Scenario
A healthcare professional is caring for a patient who has only Medicare Part A and B. The patient has limited income, most of which goes toward paying for Medicare Part B, and she urgently requires placement in a nursing home because she can no longer live independently. Based on available information, the healthcare professional recognizes that Medicaid may cover long-term care for low-income elderly individuals and believes the patient meets the eligibility criteria.
Requirements and Steps for Applying for Medicaid
The federal government has classified Medicaid as an insurance program required to cater to low-income individuals faced with health challenges. To qualify as a beneficiary for the program, the person must be a low-income earner, sixty-five years or older, a child, disabled, or pregnant (Gemar, 2022). Communicating with the state office and obtaining the required documents enables an assessment of whether one qualifies to be a program beneficiary.
To ensure inclusion into the program, the following steps are followed:
- Help the patient obtain documents such as a birth certificate or driver’s license, which serve as proof of age.
- Providing the required documentation to prove one’s citizenship.
- Helped gather earnings records to establish income levels.
- Preparation of the necessary documents, which act as proof of one’s residence.
- For the disability case, the patient must be assisted in obtaining a certificate issued by a Medicaid-approved physician.
- Copies of any existing insurance already being used by the patient must be provided to determine the extent of coverage and whether the patient is eligible for inclusion in the Medicaid program.
The most necessary documents for a patient to be included in the Medicaid plan are a Social Security card, a birth certificate, a Medicare card, and a driver’s license, if available. Other required details include evidence of earnings from other sources, ownership of any property, life cover policies, and burial lot details (Morris et al., 2019). Moreover, the potential beneficiary needs to provide tax return information for at least five years in the past, as well as current account information and bank statements.
Interprofessional Collaboration
Other health professionals must be involved to ensure that the patient receives the necessary healthcare. They include essential caregivers, social workers, occupational or physical therapists, and case managers (Bumpus, 2022). In this case, the professionals will assist in obtaining all the necessary documents for registration in the new program. They help fasten the entire process by ensuring timely material provision. Therefore, their absence will result in a delay in the entire registration procedure.
Medicaid’s Role in Long-Term Care
As previously mentioned, Medicaid is entirely financed by the federal government to meet the current medical needs of low-income individuals in the state. The program plays a significant role in healthcare service provision, with its operations improving and evolving with time. Research has shown that the system helps one in every five low-income Americans aged sixty-five and above face health challenges (Gemar, 2022). To ensure long-term healthcare services to the disabled and elderly, the program provides care in existing intermediate facilities and nursing homes, mainly to mentally ill patients. Additionally, support and services are provided for individuals living in isolation within society.
The program also provides necessary medical equipment, home and individualized care, case management, rehabilitation therapy, respite care, and transportation to care providers. Although states can design their medical packages, they must provide home services and nursing facilities to elderly beneficiaries. All other long-term arrangements are optional, and the individual state must design its plan.
However, it is essential to recognize that long-term care for the disabled and elderly necessitates ongoing monitoring of the services provided in various settings. Due to varying long-term plans in different states, the general spending per individual beneficiary varies significantly, depending on the mix of services. Due to the increasing number of Americans over 65 years old, the long-term plan for older people is likely to remain an essential topic among policymakers.
References
Bumpus, S. (2022). When TikTok is not enough: Engaging nurses at all levels in the advocacy process. Nurse Leader. Web.
Gemar, L. (2022). How Relational Contracting Can Solve Medicaid Long-Term Care’s Accountability Crisis. University of Pennsylvania Law Review, Forthcoming. Web.
Morris, H., Hagen, L., Hyshka, E., & Francescutti, L. H. (2019). Empowering students and influencing policy change through experiential public health advocacy education. Journal of Nursing Education, 58(12), 698–703. Web.