About Long Term Care Medical Assistance

Cúram Long Term Care Medical Assistance consists of three Medical Assistance coverage types that provide coverage for individuals who require an institutional level of care over an extended period of time. Long Term Care refers to the medical, social, personal care, and supportive services needed by people who have lost some capacity for self-care because of old age or a chronic illness or a condition. This definition generally excludes medical care for acute conditions; however, post acute care, such as skilled nursing care and home health care, is often classified as long-term care.

To qualify for LTC:

Long Term Care may be received in a medical institution or, for those for whom it is possible to receive the same level of medical care at home, on a home and community based services waiver program (HCBS). There are many different Long Term Care waiver programs covered in different states, the most common being Elderly, Physical Disabilities, Mental Retardation/Developmental Disabilities (MR/DD) and Brain Injury. The term 'institutionalized individual' refers to those on HCBS waiver programs as well as those physically in medical or nursing home institutions.

To qualify for LTC:

• The individual must be institutionalized AND
• The individual members must satisfy the non financial AND
• The household must satisfy level of care AND
• The household must satisfy the 30 consecutive day requirements AND
• The individual must be categorically eligible AND
• The individual must not have an expensive home AND
• The individual must not be subject to an invalid resource transfer sanction AND
• The individual must satisfy the Resource Test AND
• The individual must satisfy the applicable Income Test