Last column, I addressed how Medicaid may be a critically important resource to help with the challenges of long-term care needs. Our office is very fortunate to be joined by attorney Boyd Peterson, someone I consider to be one of the foremost authorities in the State of Idaho to address long term care Medicaid issues.
Over the next few columns, I will discuss the requirements to qualify for this type of Medicaid assistance. Chances are those requirements are very different than what you have heard. Today’s column addresses how an applicant’s health needs are assessed.
When an applicant seeks Medicaid assistance for long term care, a qualified nurse will conduct an assessment to determine the appropriate level of care needed; although that assessment may not be necessary if the individual is already receiving nursing home level of care. This assessment is done using what is called a Uniform Assessment Instrument (UAI). The nurse will conduct a face to face interview, but may also consult medical records, the primary care physician and/or family members as needed.
The first thing the nurse will review is the applicant’s ability to perform activities of daily living (ADLs). ADLs include actions such as bathing, dressing, toileting, and mobility. The nurse will also assess conditions for which the applicant is being treated or may need a health referral.
Finally, the nurse will assess the applicant’s psychological, social, and cognitive condition for specific abilities and limitations that will assist in identifying appropriate resources. From the UAI, a personalized support plan is created to assist the applicant.
Most applicants prefer to receive assistance in their own home, an approach that is encouraged by Health and Welfare. However, if warranted by the applicant’s health condition, the applicant can choose a different level of appropriate care. If care in a skilled nursing facility is needed, a doctor will make this determination.
The UAI allows for a uniform, fair approach to determine the health needs of an applicant, and to ensure the appropriate level of care is provided. However, even if the applicant’s medical necessity is established, there are certain financial requirements that must be met. I will begin addressing those requirements next column.