Mandatory Medicaid benefits include hospital, medical, laboratory, X-ray and home health care services. Optional benefits include prescription drugs and case management. Most people age 65 and older and many people under 65 with disabilities have Medicare, but Medicare doesn't cover most of the LTSS; instead, Medicaid is the primary payer of the LTSS. LTSS encompasses the wide range of paid and unpaid medical and personal care services that help with activities of daily living (such as eating, bathing, and dressing) and instrumental activities of daily living (such as preparing meals, administering medications) and do household chores).
They are provided to people who need such services because of age, chronic illness, or disability. These services include nursing facility care, adult day care programs, home health care services, personal care services, transportation, and supported employment. They can be provided for several weeks, months, or years, depending on the person's health care coverage and level of need. For a long time, there have been difficulties in finding enough workers to provide LTSS to all people who need such services, and the COVID-19 pandemic considerably aggravated those problems.
As the population ages and advances in medicine and technology allow people with severe disabilities to live longer, the number of people who need LTSS is expected to increase. Medicaid is a joint federal and state program that helps cover the medical costs of certain low-income individuals, families and children, pregnant women, the elderly, and people with disabilities. Medicaid also helps cover the medical costs of other adults. Medicaid offers benefits not normally covered by Medicare, such as personal care and nursing home care services. The rules about who is eligible for Medicaid are different in each state.
If you apply for Medicaid and are eligible to receive it, you will receive more information about how to use your benefits and you will have the opportunity to choose a HealthChoices managed care organization (MCO) to help you coordinate your care. Your MCO works with providers and you can contact your MCO to find doctors in your community. Medicaid provides health coverage to millions of Americans, including low-income adults, children, pregnant women, older adults, and people with disabilities who meet the requirements. States administer Medicaid, in accordance with federal requirements.
The program is jointly funded by the states and the federal government. The changes in Medicaid policies have implications for the approximately 80 million people who rely on the program for health coverage, for state and federal budgets and expenditures, and for healthcare providers, including nursing facilities and home and community service providers. Medicaid coverage is limited for immigrants and, with the exception of emergency services, Medicaid coverage is not available to undocumented immigrants. Services provided in non-institutional settings are known as home and community-based services (HCBS), and these settings can include a person's home, adult day care, assisted living environments, and group homes. This change reflects the preferences of beneficiaries to receive care in non-institutional settings and the requirements for states to provide services in the least restrictive environment possible, stemming from the Olmstead decision.
Medicaid accounts for one-sixth of health care spending (and half of spending on long-term services and supports) and a large part of state budgets (figure). Medicaid accounts for one-sixth of health care spending (and half of spending on long-term services and supports) and a large part of state budgets. Medicare provides home and skilled nursing care under specific circumstances, but the Medicare benefit is considered “post-acute care” and is generally not available to people who need ongoing services. Long-term coverage of services and supports is mandatory in nursing facilities, but most HCBS coverage is optional.
Unlike commercial health insurance and Medicare, Medicaid also covers non-emergency medical transportation, which helps members keep appointments, and long-term care, including nursing home care and many home and community services (HCBS). Medicaid pays Medicare premiums and often provides comprehensive coverage for services not covered by Medicare (such as most long-term services and supports) to nearly 1 in 5 Medicare beneficiaries (13 million). Medicaid, also known as Medical Assistance (MA), pays for the health care services of people who qualify.
