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Introduction
to Medicaid Long Term Care The Long Term Care unit serves three populations:
Nursing Homes Eligible individuals receive assistance with paying cost of care and other medical expenses through the Medicaid program. Medicaid allows eligible individuals to keep $30 for personal needs, an amount to maintain private health insurance premiums, and operational expenses for certain types of income. A spouse living at home may be allowed to keep some of the institutionalized spouse’s income for living expenses. The remainder of the person’s income is owed to the nursing home. This amount is known as the patient monthly liability. Cost of Care in a Nursing Facility Listing of Facilities in Wilson County Long Term Care Ombudsman Program Online eligibility manuals and eligibility information can be accessed at www.info.dhhs.state.nc.us/olm/manuals/dma Community Alternatives Program Individuals in danger of
being placed in a nursing facility may be able to remain at home by
receiving CAP services through the Medicaid program.
Wilson
www.wgmhc.com (Wilson-Greene Mental Health)
www.wilmed.org
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Individuals who are no longer able to remain safely at home, but who are not medically ready for nursing home services may qualify for assistance with payment of room and board in a licensed adult care home. These homes do not provide medical care, but can administer medications and provide personal care services including assistance with bathing, eating and dressing. The facilities serve as a bridge between home care and nursing home care. Eligible individuals must have income and resources below state-mandated limits. Recipients are allowed to keep part of their income to use to meet their personal needs including toiletries, clothing, hair care and snacks. Unlike the Medicaid program, Special Assistance regulations do not allow income to be protected for the spouse who remains at home. In addition to a cash payment, recipients are automatically entitled to Medicaid benefits. For a list of home licensed by Wilson-Greene Mental Health, call (252) 206-5058. Homes licensed by Wilson County can be accessed below. What to look for in choosing a facility Once a family has decided
that placement is needed for their loved one, they are faced with locating
a facility or adult care home that will meet the needs of the individual
and the family. Guidelines for
choosing a facility and knowing what to look for are available at the
local department of social services. The
Centers for Medicare and Medicaid Services (previously known as Health
Care Financing Administration or HCFA) website www.medicare.gov
contains guidelines that may be helpful.
The Internet has numerous websites that will help guide the
family’s decision. What
to do if you want to file a complaint against a facility What
to do if you suspect that a person or a facility is committing welfare
fraud Medicaid is a billion-dollar industry and costs taxpayers more dollars per recipient than any other social services program. Suspected fraud can be reported anonymously. You can contact the fraud hotline at 252.399.1168. Program Integrity at the State Office How to locate a doctor or dentist who will accept Medicaid or locate a doctor who accepts Carolina Access How to apply for
assistance You must
apply in the county in which you live or in the county where you lived
immediately prior to moving into a nursing facility or an adult care home.
A signed application is required before assistance can be received.
To apply in person, visit the department at What
to bring with you when you apply Frequently asked questions What do I need to do if a relative needs to be placed in a nursing home or an adult care home? Contact the department of social services in the county where the relative needing placement resides. You may request a home visit if you cannot go into the office. You may wish to bring in social security numbers, Medicare and health insurance information, most recent bank statements for all accounts, life insurance policies and prepaid burial contracts, proof of other assets and verification for all types of income when you come. These items and others may be requested in order to determine eligibility. You do not have to bring these with you in order to apply. The caseworker will give you a list of needed information and will assist you if you have difficulty in obtaining verifications. You can locate the department of social services for any county in NC. If you need assistance locating a facility, you can make a placement application on the same date you apply for Medicaid or State/County Special Assistance. Do a husband and
wife have to be destitute before one can receive assistance? When one spouse must go to a nursing home, assets and income are protected for the spouse who remains at home. The amount changes annually. Additional information can be found at http://www.dhhs.state.nc.us/dma/. Look for Consumer and Eligibility Information. The State/County Special Assistance program for adult care homes does not allow income or assets to be protected for the spouse at home. Contact the department for specific details. If I go to a
nursing home, will Social Services take my home? Group I Recipients under age 55 who reside in a nursing facility (including ICF/MR) on a permanent or indefinite basis. Group II Recipients age 55 or older who: Reside in a nursing facility (including ICF/MR) for any period of time, or Who are authorized under the CAP program. Estate recovery is never initiated until the recipient’s death and recovery is waived under certain circumstances. Contact the department for more information at 252.206.4000. Additional information can be found at the Division of Medical Assistance website. www.dhhs.state.nc.us/dma Can I transfer
my assets to my children and be eligible for Medicaid? A person can transfer assets and receive Medicaid in a private living arrangement. However, Medicaid law prohibits the transfer of assets at less than market value by anyone seeking Medicaid payment for nursing home costs. Some transfers may not result in a period of ineligibility. Additional information can be found at www.dhhs.state.nc.us/dma in the Eligibility and Consumer Information sections. Helpful links Social Security Administration www.ssa.gov/ Centers for Medicare and Medicaid Services (formerly Health Care Financing Administration or HCFA) http://cms.hhs.gov/ Prescription drug assistance www.needymeds.com Consumer Action Website www.pueblo.gsa.gov
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