Introduction
Medicare and Medicaid are two different programs administered and funded by separate parts of the government and primarily serve different social groups. Medicare is a federal program providing health coverage for people over or under 65 who have a disability regardless of one’s income. Medicaid is both a state and federal program that provides health coverage for individuals with a meager income. Medicaid’s health insurance encompasses many Americans, including “eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities” (Medicaid, n. d., para 2). Concerning long-term care for the elderly and disabled patients, Medicaid covers nursing home services for all eligible people age twenty-one and older (Medicaid, n. d.). Such services are highly critical as they are developed to help older people and people with disabilities receive proper health care support.
Nursing Homes and Medicaid Coverage
The case scenario involves a patient who only has Medicare Part A and B, where Part A covers the inpatient/hospital insurance, and Part B provides the outpatient/medical coverage. The patient is an older woman who requires placement into a nursing home, representing long-term care needed by low-income older people. According to Medicaid, it is the primary payer throughout the country for long-term care services (Medicaid, n. d.). Medicaid individual requirements include the elderly with physical and cognitive impairments. In addition, such governmental health insurance enables the payment for these services through different means and varies from institutional care to community-based long-term services and supports (LTSS). One should also consider that Medicaid programs and services eligibility ranges from state to state.
Considering the role of a healthcare provider, it is crucial to advocate for the patient regarding one’s disabling condition and chronic illness because Medicare and commercial health insurance usually cannot cover the LTSS services. After ensuring that the patient meets the criteria required by Medicaid, it is essential to examine other factors, including eligibility, state policies, and the long-term benefits it provides. As described by Tuck & Moore (2019), eligibility for Medicaid-covered long-term services relies on both functional and financial criteria. Medicaid enables LTSS to individuals that comply with income and other eligibility requirements (U.S. Department of Health and Human Services, 2020). For patients with longer-term needs for services, they might pay out-of-pocket in the beginning. However, the majority of individuals ultimately qualify for Medicaid since they spend down their financial resources. With that said, it would be helpful to collaborate with the health care providers in the target nursing home, including registered nurses, certified nursing assistants, physical therapists, and administration to promote Medicaid’s LTSS access.
Conclusion
Medicaid’s long-term care services are a fundamental source of support for a significant number of poor and low-income people, specifically the elderly group. The older population with disabling conditions and chronic illnesses, specifically those with low income, are at risk of impoverishment due to their long-term care needs. Therefore, the health care professional needs to examine the Medicaid key requirements and eligibility to advocate for patients’ access to such health care coverage provided by the government. Medicaid serves as the national safety net for the poor and the middle class with long-term care needs. However, concerning the Medicaid critical gaps and inequities, the health care providers should collaborate to assure that elderly, and nonelderly individuals with disabilities could access the long-term care services to support their health and wellbeing.
References
Medicaid (n. d.). Long term services & supports, Medicaid.gov. Web.
Tuck, K. D., & Moore, J. E. (2019). Understanding long-term services and supports in Medicaid. Institute for Medicaid Innovation, 1–26.
U.S. Department of Health and Human Services (2020). Medicaid eligibility, LongTermCare.gov. Web.