Planning and Paying for Long-term Care (Part 4 in a Series: Medicaid/Medical Assistance)

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As of January 1, 2012, the average cost of skilled nursing care in Pennsylvania is $8,112.13 per month. Recall that according to national statistics, approximately 50% of nursing care throughout the country is paid by Medicaid – more than double any other source of payment (private funds, Medicare, long-term care insurance, etc.). Medicaid is a joint federal and state program under which States receive federal funding to establish programs to “dispense” medical care (including skilled nursing care) to needy and qualifying individuals.

Each State’s Medicaid program must comply with complex requirements imposed by federal statutes and regulations. As described by one federal court in Pennsylvania, these statutes and regulations are “one of the most completely impenetrable texts within human experience and dense reading of the most tortuous kind.” The court further added, “The court has nothing but sympathy for officials who must interpret or administer the Act.” This complex web of federal statutes and regulations is further exacerbated in that, as part of administering the Medicaid program, each State adopts its own statutes, regulations, and policies, all of which are subject to change from year to year and even month to month.

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