up only 29 percent of the total Medicaid population, they account for 62 percent of Medicaid expenditures.

Before they enter a facility, 19 percent of nursing home residents are eligible for Medicaid benefits. Another 19 percent exhaust their personal assets and become eligible for Medicaid during their first year in the nursing home. After the first year, 4 percent more will become eligible. Clearly, nursing home care is expensive, and Medicaid allows people in need to keep receiving vital care.

Qualifying conditions to gain Medicaid nursing home coverage can be complicated but, generally speaking, a person must be at least 65 or have a disability, meet federal income and resource requirements, and require nursing home-level care. In some instances, help is available for assisted living services, according to the state Department of Human Services. If a loved one is having trouble paying for the care they need, Medicaid planning professionals and elder law attorneys can help you determine whether Medicaid is a possible solution.

Although Medicaid clearly fills a critical need for seniors, it also provides health care for low-income people and families. It’s meant for children, pregnant women, senior citizens, and people with blindness or other disabilities. In 2015, under the Affordable Care Act, it was extended to non-elderly adults with incomes at or below 138 percent of the federal poverty limit. Many of these adults are working, but in low- paying jobs.

In Pennsylvania, the state government pays for about 55 percent of the Medicaid program, and the federal government pays the remainder. Any cuts to Medicaid funding translate to an increased number of people without coverage, and potential cuts in services or employees, all of which would weaken the entire health care system.

The Medicaid program is vital to sustaining the health of our communities.