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The Merck Manual of Health & Aging Logo

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Table of Contents

Index

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CHAPTER 66   Paying for Health Care
TOPICS   Introduction ~ Medicare ~ Medicaid ~ Private Insurance ~ Understanding Managed Care
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Medicaid

Medicaid helps pay for health care for people of all ages who have a very low income and few assets. For older people, Medicaid often pays for nursing home care.

If people have a very low income but have assets such as a home or stock investments, they may not qualify for Medicaid. To qualify, they may have to "spend down." That is, they may have to sell their stocks and other assets and use the money to pay for health care until their income plus assets is low enough to qualify. In some states, people may be able to keep their home so that certain family members can remain there. However, when the family members leave, the government can sell the home to recover the money it has spent on care. Eligibility requirements for Medicaid vary from state to state. If people qualify for Medicaid and Medicare, most health care costs are covered.

Medicaid, which is funded by the federal and state governments, is the main public payer for long-term care, such as skilled nursing care (including that in a nursing home). Medicaid is required to offer long-term care to eligible people who are 21 years or older and who participate in the Medicaid program. Medicaid also helps pay for hospital care, laboratory tests (such as blood and urine tests), diagnostic tests (such as x-rays), visits to the doctor, and home health care. Because each state manages its own Medicaid program, the services covered vary from state to state. In some states, Medicaid helps pay for other items, such as prescription drugs, dental care, eyeglasses, and intermediate-level nursing care. Intermediate-level nursing care involves less care than skilled nursing care but more care than personal care. Its purpose is to maintain a person's condition and, if possible, to improve it.

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