Cody - Medicaid is a joint funded federal & state program with each state managing it's program uniquely. So how NY does Medicaid will be different than TX but within an overall guideline from the Feds. Some programs are required to have "dedicated" funding - which means states must have theses programs in place year after year after year in order to get federal $$$. Medicaid for skilled nursing care in a NH is dedicated funding; CHIP is dedicated funding. So states have to have some basic system for dedicated programs.
However there is a whole bunch of medicaid programs that are paid by "waivers" which means a diversion of Medicaid $$$ is used to pay for them & these can change or be stopped. Most waiver progams are funded in 3 or 5 year planning cycles; so if your program is defunded it means it has run its course for funding & the program will know this in advance. Right now the trend for waivers is to fund larger on-site community partnered caregiving programs -like PACE - and get away from 1-on1 elders caregiving program. If there's a PACE in your area, then you will likely need to apply to participate in PACE first & foremost before medicaid will pay for another program for you. If PACE doesn't fit your needs, then you can get into another waiver paid program.
Medicaid paying for AL is done via a waiver.....that's why some states pay for AL while some states do not ever pay for AL or do it on a very limited & restrictive waiver.
Some states are just more socially conscious for their residents. MN provides a lot more programs for individuals/families & they do the highest personal needs allowance ($ 115) for elders in a facility on Medicaid as MN is a very socially conscious state. Other states have the daily compensation rate for NH medicaid beds very very low so have fewer facilities that will participate in Medicaid as its hard to be profitable. Like TX is a low daily compensation rate (was around$155 a day when my mom was alive & in a medicaid bed) for NH care and a lot of NH just do not participate at all in Medicaid as they can't run a bed on $155 day rate. If a NH has you there as a Medicaid bed resident and the NH goes off Medicaid, they will have to find you a medicaid bed in another facility - safeguards like this are required by the feds for states to get dedicated Medicaid funding.
In general IF your state rejected the expansion of Medicaid allowed under the Affordable Care Act (aka Obamacare) they are likely a state that provides the absolute minimum level of services required to get Medicaid funding from the Feds.
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However there is a whole bunch of medicaid programs that are paid by "waivers" which means a diversion of Medicaid $$$ is used to pay for them & these can change or be stopped. Most waiver progams are funded in 3 or 5 year planning cycles; so if your program is defunded it means it has run its course for funding & the program will know this in advance. Right now the trend for waivers is to fund larger on-site community partnered caregiving programs -like PACE - and get away from 1-on1 elders caregiving program. If there's a PACE in your area, then you will likely need to apply to participate in PACE first & foremost before medicaid will pay for another program for you. If PACE doesn't fit your needs, then you can get into another waiver paid program.
Medicaid paying for AL is done via a waiver.....that's why some states pay for AL while some states do not ever pay for AL or do it on a very limited & restrictive waiver.
Some states are just more socially conscious for their residents. MN provides a lot more programs for individuals/families & they do the highest personal needs allowance ($ 115) for elders in a facility on Medicaid as MN is a very socially conscious state. Other states have the daily compensation rate for NH medicaid beds very very low so have fewer facilities that will participate in Medicaid as its hard to be profitable. Like TX is a low daily compensation rate (was around$155 a day when my mom was alive & in a medicaid bed) for NH care and a lot of NH just do not participate at all in Medicaid as they can't run a bed on $155 day rate. If a NH has you there as a Medicaid bed resident and the NH goes off Medicaid, they will have to find you a medicaid bed in another facility - safeguards like this are required by the feds for states to get dedicated Medicaid funding.
In general IF your state rejected the expansion of Medicaid allowed under the Affordable Care Act (aka Obamacare) they are likely a state that provides the absolute minimum level of services required to get Medicaid funding from the Feds.
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