Medicaid 101-Medical Requirements to Qualify for Medicaid

Posted By: Ken Russell | September 9th, 2019

When a senior applies to Medicaid for long-term care, they must submit a health assessment, known as the Pre-Admission Screening and Resident Review (PASRR). The health assessment determines a person’s necessary level of care, and plays an important role when Medicaid evaluates an applicant’s eligibility. The key components of the health assessment include:

  • A cognitive assessment – to determine how well a person understands their needs.
  • A physical health evaluation – to determine how a person’s overall physical health impacts their ability to care for themselves.
  • An overview of drug use and medications – to determine if an individual can safely administer their own medication without supervision.

To qualify for any long-term care program through Medicaid in Pennsylvania, a person must require an institutional level of care as determined by their physician. Those who require an institutional level of care are considered Nursing Facility Clinically Eligible (NFCE) in Pennsylvania.

Physicians use an individual’s functional abilities to determine his/her necessary level of care. A person with a long-term physical or mental health condition that limits their functional capacity may require an institutional level of care. Additionally, he/she must require health-related services which only trained medical technicians and physicians can administer.

If a person cannot live safely without supervision and assistance from trained medical staff, they may qualify for Medicaid coverage of long-term care. If an individual wishes to receive his/her care in a home or community-based setting, it must be confirmed safe by their physician.

Many seniors willingly admit themselves to a long-term care facility without a PASRR. Medicaid Will Not Cover them. Medicaid requires all applicants to prove they require the services they are requesting, before they may receive those benefits.

If you or a loved one is in need of a nursing home, or are in a nursing home already, you need to be aware of the level of care required to qualify for Medicaid benefits. Baratta, Russell & Baratta can help you navigate through Medicaid planning process. Please feel free to contact us at 215-914-2222.

About the Author

Ken Russell is the principal attorney in Baratta, Russell & Baratta Trusts & Estates department. Ken has been providing estate planning and administration legal advice for over 20 years. Ken understands the importance of your legacy and ensuring your loved-ones receive the fruits of your lifetime of effort.

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