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What
is the Medicaid Program?
Medicaid, also known as Title 19, is a medical assistance program
run by the Connecticut Department of Social Services (DSS). It is available to those
who have limited income and assets and who can not pay their own medical costs.
What coverage does
Medicaid provide for nursing home care?
For those who are eligible, Medicaid will cover most costs
relating to nursing home care. Medicaid will pay for room and meals, the nursing home
staff, nurses, therapists, doctor's visits, some prescription drugs, dental care, medical
equipment such as wheel chairs, eyeglasses and hearing aids. Medicaid will not pay
for podiatrists, chiropractors, naturopaths, and independent: psychologists, speech
pathologists, audiologists, and physical therapists. Medicaid will usually not pay for a
single room and will not pay for televisions or phones.
Under federal law, the facility must inform each resident who is
entitled to Medicaid benefits, in writing, at the time of admission to the nursing
facility, or when the resident becomes eligible for Medicaid of the items and services
that are included in nursing facility services under Medicaid. The facility must also give
notice to residents as to other items and services that the facility offers and which are
not covered by Medicaid for which the resident may be charged, including the amount of
charges for those services. This information must be provided whenever changes in the
charges go into effect.
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Do
those covered by Medicaid receive less care than those who pay on their own?
Discrimination against residents whose care is paid for by
Medicaid is unlawful. Under state and federal law, all residents are to be treated equally
with other patients regardless of the source of payment. All nursing home residents are
entitled to all the care and medical services they need in order to attain or maintain
their highest practicable physical, mental, and psychosocial well-being.
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Who is eligible for
Medicaid for nursing home care?
The rules for Medicaid are very complicated and change
often. There are income and asset limits for eligibility. If the cost of
nursing home care is greater than the income of the person in the nursing home, Medicaid
may be available. For couples, if one person needs nursing home care, the spouse in
the nursing home may be eligible for Medicaid and the spouse in the community can still
keep enough assets and income to prevent impoverishment.
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How much income
and assets can a nursing home resident on Medicaid keep?
A resident covered by Medicaid is allowed to keep $65 per
month for personal needs -- this is commonly know as a "personal needs
allowance" which increases each July. Single veterans (or their surviving
spouses) are permitted to keep an additional allowance of $90 per month. Those
residents receiving reduced SSI benefits of $30 per month are entitled to receive $35 per
month in State Supplement benefits.
A resident can have a bank account so long as the amount of
savings does not go over $1,600.
Residents may also use all or part of their income for medical
services and equipment that Medicaid does not pay for. For example, if a resident
loses a new hearing aid and Medicaid won't pay for a replacement, the resident could
purchase one using the resident's income.
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Can
I be transferred or discharged from the facility because I am covered by Medicaid?
No. Under federal law, any resident who becomes eligible for
Medicaid must be allowed to stay in a nursing home. A transfer or discharge solely
because you go on Medicaid is unlawful. For more information see Nursing Home Transfers and
Discharges and Room-to-Room
Transfers in a Nursing Home.
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What are the
laws regarding Medicaid covered nursing home care?
Patients’ Bill of Rights.
Connecticut General Statutes § 19a-550(b).
Resident rights.
42 Code of Federal Regulations §
483.10.
Admission, transfer and discharge rights.
42 Code of Federal Regulations §
483.12(d).
Quality of care.
42 Code of Federal Regulations §
483.25.
Click here to
find other pertinent nursing home regulations within Part 483 of Chapter IV of Title 42 of
the Code of Federal Regulations.
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