Will Medicaid or Medicare help pay for my mother's long-term care?

9 answers | Last updated: Oct 24, 2017
A fellow caregiver asked...

My 70-year-old mother had a stroke last weekend. She's on a fixed income with few assets and is probably going to need long-term rehabilitation and care. I expect that she'll eventually need to move to a nursing home. How much of these expenses can I expect Medicare and Medicaid to cover?

Expert Answers

Barbara Steinberg is the CEO and founder of BLS Eldercare Financial Solutions, which specializes in helping families pay for long-term care for their loved ones. A registered financial gerontologist, she speaks regularly on the topic of paying for long-term care and is a financial expert for Caring.com.

Medicare and Medicaid serve two very different purposes: Medicare is similar to regular health insurance, providing coverage to people over the age of 65. Medicaid, on the other hand, is basic health insurance for people older than 65 who have limited income and assets.

If your mother requires skilled care, Medicare will cover rehabilitation and nursing home care. However, it won't cover custodial or intermediary care. For example, it won't cover an at-home health aide unless one is determined to be medically required.

To get Medicare coverage for nursing home or rehab expenses, your mother will have to meet certain requirements: She must move to a nursing home within 30 days of her hospitalization, and she must have initially stayed in the hospital for at least three or more days.

If she meets those qualifications, Medicare will cover 100 days in a nursing home. The first 20 days are covered in full with a $124 per day co-payment for the next 80 days.

As for Medicaid, it does cover custodial and nursing home care -- for those who are in financial need. This means that your mother would have to spend down her assets to roughly $2,000 (depending on the state she lives in) before she could qualify for the program. Once she qualified, the cost of a Medicaid-approved nursing facility would be covered. However, whatever income she received would automatically go first to cover the cost of the nursing home.

Unfortunately, just because a facility is Medicaid-approved doesn't mean that it will meet with the approval of you and your mother: Medicaid-approved nursing homes aren't always the best option in terms of quality care.

Community Answers

Ruogoll answered...

This was most beneficial, it explained the differences between Medicare and Medicaid.

A fellow caregiver answered...

This was helpful but also very sad. For many caregiver's there is no place to go.

Shannonm answered...

Great summary above. Most patients will get some initial Medicare coverage for therapy, etc. after having a stroke (as per the answer above). If your Mom has a Medicare supplemental policy, that typically covers the mentioned copay for days 21-100. And, be aware, when discussing days provided...we often hear people say "What about my 20 days, or 100 days? I thought I get that."...isn't automatic, patient must have the need for skilled care, be showing progress in therapy, etc. for it to be considered medically necessary and not custodial. Here's a couple articles you may find helpful: http://www.agingwisely.com/long-term-care-and-medicaid/ & http://www.agingwisely.com/2011-medicare-fact-sheet/.

If your Mom has limited assets and it appears she will need long term care in a facility after rehab., you may wish to talk with a board certified elder law attorney about Medicaid as a payment option, if planning needs to be done (www.naela.org is one resource). You should begin to talk about these issues w/the social worker at the rehab. immediately and start your research process, i.e. looking in to options. Another resource that can be very helpful is a geriatric care manager: www.caremanager.org--though you'll have to pay a fee, you can get expertise on what the options are like in your community, an assessment of what might be anticipated in terms of care needs and referral to resources like a good elder law attorney in your area and recommendations on facilities and providers.

Catsumrs answered...

Having my dad in a so called rehab at the moment, I have to say that Medicad should be ashamed of what they dictate to these patients. My dad has suffered with prostate cancer for over 11 1/2 years now. Last month he suffered a stroke while driving to church. We are thankful he was in the parking lot at the time and no one was injured. He went to the hospital but 2 1/2 days later my mother walked into his hospital room and was told my dad was being moved to a rehab center. No one at the hospital told us anything the night before, just found his clothes stuffed into a plastic bag. They didn't even inquire as to where we might like him to go.They shoved this PT down his throat3 times a day. He could walk and talk, eat, swallow, what was affected was his left eye, his sight was damaged, along with some of his memories. We asked from day one that an eye doctor be called in to examine his eyes, that is a very important thing to do after a stroke.. 3 1/2 weeks later they tell us that my father is being released because we didn't make an eye appointment for my dad! I got him an appointment with a specialist the very next day. He got a great exam and was told he may benefit from prism glasses, which are being made for him as we speak. Now this rehab says because the glasses will take a week, my dad still has to go. They keep citing its Medicad's rule... Sorry I don't buy that for one moment but if it is true, shame on them. I may also add that my dad's cancer treatments were denied while he was there because we were told Medicare would not pay. So I guess the only way to survive in a "rehab" is to be healthy before you enter... My dad didn't require chemo or anything, he got a hormone injection every 4 months, thats it. I guess the good doctor couldn't be bothered to make the 10 minute visit. There is no help for the patient and yes as one pointed out before me, no help for the caregivers. As I spoke to my dad one day, he said two things: he never thought he'd live to see the day when medicine and the care, would become so cold. The second thing was, he prays every night that they "good lord takes hime as he sleeps".. With that said we have decided that we are taking dad home. We will go back in time as they did with our grandparents, we will take care of our own... These cancer doctors made so many promises to my dad,all of which they have turned their backs on. I hope they at leat keep one and that being keeping him pain free.

Karenlorenzo answered...

Great insight on how medicare and medicaid will help pay for long term care expenses. However, as stated in the answer above, medicare is only good for 100 days and while medicaid covers custodial/personal care, you will not get the quality care when and where you need it, and medicaid also have an asset recovery procedure to pay for long term care expenses incurred as explained in infolongtermcare. If you have long term care insurance, it cover the expenses based on your needs and preference, but you should have purchased it prior to the onset of any illness or disabilities.

Tony heaney answered...

This is a common confusion especially among older adults who fail to plan for long-term care because they think that medicaid and medicare will cover their expenses. Please note that medicare only covers rehabilitative care in a skilled care facility and it will only last for 100 days, the first 20 days is covered but for the remaining 80 days, you have to make out of pocket payments, and from day 101 onward, you are on your own. While medicaid covers long-term care expenses, you have to pass the poverty criteria which are under strict conditions, in addition, you have to keep in mind that medicaid's expenses are focused on nursing homes so if you prefer to age in place, medicaid is not the right long-term care solution. Long-term care insurance on the other hand is the most viable way to cover ltc expenses in any settings that you prefer including home care. However, before buying one, it is important that you seed the aid of an ltci specialist so they can help you find a coverage that will best suit you based on your personal circumstances. Explore your options on which is the best way to pay for your long-term care needs, these resources can be helpful in providing information about medicare, medicai, long-term care and long-term care insurance: http://www.longtermcare.gov http://www.longtermcareprimer.com/

A fellow caregiver answered...

My Mom had 2 strokes in 3 yrs.leaving her disabled with no use of her left side. She has a live in aide and is on medicare and community medicaid. My mom fell and broke her leg and was in the hospital for a couple of weeks and then sent to rehab.nursing facility where she stayed for about 2 months. She now has a bill for over $4,ooo.oo that the facility is looking for payment on. My mom has been in other facilities for longer periods of time and did't have to pay any one of the facilities.Nursing facility is say that it is because she was in cronic care. We are fighting this. Wondering if she has a case and will not have to pay facility. She does not have the money.

Sherry v answered...

All these stories are true and sad. What strikes me (I provide occupational therapy services) is the lack of understanding of the Medicare system before anyone needs it. The other thing that strikes me is the somewhat bold misunderstanding that because dad or mom lived so long, worked so hard, etc., that somehow now "They" (government/Medicare/Medicaid) should pay for all their care. When my Dad was needing assisted living, we had to explain to him over and over that because his assets were so limited he had few choices. Had he prepared better for his retirement years, he would have had more options; he had nearly no savings. We are now seeing the real struggle of the greatest generation to afford a dignified end, and yes, the best thing you could do would be to take your loved one home, hire some help, and let them die among those who care. Medicare and medicaid are COST SHARING not intended to be TOTAL CARE. Total care is very expensive, and hard to find, especially in rural areas. As a culture, we will have to adjust our thinking. Most elderly end up spending 90% of their total lifetime medical costs in the last year of life, trying to avoid the death which is coming. A good book on the subject is by Katy Butler entitled Knocking on Heaven's Door. Preplanning and living wills are all good, but it is imperative that families talk about what to do, and how much debt to go into in the last years of one's life. This is a national problem and I am sorry for all who are going though it now. I took advantage of my FMLA at my hospital job several years ago to take my Mom home from the hospital so she could die at home; neither of my siblings wanted to even take a turn at cares. We had a good last month, with Hospice services provided at home (medicine for pain and emotional support for me, covered by Medicare), laughed and cried, and she died in her sleep. People should not die afraid and alone, if there is another way.