Medicaid is a medical assistance program for those who have no other means to pay for necessary medical care. Unlike Medicare, Medicaid does not require any specific contribution before one is entitled to benefits.

Medicaid for persons in nursing homes is called "institutionalized" or "long-term care" Medicaid. Some states, such as Florida, have special programs that allow Medicaid to pay for services in the home of an elder in order to avoid the added cost of nursing home “institutionalized” care. In order to receive Medicaid, an individual must prove financial and medical need.

FINANCIAL ELIGIBILITY
MEDICALLY NEEDY
DO I QUALIFY

In addition to financial eligibility requirements, the Medicaid program has a system of medical screening to make certain that only "necessary and reasonable" medical care is paid for. In cases involving long-term institutionalized care, the medical screening process focuses on clinical thresholds to determine whether the individual really needs the high level of services that are provided in nursing homes.

In Florida, CARES, is the federally mandated nursing home pre-admission assessment program. Either a CARES nurse or social worker assesses persons who are applying for Medicaid nursing home care, with medical review by a physician prior to approval. Objectives of the CARES program include the following:

Prevention of unnecessary or premature admission to a nursing home; More effective coordination of an individual's medical, social and psychological needs and resulting level of care; Referral and assistance in obtaining in-home and community services to avoid nursing home care; and Education of the public, particularly health care providers, about less costly alternatives to long term care.

Disabled persons who receive Supplemental Security Income ("SSI") and financially needy persons who receive Aid to Families with Dependent Children ("AFDC") automatically receive community Medicaid. In both cases, qualification is based upon the fact that the individual already has proven financial need by qualifying for either SSI or AFDC. They are considered "categorically needy."

Those who are not categorically needy must satisfy Medicaid's separate criteria for poverty. These consist of both income and asset standards.

Click on the link below for more specific information on; financial eligibility requirements and the process and paperwork you will have to go through to receive Medicaid benefits.