Medicaid Basics in Maryland, Part 1 - What it Does

Medicaid in Maryland

Long-term care is a necessity for many people to consider as they approach their senior years. Live long enough (many of us will see our 90s), and you’re likely to need help with basic activities, such as eating, getting dressed, and taking a bath or shower.

Paying for long-term care is a concern for most older adults, and the cost of care could decimate your retirement savings. According to a recent Genworth Financial report, the annual median cost of a stay in a private nursing home room is a whopping $100,375.00, whereas a home health aid could run you $50,336.00 a year. For low-income seniors, these costs may even prevent retirement.

Medicaid for Long-Term Care in Maryland

Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, people with disabilities, and the elderly population. Medicaid is administered by the individual states in accordance with federal requirements, and is funded jointly by the states and federal government.

Low-income seniors in Maryland may be eligible for Medicaid coverage if they meet certain criteria. If eligible, Medicaid covers a wide range of costs, including doctor’s appointments, checkups, and prescriptions. For seniors, these coverage benefits can extend to skilled nursing care, rehabilitation facilities, and long-term care. Some of these services may require a Medicaid waiver, which has additional eligibility requirements.

The Medicaid Long Term Services and Supports (LTSS) program is the primary source of nursing home funding for low-income seniors in the state of Maryland. At present, 96% of the nursing homes in Maryland accept Medicaid as payment, making it a strong choice for seniors requiring skilled nursing care. Medicaid determines how much care they will cover depending on the patient’s health condition and financial outlook, and will cover up to 100% of the costs for applicants who are eligible.

Medicaid may also cover assisted living facilities, adult day cares, and in-home aids. Many seniors would rather stay at home or live in a community, and are opposed to living in a nursing home. Medicaid LTSS doesn’t cover all types of long-term care by default, but low-income seniors can apply for a Home and Community-Based Waiver to qualify for coverage. Maryland offers several Medicaid waivers to help seniors pay for home and community-based care as an alternative to a nursing home, including the Community First Choice programs. Each waiver has its own eligibility requirements, and some are only given to a limited number of residents per year.

Who Runs Medicaid in Maryland?

Medicaid in Maryland is administered by the Maryland Department of Health and Mental Hygiene (MDH) in accordance with federal guidelines. The MDH works in conjunction with the federal government to pay for Medicaid services. The federal government currently covers approximately 60% of the costs of Medicaid in Maryland, while the state covers approximately 40% of the costs.

Who is Eligible for Medicaid in Maryland?

To be eligible for Medicaid in Maryland, a person must meet a set of financial and medical criteria. Seniors seeking financial assistance for Long-Term Care (LTC) are subject to further eligibility requirements.

For Medicaid to cover nursing home care, an applicant must be at least 65 years of age or have a disability, have an income within a certain acceptable range, and have limited resources with which to pay for care (including stocks, bonds, property, accounts, retirement, annuities, etc.). Married couples are subject to different limits than single people, and certain assets are excluded (for example, a home) when Medicaid reviews an applicant’s resources.

Seniors who don’t meet Medicaid’s limits for income and resources are not immediately eligible for coverage, but they may appeal their application or reapply with additional information to support their claim for assistance.

Contact a Wayside Legal Elder Law Attorney Today

Wayside Legal LLC is an award-winning law firm located in North Bethesda, Maryland, with experience handling Medicaid issues in Maryland, D.C., and Virginia. If you are facing a situation where you need assistance with long term planning, contact a Wayside Legal attorney today for a consultation to discuss your specific elder law issues.