Medicaid / Medicare
Medicaid
Medicaid, established by Congress in 1965, is a state government health insurance program for people of all ages whose income is too low to provide for routine health care costs, or whose health care costs are too high to be covered by their income. This health insurance covers the cost of nursing care for as long as the care is required if a resident is eligible.
A comprehensive application process is used to determine eligibility for the Medicaid program. This process requires that applicants provide detailed information and documentation regarding income and assets. A Medicaid applicant must be a citizen or permanent resident in the United States, must meet New York State income and resource limitations and must show medical need.
Currently, a Medicaid recipient in a nursing home is allowed to retain $50 of monthly income as a personal needs allowance to meet personal expenses that are not covered by Medicaid. Call your local Department of Social Services office for additional information on Medicaid.
Medicare
Medicare is a federal health insurance program for disabled people and people over age 65. Skilled nursing services must be needed on a daily basis to be eligible for Medicare. Medicare will pay a maximum of 100 days of care in an approved nursing facility for patients in need of skilled care following a hospitalization of at least three full days. To qualify, the patient must be admitted to the nursing facility within 30 days of discharge from the hospital.
Many people leave a hospital and enter a nursing facility expecting Medicare to continue to pay for health services indefinitely. This is not the case. Medicare will not pay for a nursing home stay if it is determined that only custodial care is required. Under Medicare rules, the need for skilled nursing care must be daily. The program has a number of specifics about what services are included and requires that you be responsible for a co-payment. For further information, contact your local Social Security office or call 1-800-772-1213 for a copy of the Medicare Handbook. You can also visit the Medicare website at: www.medicare.gov.
