Louisiana Medicaid Long Term Care Benefits

Understanding Medicaid's Long Term Care Benefits in Louisiana

Medicaid is most commonly thought of as the medical portion of the U.S. government's welfare system. It is often confused with Medicare, which provides federal government insurance for retirees. Contrary to Medicare, Medicaid is a state/federal partnership program that was initiated by the federal government but is run by state social service agencies. In Louisiana, Medicaid is run by the Louisiana Department of Health. Funding comes from both the state and federal governments, as do the rules governing eligibility.

There is some overlap between Medicare and Medicaid programs. Medicaid is the primary source of long-term care benefits, but Medicare also pays for a portion of some stays in a nursing home that are essentially considered rehabilitative extensions of previous hospital visits. Medicare requires that, before coverage can commence for a nursing home stay, a patient must have been hospitalized for three consecutive days and be subsequently admitted to the nursing home within 30 days from the discharge date. Custodial care is not a sufficient need for Medicare coverage. The patient must require “skilled care,” which must be administered by a doctor or nurse, and it must be considered medically necessary in order to avoid deterioration of a patient’s health. Medicare only covers up to 100 days of skilled care in a nursing home stemming from a particular spell of illness. Even then, Medicare is not a full ride for the whole 100 days.

Nursing Home Medical Qualifications

Before Medicaid will authorize payment for nursing home services, a patient must prove he or she is 65 or over, blind, OR disabled. A medical assessment of the nursing home patient will be performed to evaluate a patient’s ability, or lack thereof, to perform certain Activities of Daily Living (called ADLs), such as bathing, using the toilet, preparing meals, and putting on clothes. The more help the patient needs, the more likely the patient will meet the necessary Medicaid nursing home medical qualifications.

It is important when seeking Medicaid coverage that the applicant be in a Medicaid-approved facility that also has a Medicaid-certified bed.

Medicaid Benefits Income and Resource Requirements

In addition to medically qualifying, a patient must meet certain income and asset criteria to qualify for Medicaid long-term care benefits. These criteria are complicated and, therefore, the subject of separate discussion in special sections of this website. If you have questions, contact our office at 504-447-6000 and set up an initial consultation.