Understanding Medicaid Entitlements and Long Term Care

Medicaid provides long term care to seniors in nursing homes and in their home or communities. It does so in three different ways.

1) Medicaid Nursing Home Care – This is also called “Medicaid Institutional Care” and is an entitlement program. This means that anyone who is eligible financially and medically for nursing home care will receive nursing home care paid for by Medicaid, as long as an individual resides in a state-certified Medicaid nursing home. This is true nationwide.

2) Medicaid HCBS Waivers / 1915 Waivers – Medicaid also provides nursing home level of care outside of nursing homes to individuals living in their homes or communities (meaning other people’s home, including adult foster care homes, or assisted living residences).  These programs are called “HCBS Waivers” (Home and Community Based Services Waivers) or 1915 Waivers. Waivers are not entitlement programs. These programs limit enrollment, so even if one meets the eligibility requirements, they are not guaranteed assistance and may have wait lists. Forty-seven states have HCBS Waivers, but their benefits, eligibility requirements, enrollment limits, and even their names differ from state to state. 

3) Regular Medicaid Programs – Also provided are long term care services to individuals in their homes and communities through their “Medicaid State Plans,” as opposed to through HCBS Waivers. Medicaid State Plans are also referred to as “regular Medicaid” or simply “Medicaid.” The level of care provided is not nursing home level of care, but includes Personal Care Services and Home Health Care. These programs are entitlements and are sometimes referred to as “Community Entitlement Programs.”  The names of the programs, qualifications, and benefits are different in each state. Unfortunately, not all states offer Personal Care Services and Home Health Care. Some offer these services strictly through their Medicaid HCBS Waivers.