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Government Programs That Can Pay for Long-term Care for the Elderly

If you or a loved one has financial constraints but needs long-term care, there are government-funded options. The programs have different eligibility requirements which are based on income, assets, the kind and level of care needed, marital status and age.


MEDICAID-FUNDED HOME-CARE PROGRAMS

Medicaid is a state/federal program for low-income families and individuals. Eligibility is determined by the Michigan Department of Health and Human Services. There are four types of long-term Medicaid coverage for seniors:

■ MI Choice Home and Community-Based Waiver Program
■ PACE -Program of All Inclusive Care for the Elderly
■ Home Help Grant
■ Nursing home

MI Choice Home and Community-based Waiver Program

The MI Choice Waiver Program gives people an alternative to a nursing home by providing care and support at home (including
assisted living facilities and adult foster care homes). The program is funded by Medicaid and provides people the assistance they need to live independently.

Services may include:

■ Personal care/homemaking/housekeeping
■ Private-duty nursing
■ Respite services
■ Personal Emergency Response systems
■ Chore service and transportation
■ Home injury control
■ Home-delivered meals

To be eligible for the program, you must be age 65 or older (or age 18 and older with disability), meet MI Choice income and asset requirements and require nursing home-level care. In 2020, the income limit for MI Choice is $2,349/month gross.The amount typically rises $50 per year. Assets are limited to $2,000 for a single person. Keep in mind that not everything is counted as an asset. The home
you live in, your car and your personal belongings will not be considered part of your assets. For married couples, spousal impoverishment applies. The Area Agency on Aging 1-B and other Area Agencies in Michigan administer MI Choice for residents in their regions. Macomb Oakland Regional Center  is another waiver agent which serves the same geographic area as the Area Agency on Aging 1-B.

A support person will work directly with participants and their families after enrollment to understand their needs and to coordinate
services with our pool of home care providers and others who work directly with MI Choice participants. If you think you or your loved one may qualify for the program, call our Information and Assistance Line (800-852-7795) to get started. Have information ready on income, assets, type of assistance needed and any medical conditions. Participation is limited, which means there may be a waiting list for benefits.

PACE (Program of All-Inclusive Care for the Elderly)

This program is similar to MI Choice, except that it is funded through both Medicaid and Medicare and is designed for people age 55 years and older who are medically eligible for nursing home-level care but are able to live independently. The financial eligibility requirements for PACE are the same as for the MI Choice program ($2,349/month gross in 2020, with assets of $2,000 or less). Spousal impoverishment applies to this program, as well. If you are not Medicaid-eligible, you can pay for part of the program Medicaid would have paid, and Medicare pays for the rest.

Other requirements include:

■ You must live within a PACE-approved geographic area (designated by zip code).
■ You must be able to live safely in the community (not in a nursing facility) at the time of enrollment.

Participants’ social, medical and physical needs are coordinated by a team. PACE focuses on preventive care in a person’s home. People who join a PACE program must receive their primary medical care through PACE, and will need to see a PACE doctor. Michigan has 16 PACE centers. The program covers many Michigan communities, including parts of Livingston, Macomb, Monroe Oakland, Washtenaw
and Wayne counties. A person with MI Choice cannot also be enrolled in PACE. To find a PACE program near
you, visit the PACE Association of Michigan website.

Michigan Home Help Program

This is a program which helps people who need hands-on assistance with activities of daily living (ADL) such as bathing, transferring and
meal preparation. The Michigan Department of Health and Human Services will do an assessment to determine need and must approve providers who want to participate in the program. To qualify, a person must be Medicaid-eligible and require physical assistance with at least one ADL.

Nursing Home Care

If you are in a nursing care facility, Medicare, the health insurance program for people ages 65 and older, and other insurance providers may not cover all the costs of your care. Medicaid will cover the cost of care if you meet financial and medical eligibility requirements. To apply for Medicaid, you need to contact the Michigan Department of Health and Human Services office in your area and ask for a Medicaid
Application Patient of Nursing Home. You can pick it up at your local MDHHS office, call the office to request that it be sent
by mail, or download it online.

The nursing facility must be certified by Medicaid to provide the medical care you need. Financial and medical eligibility are determined via the Michigan Medicaid Nursing Facility Level of Care Determination requirements.

Keep in mind there is a patient pay amount that is based on assets and income, other insurance you may have and other factors. The portion of the bill you aren’t expected to pay is picked up by Medicaid. To determine if you are eligible for Medicaid, you will be asked
about your assets and income, medical expenses, marital status, other health insurance, your spouse’s assets and income and income of dependents in your home.

To prevent people from transferring their assets to other family members in order to meet Medicaid financial eligibility requirements, Medicaid looks at your financial statements going back up to five years. Medicaid will cover nursing home care as long as you meet eligibility requirements.


NON-MEDICAID LONG-TERM CARE OPTIONS

 

Community Living Program (CLP)

AAA 1-B’s Community Living Program offers in-home assistance to residents ages 60 years and older in our six counties. The program
emphasizes self-directed care, providing consultation and resources designed to help participants live independently and meet personal goals. While there are no strict financial eligibility requirements, CLP is meant for people with the highest financial need, which is
determined through screening.

Services could include:

■ Homemaking
■ Personal care assistance
■ Adult day services
■ Respite care
■ Emergency medical response system
■ Meals on Wheels
■ Assistive technology
■ Safeguards for people with memory loss

Veterans

There are a few good options for veterans needing long-term care:

Wartime veterans and surviving spouses who are eligible for a VA pension and require the assistance of another person, or are disabled and housebound, may be eligible for additional monthly payments that are added to their pension.

Aid and Attendance Allowance
Veterans who receive a VA pension may qualify for additional monthly payments called an Aid and Attendance Allowance if they:

■ Require physical help with everyday needs like bathing, dressing and toileting, or are bedridden
■ Live in a nursing home and are physically or mentally incapacitated
■ Have poor eyesight

Housebound Allowance
Veterans who are permanently disabled and live in their own home may be entitled to monthly increases in their pension. The
money may be used to pay for services in the home. Typically, the Aid and Attendance benefit is not counted when applying for Medicaid. However, if a single person who receives Aid and Attendance enters a nursing home, the VA may reduce the monthly benefit. Veterans who receive a pension may not be eligible for Medicaid.

Veterans Directed Home- and Community-Based Services
Provides a budget for certain veterans to buy services in their homes or an independent living facility. Veterans who qualify must be eligible for nursing home care. In some cases, they can pay family members to care for them.

For more information on eligibility criteria and coverage, contact your local VA office.


MORE RESOURCES

For more information on home care programs, visit our Services for Seniors page or call our Resource Center at (800) 852-7795