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What Does Medicaid Cover for Elderly Residents in North Carolina?

Medicaid provides health care for low-income individuals of all ages. This program particularly benefits elderly residents in North Carolina by covering services in nursing homes, assisted living facilities, and offering non-medical supports to help seniors remain in their homes. There are three specific Medicaid long-term care programs designed for seniors in North Carolina:

  • Institutional/Nursing Home Medicaid: This is an entitlement program where eligible seniors receive assistance specifically in nursing homes.
  • Medicaid Waivers/Home and Community-Based Services (HCBS): Aimed at postponing nursing home care, these benefits can be accessed at home, in adult day care, family care homes, or assisted living facilities. However, there’s a cap on participants and possible waiting lists.
  • Regular Medicaid/Aged Blind and Disabled: Also an entitlement, providing limited long-term care services like personal care assistance to those meeting the eligibility criteria.

Striving for Eligibility: Income and Asset Criteria

The path to qualifying for these Medicaid programs depends on financial and medical requirements that differ based on marital status and are updated annually. For 2024, a single applicant seeking Nursing Home Medicaid needs to have an income below approximately $6,381 to $9,087 per month, assets less than $2,000, and require a Nursing Home Level of Care.

Income and Asset Definitions

In determining eligibility, Medicaid considers nearly all sources of income and differentiates between countable and non-countable assets. Regular income sources like employment wages, pension payments, and IRA withdrawals are included in the eligibility assessment. To meet the financial criteria, seniors might reduce countable assets by investing in non-countable items, such as home improvements or paying off debt, or engage in Medicaid Planning—a process to help manage assets and income to achieve eligibility.

Home Exemption and Medical Need

For a home to be exempt from asset calculations, the Medicaid applicant or their spouse must reside in it. Additionally, the applicant must demonstrate a medical need for long-term care, whether it’s through a Nursing Home Level of Care for specific programs or assistance with daily living activities for regular Medicaid.

In crafting a strategy to align with Medicaid’s financial thresholds, seniors often find it beneficial to consult with professionals who can offer insights into managing assets and preparing applications. This cautious approach helps in maximizing the chance to secure Medicaid benefits, ensuring they can afford the care they need.

Final Thoughts and Legal Guidance

For many seniors and their families, understanding and accessing Medicaid benefits for long-term care can seem difficult. Southport, NC Attorney Julian Doby advises, “While planning for Medicaid eligibility, it’s crucial to review your financial situation thoroughly and consider all available avenues for qualifying. Professional guidance can clarify the process and help protect your assets.” It’s essential to remember that planning ahead and seeking advice can make a significant difference in securing the necessary care and support.

Disclaimer: This information is intended for educational purposes and is not legal advice. For personalized advice, consider consulting a legal professional.