Medical and long-term care costs can be high, and many seniors find their retirement savings and income aren’t enough to cover bills if their health needs change. Fortunately, Medicaid can bridge the gap between your Medicare coverage and remaining out-of-pocket medical expenses. Understanding what Medicaid is and what it covers can help you make informed decisions regarding your options for paying for medical and residential care.

What Is Medicaid?

Medicaid is a health insurance program that provides medical coverage to over 90 million Americans. This program is jointly funded by the state and federal governments, so exact coverage and eligibility requirements vary depending on where you live. In general, Medicaid covers medical expenses that your Medicare coverage doesn’t, which may include co-pays and coinsurance, deductibles and prescription drug costs. It’s an entitlement program, meaning there are no wait lists and everyone who meets eligibility guidelines is guaranteed coverage.

In Missouri, the Medicaid program is called MO HealthNet. About 1.3 million people, including one in seven seniors, rely on this program for their health insurance coverage. It’s open to all permanent state residents, regardless of how long they’ve lived in Missouri, who meet income-related guidelines.

What Does Medicaid Cover?

Federal guidelines set minimum requirements for what Medicaid has to cover, but because this program is partially funded at the state level, states may expand coverage. In Missouri, Medicaid pays for medical services such as:

• Inpatient and outpatient care
  
  
• Physician services
• Home care and home health care
• Durable medical equipment
• Nursing home care
• Lab and X-ray services
• Nonemergency medical transportation

To have services covered, you typically need to seek care from health care providers who accept Medicaid. You can find providers through the Missouri Department of Social Services.

What Are Medicaid Waivers?

Medicaid waivers are programs that help seniors avoid nursing home placement by getting the services they need in the community. They waive Medicaid’s rules by expanding coverage to expenses the regular program leaves out, such as attendant care, help with daily living activities and nutrition services. While these services would typically only be available to those living in institutional settings, some states have Medicaid waivers to help seniors avoid intensive care and remain in their residential care community.

Medicaid Waivers in Missouri

In Missouri, there are several Medicaid waivers that can help you delay or avoid nursing home placement and get coverage for the services you need in assisted living or memory care communities. Like the regular Medicaid program, these waivers have eligibility requirements. However, the income limits are higher, so even if you don’t qualify for the regular Medicaid program for medical expenses, you may be able to get coverage for long-term care. Unlike regular Medicaid, these programs have limited funding and a fixed number of enrollment slots.

Supplemental Nursing Care Assistance

The Supplemental Nursing Care Assistance program provides a cash benefit for those who live in assisted living communities within Missouri. While this benefit doesn’t cover the full amount of your care, you can combine it with your assets or retirement income to offset expenses. According to the most recent information available through the Missouri Department of Social Services, the amount of this benefit ranges from $156 to $390 per month, depending on the setting you live in.

Structured Family Caregiving Waiver

The Structured Family Caregiving Waiver is available to those diagnosed with Alzheimer’s or other forms of dementia who qualify for nursing home level care. Through this waiver, your loved one may be able to continue living in a residential memory care setting, avoiding a stressful transition to a more clinical environment.

Paying for Assisted Living and Memory Care With Medicaid Waivers

If you’re considering care at The Gardens at Barry Road or you’re a current resident and want to determine whether you can pay for assisted living or memory care services with a Medicaid waiver, contact a Customer Service specialist. They can help you determine whether Medicaid may be a solution for your long-term care expenses.  

Who Qualifies for Medicaid?

Missouri has adopted an expanded Medicaid program, meaning it’s available to all adults who meet income, citizenship and residency guidelines. For seniors, the income limit for the regular Medicaid program is $963 per month for a one-person household and $1,297 per month for a two-person household. You can have up to $5,301.85 in countable assets, which includes assets such as vacation homes and money you have in bank accounts.

The Medicaid waiver programs have more generous income guidelines. To qualify for programs such as the Supplemental Nursing Care Assistance program or the Structured Family Caregiving Waiver, you can have a monthly income of up to $1,598. This is doubled for two-person households.

If your income and assets exceed these limits, you may still be able to qualify for coverage by spending down your assets, by depositing money in a Qualified Income Trust or through the state’s Spend Down Program. Before making any financial decisions to qualify for Medicaid, it’s important to talk to a professional to protect your financial future and make informed decisions.

How to Apply for Medicaid

You can apply for Medicaid by calling MO HealthNet at (855) 373-9994 or visiting myDSS. You can also talk to the office at The Gardens at Barry Road to get connected with someone who can help you navigate the system.

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