Medicaid Alabama Launches Latest Long Term Care Plans

Three new long-term care options for elderly and disabled Medicaid recipients were announced Friday in Mobile at a news conference by Alabama Medicaid Commissioner Dr. Bob Mullins Jr.
Two of the options are statewide initiatives. The third, known as PACE, short for Program of All-Inclusive Care, will be limited, for now, to recipients in Mobile and Baldwin counties ages 55 and older who meet certain criteria.
All three options are aimed at offering more long-term care choices for those who may not have been able to afford high long term care insurance costs in the past.
Mullins spoke prior to the grand opening of Mercy LIFE on Springhill Avenue, an inclusive-care facility where those who qualify for Medicaid and Medicare, and meet other criteria, have begun participating in PACE.
Mercy LIFE is the first in the state to become designated for PACE.
Twenty-three patients have been accepted into the Mercy’s PACE program thus far, and there are plans to enroll as many as 200 in the next few years.
The PACE participants at Mercy typically live at home, but visit Mercy several times a week to see a doctor, eat daytime meals, stop by the chapel, have laundry done or play board games. Mercy also offers rehabilitative services.
“It’s one of the few programs that has been shown to increase quality of life without increasing costs,” said Dr. J. Eugene Lammers, new medical director at Mercy LIFE, which stands for Living Independently for Elders. “It works.”
The reason it works, said Lammers and Mullins, is because people tend to do better when they live at home or with family.
“The ultimate goal,” Lammers said, “is to keep them in the community where they want to be.”
The two other programs announced by Mullins Friday include would:
• Help some patients with physical disabilities who are living in nursing homes to transition back home and receive care there.
• Assist patients who depend on a ventilator to breathe get treatment closer to home.
PACE provides comprehensive services and support to Medicaid and Medicare enrollees by enlisting a team of health professionals who create care plans.
PACE funding is capped, but providers have flexibility to deliver services by need.
The state pays about $55,000 a year for a Medicaid patient to live in a nursing home. For PACE, the state will pay about $41,000, a significant savings, Mullins said.

Who is Entitled for Medicaid Coverage for Nursing Homes?

Nursing facilities is just one of the long term care services covered by Medicaid. This is beneficial to people with no long term care insurance, savings and other assets that can help them pay for their ltc needs. Below you can find the requirements on how to become eligible for this coverage.

Nursing facility services for are required to be provided by state Medicaid programs for individuals age 21 or older who need them. States may not limit access to the service, or make it subject to waiting lists, as they may for HCBS. Therefore in some cases NF services may be more immediately available than other long term care options. NF residents and their families should investigate other long-term care options in order to transition back to the community as quickly as possible.

Need for nursing facility services is defined by states, all of whom have established NF level of care criteria. State level of care requirements must provide access to individuals who meet the coverage criteria defined in Federal law and regulation. Individuals with serious mental illness or intellectual disability must also be evaluated by the state’s program to determine if NF admission is needed and appropriate.

Nursing Facility Services for individuals under age 21 is a separate Medicaid service, optional for states to provide. However all states provide the service, and in practice there is no distinction between the services.

In some states individuals applying for NF residence may be eligible for Medicaid under higher eligibility limits used for residents of an institution. See your state Medicaid agency for more information.

You can find out more when you visit Medicaid