Medicaid

Medicaid According to the Federal Medicaid agency, the Centers for Medicare and Medicaid Services, 44.30% of non-Alzheimer's and non-dementia patients enter a nursing facility while 52.90% of Alzheimer's and dementia patients enter a nursing facility. Non-Alzheimer's and non-dementia patients stay an average of 3.25 years in a nursing facility. Alzheimer's and dementia patients stay an average of 10.90 years in a nursing facility. Only 4.90% of those entering a nursing facility have any type of long-term care insurance. Most people are unable to obtain long-term care insurance because it is either very expensive or they cannot medically qualify.

According to recent studies by the insurance industry, nursing facility rates at most nursing facilities in Oklahoma average approximately $4,000 to $4,500 per month for semi-private room care. Un-reimbursed prescription medications for nursing home residents average approximately $200 to $1,000 per month. As a result, long-term care costs (i.e. nursing home expenses, in-home health care expenses, prescription medications and medical expenses) can easily cost from $50,000 to $70,000 per year. These costs can even be higher if care is being provided in the home.

When faced with these exorbitant and escalating long-term care costs, individuals have three options in paying for care. First, they can self pay. Although this is the simplest approach, it can also be the most costly leading to financial insecurity and uncertainty. Second, they can purchase long-term care insurance. Although this is highly recommended, they must usually do this between the ages of 50 and 65. Even then, they still may not medically qualify for the insurance; of if they do medically qualify for the insurance, the premiums may be so high as to prevent them from being able to afford it. Third, they can do Medicaid planning to qualify for Medicaid benefits. Medicare is not an option as it only pays for up to 100 days of skilled nursing care. In some cases, Medicare will not pay for any of the nursing facility stay even if the individual has all 100 days remaining to be used if the medical personnel determine the individual is receiving nursing facility care and not skilled nursing care.

The second option (long-term care insurance) and the third option (Medicaid planning) are not mutually exclusive. Often, these two options compliment each other in planning for the client. SRB encourages clients to address their long-term care issues as early as possible by trying to purchase long-term care insurance or by doing some Medicaid pre-planning. Unfortunately, many clients do not consider any type of planning until they can no longer medically qualify for or afford long-term care insurance. If the client is needing immediate care, SRB will perform crisis or emergency planning to qualify the client immediately for benefits. If the client does not need immediate care, SRB will perform pre-planning to ensure the client is protected if and when the client needs care. Although SRB can perform both types of planning, pre-planning is preferred over emergency planning. Pre-planning is less costly than emergency planning, and it is performed at a time when the client and the client's family are not facing as many issues as they are when emergency planning is done. Although not required, clients should always try to do their planning as early as possible.