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, 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.

Medicaid Long Term Care

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. All states have HCBS Waivers, but their benefits, eligibility requirements, enrollment limits, and even their names differ in every 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 a "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 every state. Unfortunately, not all states offer Personal Care Services and Home Health Care. Some offer these services strictly through their Medicaid HCBS Waivers. 

Naming Confusion - The phase Home and Community Based Services is used several different ways and usually without clarification.  It can refer to 1) non-entitlement Medicaid Waivers, 2) regular Medicaid funded programs provided outside of nursing homes and 3) Non-Medicaid, state funded services provided outside of nursing homes.

Learn More

Find Other Financial Assistance for Care

Learn about Medicaid Eligibility Requirements

Get Assistance Qualifying for Medicaid

Understand the Difference Between Medicare & Medicaid

Medicaid's Assisted Living Benefits

Medicaid's Home Care Benefits

Medicaid's Adult Day Care Benefits