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What It Means to Need ‘Nursing Home Level of Care’ for Medicaid Eligibility

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Home » What It Means to Need ‘Nursing Home Level of Care’ for Medicaid Eligibility

What It Means to Need ‘Nursing Home Level of Care’ for Medicaid Eligibility

November 10, 2021
Geoff Hoatson

When applying for Medicaid’s long-term care coverage, in addition to the strict income and asset limits, you must demonstrate that you need a level care typically provided in a nursing home.

Whether you are applying for nursing home coverage or through a Medicaid waiver program for coverage at home, you must meet the level-of-care requirement set by the state. Each state has its own criteria for determining if you meet the mandated level of care, and the criteria is not always clear.

The state looks at an applicant’s functional, medical, and cognitive abilities to determine if care in a nursing home is called for. In general, you must be unable to care for yourself or pose a danger to yourself without outside help. The following are the factors usually considered when making a level-of-care determination:

  • You need help with two or more “activities of daily living” (such as bathing, dressing, eating, moving, and going to the bathroom).
  • You need frequent medical care, such as assistance with medication, injections, IVs, or other medical treatment.
  • Your cognitive ability is impaired by Alzheimer’s disease or another form of dementia, you have trouble making decisions on your own, or you are unable to process information.
  • You have behavior problems, such as wandering away from home or aggressiveness.

When assessing a Medicaid applicant, the state will conduct the evaluation. The state may require a doctor’s diagnosis, but it will also likely require the applicant to answer a series of questions about his or her ability to perform activities of daily living as well the applicant’s mental abilities and behavior problems and the applicant’s family’s ability to provide support.

Navigating the Medicaid application process is not an easy feat. That is why it is crucial you hire an elder law attorney who is able to guide you through the strict rules and laws that surround Medicaid benefits.

Luckily the team at Family First Firm is here to help you! Give us a call at(407) 574-8125 or email us at [email protected] to learn how we can help you get qualified for Medicaid without going broke in the process.

Copyright © 2022. Family First Firm – Medicaid & Elder Law Attorneys. All rights reserved.
The information in this blog post (“post”) is provided for general informational purposes only and may not reflect the current law in your jurisdiction. No information in this post should be construed as legal advice from the individual author or the law firm, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting based on any information included in or accessible through this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country, or other appropriate licensing jurisdiction.
Family First Firm – Medicaid & Elder Law Attorneys
(407) 574-8125
https://familyfirstfirm.com
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