Institutional Long Term Care Coverage by Medicaid

Medicaid is a government program that provides limited coverage for long term care. How limited? It only covers Institutional Care, Community Based Long Term Care Services and Supports. You can find out more about institutional care below.





Many people ignore the practice of shopping for long term care quote and purchasing a policy thinking that Medicaid will provide them with everything they need in the future. It's not that helpful as everyone thinks it is but still it provides limited care.

Institutional services that Medicaid covers are those authorized in the Social Security Act only and they are services for people 65 and above who needs to be put in a facility for mental diseases, hospital services, inpatient psychiatric services to those who are below 21 years old, nursing homes, intermediate care facilities for people with mental diseases and preadmission screening and resident review.


Institutional benefits share the following characteristics:


- Institutions are residential facilities, and assume total care of the individuals who are admitted.


· The comprehensive care includes room and board. Other Medicaid services are specifically prohibited from including room and board.


· The comprehensive service is billed and reimbursed as a single bundled payment. (Note that states vary in what is included in the institutional rate, versus what is billed as a separately covered service, for example physical therapy may be reimbursed as part of the bundle or as a separate service.)


· Institutions must be licensed and certified by the state, according to federal standards.


· Institutions are subject to survey at regular intervals to maintain their certification and license to operate.


· Eligibility for Medicaid may be figured differently for residents of an institution, and therefore access to Medicaid services for some individuals may be tied to need for institutional level of care.

Visiting the Medicaid website will give you more information regarding the extent of the coverage it offers.

Steps in Choosing Long Term Care

With the continuous rise in long term care insurance costs, people should plan this accordingly and choose the kind of long term care they think will be appropriate for their situation in the future. Most people have no idea how to go about this and that's why Medicare provides interested parties with all the information they need in order to have a comfortable and secured future. Here are the steps in choosing long term care:

1. Assessing your Needs

Will You Need Help with These Daily Living Activities?

• Bathing
• Dressing
• Eating 
• Toileting
• Getting in and out of bed, chair or wheelchair

Will You Need Additional Help in These Activities?

• Shopping
• Preparing Meals
• Going to Medical Appointments
• Household Chores
• Using the Telephone

Will You Need The Following Care?

• Medication Management
• Monitoring your Diabetes
• Getting Oxygen
• Taking Care of Catheters

2. Researching Facilities

There are many types of long term care and living choices for older people. Check out your options first. Find out more about assisted living facilities, nursing homes and other senior care communities before you make a choice.

3. Finding What is Right for You

You can ask recommendations from friends who have already tried this certain facility or you can simply ask your local long term care ombudsman to give you information regarding the facilities you are interested in.

4. Visiting Facilities

It is important to visit facilities first before you make a decision. Don't be shy in asking questions or if you have things you need to clarify. In order to help you, these are some of the questions you can answer after visiting a facility:

• Did they listen to me and make me feel comfortable?
• Did I ask all my questions?
• Did they give me answers that satisfied me?
• Are the employees helpful and respectful?
• Does the facility meet my needs?
• Is the facility clean?
• Can I afford the facility?

Long Term Care Coverage for Employees Becomes Limited

Long-term care as an employer-provided benefit continues to be a dwindling part of an employee's overall health care benefits package, according to the results of a Long-Term Care (LTC) Benefits Program Pulse Survey announced today by HighRoads , the industry leader in employer health care compliance and benefits management. Key findings show that 51% of survey respondents provide long term care while 49% do not. About half of those who have dropped LTC say they did so because the insurance carrier offering the coverage has exited the market. On a positive note: 96% of companies who are offering LTC coverage say they will continue to do so. This is just right because of the high long term care insurance costs. 

In other key findings, the survey found that, of those who do not offer the coverage, some 40% plan to do so again in the future, on a voluntary arrangement, as opposed to a group basis.

HighRoads conducted the survey to assess current employer practices and future plans for offering long-term care (LTC) benefits programs to their employees. Respondents ranged in size from fewer than 5,000 employees to more than 50,000 employees. The majority of respondents have more than 10,000 employees.

"HighRoads' survey indicates that long-term care coverage is continuing to be an endangered item for employees. The country has a growing number of retirees and no longer interested in comparing long term care quote – many of whom will need some type of long-term medical care services in the future. It is a serious issue when insurers no longer are willing to provide this as part of an employee's health benefits plan," said Michael Byers, CEO, HighRoads. "With the elimination of the CLASS provisions from the ACA, which would have enabled working Americans to purchase coverage to supplement LTC and Medicare and pay for non-medical expenses to allow a disabled person to remain independent, millions of Americans will be left without a safety net should they become disabled," added Byers.

According to data from the 2005 National Interview Survey and the 2004 National Nursing Home Survey conducted by the Health Policy Institute at Georgetown University found that over 10 million Americans need long-term services and support to assist them in life's daily activities and that number is expected to grow with the aging of the population and growing number of people with disabilities.

The HighRoads survey found that more than 90% of the employers who offer LTC do so as an additional benefit to their employees. The remainder is equally divided between offering LTC as part of their overall health care strategy and being required by union contracts to offer this benefit.

Of the employers who responded 71% offer coverage on a group basis. The remainder offer it on an individual basis.

Long Term Care Home Care Remains Unchanged According to Genworth's Annual Survey

According to Genworth’s (NYSE: GNW) 2012 Cost of Care Survey, the cost to receive care in the home remained unchanged from 2011 to 2012 and home care costs have also risen less dramatically over the past five years than for other types of long term care  services.

“Overwhelmingly, Americans prefer to receive long term care in the home and the relatively muted increase in home care costs over the past few years can be viewed as a positive for consumers,” said Steve Zabel, senior vice president of Long Term Care at Genworth. “Consumer demand for home care services has led to a proliferation of home care services providers and more choice for consumers. This competition has kept home care costs relatively stable, especially when compared to the cost of care in a nursing home or assisted living facility.”

Nationally, the median hourly cost for homemaker services and home health aide services is $18 and $19, respectively. While these costs remain flat from the previous year, costs for homemaker services have risen just 1.2 percent annually over the past five years, while home health aide services have risen 1.1 percent a year over the same period of time.

By comparison, the median annual cost for care in an assisted living facility is $39,600 nationally. This represents an increase of 1.2 percent since 2011 and a 5.7 percent annual increase over the past five years. The comparable cost for a private nursing home room rose 4.2 percent from 2011 to 2012 to $81,030, or 4.3 percent annualized over the past five years.

There may be a slight increase but it doesn't mean that people should be confident that the price will remain the same for the next year. They should still do the necessary preparations by comparing long term care quote and researching about long term care insurance costs early. In this way, they will be ready to face the future and they will have full in-home coverage.