Table of Content
- Why Would I Need Long-term Care?
- The roles of the local department of social services, the MCO and the nursing home post transition
- I. Eligibility and Enrollment
- IV. Quality Metrics and Incentives
- Transitions in Care
- Step 4b: Applicant is Financially Ineligible for Nursing Home Medicaid
- How to Apply for Long Term Care in a Medicaid Nursing Home
Some states, for instance, might consider the ability to perform instrumental activities of daily living like shopping and cooking to be factors toward becoming eligible for nursing home benefits. The financial requirements can be quite complex as well, depending on assets, like investments and property, and the applicant’s marital status. Applying for Medicaid nursing home care, assuming the individual is not already enrolled in Medicaid, is a multi-step process.
In all 50 states and the District of Columbia, Medicaid will pay for nursing home care for persons who require that level of care and meet the program’s financial eligibility requirements. Readers should be aware that the financial requirements and the level of care requirements vary based on the state. Furthering the complexity is that the financial requirements change based on the marital status of the Medicaid beneficiary / applicant.
Why Would I Need Long-term Care?
A nursing home resident may deduct medical costs, including Medicare premiums, that are not covered by Medicaid from their income. This further lowers the amount of monthly income that a nursing home beneficiary gives to the state to help cover the cost of their long-term care. For a clearer understanding, one may wish to contact a Medicaid planner.. In most cases, a face-to-face functional needs assessment is required. This may occur in one’s home, a hospital, an assisted living residence, a nursing home, or in another setting. One’s primary residence is the best setting in which to conduct the functional assessment.
The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Michigan Medicaid when not financially eligible will result in the application, and benefits, being denied. For married applicants, the 2022 asset limit for Michigan ABD Medicaid is $3,000 combined between the two applicants/spouses, and the income limit is a combined $1,526 / month. These limits are used for both married couples with both spouses applying for ABD Medicaid and married couples with only one spouse applying.
The roles of the local department of social services, the MCO and the nursing home post transition
You must enter the SNF within a short time of leaving the hospital and require skilled services related to your hospital stay. Time that you spend in a hospital as an outpatient before you're admitted doesn't count toward the 3 inpatient days you need to have a qualifying hospital stay for SNF benefit purposes. Go to Community & Volunteer Opportunities Information on resources in your community and volunteer recruitment and training, and services provided at local DHS offices.
Sometimes it’s not possible to live by yourself or with your family. In those cases, assisted living or a nursing home might be right for you. These facilities are professionally staffed businesses that provide different levels of care, depending on what you need.
I. Eligibility and Enrollment
The services needed to attain this level of well-being are established in the individual's plan of care. The initial implementation will shift the responsibility for NAMI collection to the MCO. The MCO may delegate the collection of NAMI to the NH or other entity. The handling of NAMI with the provider should be outlined and agreed to during the contracting process. Once re-budgeting is complete, the local district must inform the plan and nursing home of the NAMI amount to be collected from the member. After the first full year of the transition, the State will assess the impact of the transition policies and determine whether the transition payments should be extended beyond the three year requirement.
The survey protocols and interpretive guidelines serve to clarify and/or explain the intent of the regulations. All surveyors are required to use them in assessing compliance with Federal requirements. Deficiencies are based on violations of the regulations, which are to be based on observations of the nursing home’s performance or practices. Michigan Medicaid offers two ABD Medicaid programs relevant to residents requiring long term care. One way to get help is a benefits counselor at your local Area Agency on Aging.
The UAS-NY assessed needs are compared with the MDS assessments conducted by the SNF and considered when authorizing services, equipment and supplies for the member. The care plan, MDS, UASNY, medical record and input from the care management team provides the MCO with the necessary information for the authorization of services both in the SNF and upon discharge from the SNF. Following the appropriate assessments, the MCO in which the individual is enrolled is responsible for reviewing all documentation and approving or adjusting the care plan to ensure the needs of the consumer are appropriately met. Post transition, the role of the LDSS will be limited to determining whether an individual is Medicaid eligible for community or institutional based services. Once a clinical determination is made by the MCO, provider team and member, the LDSS will conduct the eligibility review, as applicable. The local district must inform the MCO, consumer and NH of the determination.
Payment to a facility for reserved bed days for both temporary hospitalizations and health care professional therapeutic visits may not exceed a combined aggregate of fourteen days in any twelve month period. In all transition planning the MCO will inform the member and family about the community and nursing home options available and how to determine which may be the most appropriate setting prior to choosing placement. When a member is being discharged from a hospital to a skilled nursing facility, the SNF selected must have the capability to meet the special needs of the member. The member´s choice of SNF must be considered by the MCO except where the member´s choice would result in an unsafe discharge, or is an out of network SNF and an in- network SNF that meets the member´s needs has an available bed.
To be eligible for Michigan Medicaid, a person has to meet certain financial requirements and functional requirements. MI Health Link HCBS Waiver beneficiaries must need a Nursing Facility of of Care. To see if this level of care is required, the state uses the Michigan Medicaid Nursing Facility Level of Care Determination. This also helps the state determine which program benefits each individual will receive.
Medicaid is separate from Medicare, which is a federal program that pays certain healthcare expenses for individuals ages 65 and older. It is estimated that between 80% and 90% of nursing homes accept Medicaid. While this percentage sounds high, these percentages are very misleading.
This is because private pay residents pay approximately 25% more for nursing home care than Medicaid pays. In 2022, the nationwide average private payer pays approximately $255 / day for nursing home care while Medicaid pays approximately $206 / day. Nursing homes, unlike assisted living communities, do not line item their billings. The cost of care, room, meals, and medical supplies are all included in the daily rate.
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