Understanding Medicaid in Long-term Care

Jessica Luckett
Social Services and Business Office
Southern Hills Skilled Nursing & Rehab Center

Going from the hospital to a facility, can be scary. Then to be potentially not able to then go home afterwards can also be scary. It is hard to admit that someone’s independence is being lost and they are not able to do as much as they could before and need to stay long term care. The other stressful piece is that financial aspect. It is not cheap to stay within a facility. When a resident is long term care, it cost a lot of money to stay within the facility. Another option is Medicaid. The Medicaid process is not easy and it is not a quick process. This can be very frustrating and time consuming for the resident, family and facility. Once someone gets Medicaid, it is very beneficial. It can also help those that eventually can return home and receive added services. There is also a waiver program for residents that Assisted Living is the right discharge plan.

Applying for Medicaid

Anyone can apply for Medicaid on a resident’s behalf. A lot of times, it is the business office manager at the building. Southern Hills can help with applying for any of the residents in the facility. Once, a resident applies for Medicaid, Medicaid will send out a checklist. Resident’s will need to gather the information that is requested on that checklist. Once the information has been provided to Medicaid, Medicaid will then issue another checklist or they will review the information and either approve or deny the case. Unfortunately, this can seem an easy but it is not a quick process. Please see the link to show where to go to apply for Medicaid. How to Apply or Renew for Medicaid (ohio.gov). This is also where to go to renew Medicaid benefits. Renewing benefits should happen once a year. This has changed some due to the pandemic but the resident should be prepared for this.

Requirements

The items that a resident or family should be looking for to see if they are eligible for Medicaid is making sure that if they are single, then they have less than $2000 in their account. If they have a house in the community, then a letter of intent to return home should be signed and sent to Medicaid. Medicaid will look at any life insurance policies that a resident may have. If the life insurance policy can be cashed out, Medicaid will require them to cash out the life insurance policy. Medicaid will also make sure that no improper transfer has been done. For example, giving a house to a family member for no cost. Southern Hills suggests that the resident or family pay for the resident’s funeral to help in spend down of funds.

Another requirement for Medicaid is if a resident’s income is higher than $2250 then a Qualified Income Trust/Miller Trust is needed. Here is a link that helps explain the QIT or Miller Trust in case someone needs this. QITFactSheet.pdf (help4seniors.org). This can be very confusing for a family member to try and the trust opened. Hopefully this helps explain it a little better for family members.

Once Medicaid has been approved, a resident is going to owe the facility patient liability. This amount is based on a resident’s income and Medicaid determines this amount. It will be the social security check and/or pension check minus $50. The resident gets $50 a month as an allowance for the resident to spend on anything that they wish.

Southern Hills Can Help

Southern Hills can help a resident or family member will assisting with the Medicaid process. Do not hesitate to reach out to Southern Hills and ask for the business office. The phone number is 440-816-7500.