Medicaid

Medicaid is a program that is jointly funded by the federal government and the states. Medicaid will pay for three long-term care programs: skilled nursing care, some home and community services, and hospice.

• Medicaid pays for much of the skilled nursing care in the U.S., because of the high cost of 24-hour care. In Georgia, persons who require and are eligible for nursing center placement, may pay part of the cost of the care by “spending down” and become eligible for Medicaid.
• In Georgia, Medicaid funds some home and community service programs for elderly and disabled persons, including SOURCE (Service Options Utilizing Resources in Community Environments), the Community Care Service Provider Program (CCSP), and the Independent Care Waiver Program (ICWP). CCSP and ICWP are waiver programs; SOURCE is a part of the state plan and, therefore, an entitlement program. All of these programs may authorize Medicaid funds for home and community services that are required by the clients for continued community residence.
• Medicaid funds hospice when patients do not have Medicare.

See www.cms.hhs.gov/home/medicaid.asp for additional information about Medicaid.

Medicare

Medicare, a Federal program, pays only for short-term care in the nursing center, for skilled home health care, and for hospice. Note that managed care Medicare plans may have somewhat different benefits packages than these described below.

• Traditional fee-for-service Medicare will cover up to 100 days of skilled nursing care following a three-day hospital stay within 30 days of the hospital discharge and when certain skilled levels of nursing care or therapy are required. Traditional Medicare pays 100% of the first 20 days, after which the patient must pay a co-payment, which varies from year to year.

• Medicare pays for medically necessary home health services, which include skilled nursing, medical supplies and equipment, and therapy. New physician orders must be obtained every 60 days for on-going services. There is no cost share for home health.
• Medicare pays for hospice, a benefit for terminally ill persons that includes palliative (comfort) care and support from nurses, aides, a chaplain, social services, and volunteers. Generally speaking, hospice care is designed to meet the needs of patients with a life expectancy of six months or fewer and their families, although benefit periods may be added. Hospice care may include respite care and inpatient care for symptom management. There is no cost share for hospice services.
• Medicare Part D helps pay for prescription drug costs.

Medicare Advantage and Special Needs Plans have somewhat different benefit designs than traditional fee-for-service Medicare. Some may offer added benefits, in addition to those listed above. Excellent information on coverage and eligibility are available at www.medicare.gov.

Veterans Administration Benefits

The Veterans Administration provides a full-range of long-term care benefits, including nursing center care, home care, and even adult day health in some areas. To learn more about eligibility, contact the VA office that serves your county. Information about benefits is available at www.va.gov.

Long Term Care Insurance

With Americans over 65 facing a 40% lifetime chance of spending some time in a nursing center, there is increasing interest in long term care. Public policy leaders are making the effort to implement tax changes to encourage purchase of policies to offset the heavy burden of long term care to taxpayers. The American Association of Retired Persons (AARP) provides excellent advice on how to compare long term care plans at the following link: http://www.aarp.org/research/longtermcare/insurance.

Private Pay