There is often confusion for seniors and their family members about which public insurance program pays for what services.

Medicaid, known in Maine as MaineCare, is a public health and supportive services program for low-income individuals funded by a combination of federal and state dollars. It is distinct from Medicare, which is an entirely federally-funded health insurance program for persons over the age of 65. Medicare pays for things like doctor and hospital visits, hospice care, physical and other therapies, time-limited facility-based rehabilitative or skilled nursing care, and certain types of medical equipment.

For low-income seniors, Medicaid pays for some of the health-care services not covered by Medicare, but most importantly, it pays for long-term services and supports for seniors and adults with disabilities, including assistance at home with bathing and dressing and other household and personal care activities; adult day programs; respite care; home modification services, as well as facility-based care in residential care facilities or in nursing homes (in Maine, we refer to these as nursing facilities).

Nationally, over 45 million people, or 15 percent of the population, are over the age of 65. In Maine, 19.4 percent of the population is over 65, or 258,000 Mainers. By 2025, it is expected that 25 percent of all Mainers will be over the age of 65.

Of those individuals turning 65 over the next four years, nearly 50 percent will need some form of paid assistance with care as they age, for some period of time ranging from under a year to more than five years.

The Kaiser Family Foundation has recently published national Medicaid data indicating that a full 74 percent of individuals over age 85 will need some form of long-term care services during the remainder of their lifetime. The older we get, the more likely we will need long-term care services.

Many of us will have to rely on family members for this care. But many more do not have family available and will have to pay for it out of pocket or rely on Medicaid funding. The Medicaid program was created to care for older people when they became unable to care for themselves at home and could not afford to pay for in-home or facility care. Once older people have exhausted their own personal assets, they must rely on Medicaid for long-term services. With the high cost of many of these services, only the wealthiest Mainers will be able to afford them on their own for as long as they might need them.

According to a recent report funded by the AARP Foundation, Commonwealth Fund, and SCAN Foundation, surveying long-term services and supports in each state, just 30 hours of home-care services per week for one year would cost more than the median household income of individuals in Maine over 65, and the cost of a nursing facility room for a year is as much as 312 percent of the median household income.

Recent estimates indicate that 53 percent of all long-term care (in-home care or facility-based care) is paid for with Medicaid funding and only 11 percent is covered by private insurance. According to Kaiser, the average annual cost of nursing facility care in the U.S. is $82,000 and the average annual cost of home care services is $46,000. With nearly one-third of seniors earning at or below 200 percent of the federal poverty level, or $24,000 for 2017, the cost of long-term care is well out of reach.

While many older Mainers may believe, in times of good health, that they can avoid the use and associated cost of long-term services, research indicates that along with advancing age comes the likelihood that we will experience periods of disability requiring some hands-on care. Further, hospitalization resulting from injuries sustained by a fall or resulting from chronic conditions such as diabetes, hypertension, and respiratory or cardiac issues are a likely predictor of future nursing facility admission. An estimated 66 percent of older Mainers have two or more chronic conditions. Mainers living in rural areas are particularly at risk.

Many Mainers with cognitive impairments from Alzheimer’s disease or other dementias currently receive assistance and supervision at home from family caregivers. Their ability to remain safely at home depends on the availability and the wellbeing of these family members, many of whom are themselves challenged with health conditions.

Generally, Medicaid does not pay for supervision services in the home and this imposes a burden on many family caregivers whose loved one needs 24-hour care and supervision. When family members cannot manage this level of care at home, nursing facility placement often becomes necessary. While it may be possible to piece together the necessary care through a combination of family, community, and Medicaid-funded services, the health and social services system is challenging to navigate without help, particularly for those families facing urgent needs.

The expense of long-term care services and the likelihood of our needing those services at some point in the aging process suggests that we should plan ahead as much as possible and be reminded that Medicaid is a critical safety net for most of us as we age.

Mary Lou Ciolfi, JD, MS, is a senior policy associate at the University of Southern Maine, Muskie School of Public Service in the Disability and Aging Program. She is an attorney and the former administrator of HillHouse Assisted Living in Bath.

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