With the difference between Medicare and Medicaid straightened out (see my previous article if you missed it), it is good to explore what Medicaid actually covers. A person that is asset and income eligible has three main scenarios in which government benefits may be received.
Skilled Nursing Care. I refer to the first as skilled nursing Medicaid. This is for a person who has needs that medically qualify for skilled nursing care. Such care is traditionally provided in a nursing home setting. The majority of the nursing home bill would be paid by the program for a person in a facility that accepts skilled nursing Medicaid and meets the other eligibility criteria. A single or widowed individual receiving this benefit would typically pay all but $60.00 of their income to the nursing facility each month and Medicaid would cover the remainder. According to Medicaid guidelines, the statewide average for nursing home care costs in Michigan for 2015 is $8,084.00 per month.
Assisted Living. The next care scenario would be for a person who needs assistance with certain activities of daily living (ADL’s). The MI Choice Waiver Program recognizes that nursing homes should not be the only option. This program helps provide and pay for the care that is provided in an assisted living community setting. But, this benefit is not as financially comprehensive as nursing home Medicaid. Room and board costs from the assisted living community are not covered by MI Choice Waiver. Only a certain portion of care is covered. An assessment is necessary to determine how many hours of care will be provided and paid for by the benefit. Any remaining care costs would have to be covered through the person’s income.
In-Home Care. Like assisted living, MI Choice Waiver is also available to persons who are able to remain home but still need assistance with ADL’s. After an assessment, it will be determined how many hours of care the benefit will provide. This can be a great way to alleviate family caregivers, however the benefit hours are limited so this is usually not a comprehensive care benefit.
The next article in this Medicaid Series will highlight the main rules for nursing home Medicaid and the MI Choice Waiver program.