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Medicaid, the nation’s major publicly-financed health insurance program, plays an important role in the delivery and financing of long-term care (LTC) services. These services include a broad range of paid and unpaid medical and personal care assistance. Long-term care is not medical in nature. Instead, it provides help with regular daily activities to support independent living. People may need LTC over a period of weeks, months, or years.

How much do you know about Medicaid and LTC?

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1

Who needs long-term care?

People who need LTC include seniors and those with a variety of disabilities and chronic health conditions that limit daily functioning.

2

True or False: Long-term care provides help with everyday self-care activities (such as eating or getting out of bed) and household activities (such as preparing meals or managing medications).

Long-term care provides help with a wide range of self-care and household activities.

3

Who provides most long-term care?

Most LTC is provided by unpaid caregivers, who are often family members or friends. These caregivers may help with tasks such as bathing, dressing, transportation to medical or therapy appointments, and preparing meals.

4

Where is long-term care provided?

Long-term care is provided in both institutional and community settings.

5

What was the typical cost of a year of nursing facility care in 2015?

According to a 2015 national survey, the typical cost for a year of nursing facility care was $91,000 or more.

6

What pays for most long-term care?

Medicaid pays for most LTC.

7

True or False: Medicaid covers everyone who needs long-term care.

Not everyone who needs LTC qualifies for Medicaid. People who need LTC must meet financial and functional needs criteria to be eligible for Medicaid coverage.

8

True or False: Medicaid covers long-term care provided in both institutions and community settings.

Medicaid covers LTC provided in both institutions and community settings.

9

What information does the federal government use when rating nursing facilities?

The Centers for Medicare and Medicaid Services’ Nursing Home Compare website uses health inspection, staffing, and care quality information to rate nursing facility quality.

10

True or False: The number of people needing long-term care is expected to decrease in the coming decades.

The aging of the baby boom generation, along with advances in medical and assistive technology that allow people with disabilities to live longer and more independently, will likely result in an increased need for LTC over the coming decades.

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Medicaid and Long-Term Care Quiz

You Answered out of 10 Questions Correctly.

Question

Correct Response

1

Who needs long-term care?

People who need LTC include seniors and those with a variety of disabilities and chronic health conditions that limit daily functioning.

People who need LTC include seniors and those with a variety of disabilities and chronic health conditions that limit daily functioning. Many different types of disabilities can result in a need for LTC. These include physical disabilities, like cerebral palsy or spinal cord injury; intellectual or developmental disabilities, like Down’s syndrome or autism; or behavioral health disabilities, like dementia or mental illness. In addition to health status, people’s age, gender, income, and living arrangements also can influence their need for LTC. The population that needs LTC is becoming more racially and ethnically diverse, which has implications for how services are delivered.

Learn More:

Kaiser Commission on Medicaid and the Uninsured, Serving Low-Income Seniors Where They Live: Medicaid’s Role in Providing Community-Based Long-Term Services and Supports (Sept. 2015), http://kff.org/medicaid/issue-brief/serving-low-income-seniors-where-they-live-medicaids-role-in-providing-community-based-long-term-services-and-supports/.

Kaiser Commission on Medicaid and the Uninsured, Medicaid Beneficiaries Who Need Home and Community-Based Services: Supporting Independent Living and Community Integration (March 2014), http://kff.org/medicaid/report/medicaid-beneficiaries-who-need-home-and-community-based-services-supporting-independent-living-and-community-integration/.

Kaiser Commission on Medicaid and the Uninsured, Long-Term Care in the United States: A Timeline, http://kff.org/medicaid/timeline/long-term-care-in-the-united-states-a-timeline/.

Kaiser Commission on Medicaid and the Uninsured, Medicaid’s Role for People with Dementia (Oct. 2015), http://kff.org/medicaid/issue-brief/medicaids-role-for-people-with-dementia/.

2

True or False: Long-term care provides help with everyday self-care activities (such as eating or getting out of bed) and household activities (such as preparing meals or managing medications).

Long-term care provides help with a wide range of self-care and household activities.

Long-term care provides help with a wide range of self-care and household activities, such as eating, bathing, preparing meals, managing medication, and housekeeping. Examples of LTC services include nursing facility care, adult day health care programs, home health aide services, personal care services, transportation, and supported employment services.

Learn More:

Kaiser Commission on Medicaid and the Uninsured, Medicaid Beneficiaries Who Need Home and Community-Based Services: Supporting Independent Living and Community Integration (March 2014), http://kff.org/medicaid/report/medicaid-beneficiaries-who-need-home-and-community-based-services-supporting-independent-living-and-community-integration/.

3

Who provides most long-term care?

Most LTC is provided by unpaid caregivers, who are often family members or friends. These caregivers may help with tasks such as bathing, dressing, transportation to medical or therapy appointments, and preparing meals.

Most LTC is provided by unpaid caregivers, who are often family members or friends. As a person’s care needs become more extensive, paid LTC delivered by direct care workers, such as nurses, home health aides, or personal care attendants, may be required in addition to unpaid caregiver services.

Learn More:

Kaiser Commission on Medicaid and the Uninsured, Medicaid and Long-Term Services and Supports:  A Primer (Dec. 2015), http://kff.org/medicaid/report/medicaid-and-long-term-services-and-supports-a-primer/.

4

Where is long-term care provided?

Long-term care is provided in both institutional and community settings.

Long-term care is provided in institutions, such as nursing facilities, and community settings, such as group homes or apartments. Over the last several decades, there has been a shift toward serving more people in the community rather than institutions. Many people prefer to receive services in the community, and services provided in the community typically cost less than comparable institutional care.

Learn More:

Kaiser Commission on Medicaid and the Uninsured, Medicaid Home and Community-Based Services Programs: 2012 Data Update (Nov. 2015), http://kff.org/medicaid/report/medicaid-home-and-community-based-services-programs-2012-data-update/.

Kaiser Commission on Medicaid and the Uninsured, Olmstead’s Role in Community Integration for People with Disabilities Under Medicaid: 15 Years After the Supreme Court’s Olmstead Decision (June 2014), http://kff.org/medicaid/issue-brief/olmsteads-role-in-community-integration-for-people-with-disabilities-under-medicaid-15-years-after-the-supreme-courts-olmstead-decision/.

5

What was the typical cost of a year of nursing facility care in 2015?

According to a 2015 national survey, the typical cost for a year of nursing facility care was $91,000 or more.

Long-term care is expensive. Aside from unpaid care provided by family members or friends, LTC often costs more than what people can afford to pay out-of-pocket. Institutional settings such as nursing facilities are among the most expensive LTC services. According to a 2015 national survey, the typical cost of one year of nursing facility care was $91,000 or more.

Learn More:

Kaiser Commission on Medicaid and the Uninsured, Medicaid and Long-Term Services and Supports: A Primer (Dec. 2015), http://kff.org/medicaid/report/medicaid-and-long-term-services-and-supports-a-primer/.

6

What pays for most long-term care?

Medicaid pays for most LTC.

Medicaid pays for most LTC. Medicare only provides limited coverage for post-acute skilled care and does not cover LTC. Private health insurance typically does not cover LTC. Private LTC insurance may have coverage limitations, and the cost may be too high for many people to afford. According to the Centers for Medicare and Medicaid Services, total national spending on LTC was $313.6 billion in 2014, with Medicaid covering 52% of this amount, followed by other public coverage sources (20%), out-of-pocket spending (17%), and private insurance (10%).

Learn More:

Kaiser Commission on Medicaid and the Uninsured, Medicaid and Long-Term Services and Supports: A Primer (Dec. 2015), http://kff.org/medicaid/report/medicaid-and-long-term-services-and-supports-a-primer/.

7

True or False: Medicaid covers everyone who needs long-term care.

Not everyone who needs LTC qualifies for Medicaid. People who need LTC must meet financial and functional needs criteria to be eligible for Medicaid coverage.

Not everyone who needs LTC qualifies for Medicaid. People who need LTC must meet financial and functional needs criteria to be eligible for Medicaid coverage. Financial eligibility criteria vary by state, subject to federal minimum requirements. At state option, people whose income or assets are above the eligibility threshold may “spend down” to qualify for Medicaid coverage.

Learn More:

Kaiser Commission on Medicaid and the Uninsured, Medicaid and Long-Term Services and Supports: A Primer (Dec. 2015), http://kff.org/medicaid/report/medicaid-and-long-term-services-and-supports-a-primer/.

Kaiser Commission on Medicaid and the Uninsured, The Affordable Care Act’s Impact on Medicaid Eligibility, Enrollment, and Benefits for People with Disabilities (April 2014), http://kff.org/health-reform/issue-brief/the-affordable-care-acts-impact-on-medicaid-eligibility-enrollment-and-benefits-for-people-with-disabilities/.

Kaiser Commission on Medicaid and the Uninsured, Medicaid Financial Eligibility for Seniors and People with Disabilities in 2015 (March 2016), http://kff.org/medicaid/report/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-in-2015/.

8

True or False: Medicaid covers long-term care provided in both institutions and community settings.

Medicaid covers LTC provided in both institutions and community settings.

Under Medicaid, states are required to cover nursing facility services, while most home and community-based services are covered at state option. As a result, there has been a structural bias in the program toward institutional care, which policymakers have been working to address. In 2013, spending on home and community-based services accounted for 46% of total Medicaid LTC spending, up from 20% in 1995, with variation among states and across populations. For example, as of 2013, 80% of non-elderly people with disabilities receiving LTC live in the community, while only 50% of seniors receiving LTC live in the community.

Learn More:

Kaiser Commission on Medicaid and the Uninsured, Lessons Learned from Eight Years of Supporting Institutional to Community Transitions Through Medicaid’s Money Follows the Person Program (Oct. 2015), http://kff.org/medicaid/perspective/lessons-learned-from-eight-years-of-supporting-institutional-to-community-transitions-through-medicaids-money-follows-the-person-demonstration/.

Kaiser Commission on Medicaid and the Uninsured, Medicaid Balancing Incentive Program:  A Survey of Participating States (June 2015), http://kff.org/medicaid/report/medicaid-balancing-incentive-program-a-survey-of-participating-states/.

9

What information does the federal government use when rating nursing facilities?

The Centers for Medicare and Medicaid Services’ Nursing Home Compare website uses health inspection, staffing, and care quality information to rate nursing facility quality.

The Centers for Medicare and Medicaid Services’ Nursing Home Compare website allows people to find information about nursing facilities that receive Medicare or Medicaid payments. These nursing facilities must follow national and state quality and reporting rules. Nursing Home Compare uses health inspection, staffing, and care quality information to rate nursing facility quality.

Learn More:

Charlene Harrington, Helen Carrillo, and Rachel Garfield, Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2009 Through 2014 (Aug. 2015), http://kff.org/medicaid/report/nursing-facilities-staffing-residents-and-facility-deficiencies-2009-through-2014/.

Kaiser Family Foundation, Reading the Stars: Nursing Home Quality Star Ratings, Nationally and by State (May 2015), http://kff.org/report-section/reading-the-stars-nursing-home-quality-star-ratings-nationally-and-by-state-issue-brief/.

10

True or False: The number of people needing long-term care is expected to decrease in the coming decades.

The aging of the baby boom generation, along with advances in medical and assistive technology that allow people with disabilities to live longer and more independently, will likely result in an increased need for LTC over the coming decades.

Population trends suggest considerable growth in the number of people who will need LTC in the coming decades. Life expectancy remains relatively high, baby boomers continue to age into older adulthood, and advances in assistive and medical technology allow more people with chronic and disabling conditions to live longer and independently in the community. As the number of people who need LTC increases, policymakers will continue to be challenged to find approaches to deliver, coordinate, and finance quality LTC in a way that promotes health and well-being, respects beneficiary preferences, and effectively manages costs.

Learn More:

Kaiser Commission on Medicaid and the Uninsured, Medicaid’s Role in Meeting the Long-Term Care Needs of America’s Seniors (Jan. 2013), http://kff.org/medicaid/issue-brief/medicaids-role-in-meeting-the-long-term-care-needs-of-americas-seniors/.

Also see the Faces of Medicaid videos for Abdul, Penny, Bill, Mary Frances, Maxine, and Sam and Robin,

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.