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What Types of Long-Term Care Services Does Medicaid Cover in Delaware County | West Chester County | West Chester | Media, Pennsylvania?

Affording long-term care as you get older is an obvious concern for many senior citizens. Monthly costs at personal care homes or nursing homes can be in the thousands. In-home health care services can be just as expensive. Most people cannot afford these monthly expenses without the risk of impoverishment, which is why Medicaid becomes necessary. If you meet the medical and financial requirements, they will cover a variety of services. To learn more about Medicaid eligibility in Pennsylvania, contact our experienced Medicaid planning attorney.

Nursing Home Coverage

Those people who need the level of care that a nursing home can provide could receive long-term care benefits through Medicaid if they meet the financial and medical requirements. The applicant must have a medical necessity that makes a nursing home required to maintain their wellbeing. For example, for nursing home qualification, the person must have a significant functional disability and need the ongoing assistance of another person to complete their activities of daily living and take care of themselves. There are also financial requirements that include income and assets tests as well as a 60 month look back for gifts.

Personal Care Residences & Assisted Living Facilities

Medicaid payments for long-term care do not cover personal care homes (PCHs) or assisted living residences (AL). Both types of residences are licensed in Pennsylvania as different levels of care and generally less expensive than nursing homes. Part of that is because they are less medically intensive than a nursing home would be. There are in fact very few assisted living residences in PA!

In Pennsylvania, there is no Medicaid for assisted living as there is in our surrounding states (such as in New Jersey or Delaware). There is also not any Medicaid for personal care residences in Pennsylvania (or any other state).

In-Home Health Care

Pennsylvania does have Medicaid programs for home and community-based services (HCBS).

For Medicaid HCBS, Pennsylvania recently consolidated the HCBS Waivers and moved to managed care for Medicaid under the Community Health Choices (CHC) program. There are 3 Managed Care Organizations (MCO’s) that are now used by consumers for the administration of their HCBS.

Another approach for HCBS is the Pennsylvania LIFE program. This is a program that is similar to the LIFE program and is part of the Medicaid program, but is not part of the CHC program. During the pandemic, the ability to maintain residents in the community has been an important goal of many Medicaid recipients and families.

Alternatives to Medical Waiver Programs

The financial eligibility tests for Medicaid sometimes result in the disqualification of an applicable. It is important to know that there may be some relief under the state OPTIONS program. For Veterans there may be resources through the Veterans Administration. Even if an individual has been assessed to not meet the medical or financial qualifications of Medicaid, we often find that there may very well be a way to address the assessment with additional information or appeal.

Contact a Certified Elder Law Attorney Who Knows How to Take Care of You & Access Medicaid Benefits

The types of care available may be clear. But, assessing the correct level of care for your loved one is difficult. Our firm includes the assistance of an Elder Care Coordinator who will assist with determining whether your family member is likely to meet the medical requirements of Medicaid. Also, should you need assistance in selection of a facility (whether a Nursing Home, Personal Care Residence), or customized Medicaid Planning advice, we encourage you to contact us today for assistance. Not all seniors may immediately qualify for health care waivers or programs. But, with proper advice, we can set you up for success.

Contact us today by emailing or by calling us at 610-566-4700 to schedule an initial consultation and to learn how to prepare for long-term care benefits eligibility. It is never to early or too late to start to plan.