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Navigating Title XIX: Understanding Medicaid Benefits for Seniors

Navigating Title XIX: Understanding Medicaid Benefits for Seniors

Although you might not have considered federal programs at a younger age, these benefits may suddenly seem crucial. Seniors encounter many unique health issues, and some of these challenges can appear without warning. Planning for senior healthcare needs with preventative strategies is also a smart move – even if you are not currently dealing with any major medical issues. As a general rule, it is always best to seek healthcare benefits before you actually need them. If you plan for federal benefits after encountering a major diagnosis, it may already be too late. One of the most obvious options for seniors in the United States is Medicaid. What exactly is Title XIX? How can Medicaid help you, and what is the best way to navigate this complex program?

What is Title XIX?

Title XIX falls under the Social Security Act. Although many assume that Medicaid is somewhat new, it has been around for more than half a century. Originally signed into law by President Lyndon Johnson, Title XIX implemented a joint program between the federal government and individual states. The purpose of this program is to provide free healthcare to those who need it most. In general, Medicaid is supposed to be reserved for the following individuals:

  • Low-income people
  • Blind people
  • Disabled people

Although this is a federal program, individual states can control how it is implemented to some degree. As a result, seniors should consider the requirements and features of Medicaid based on their specific state. According to the Centers for Disease Control and Prevention (CDC), these state-by-state differences can vary “considerably.”

Initially, Medicaid only provided basic levels of insurance to those who could not afford health coverage. Over the years, however, Title XIX has expanded considerably – with more Americans becoming eligible through the decades. Some of these changes have been controversial. For example, the Affordable Care Act expanded eligibility to a considerable degree – covering numerous seniors even if they were above the federal poverty level. Not all states have expanded Medicaid.

What Does Medicaid Cover?

In theory, Medicaid should provide everything you need for your healthcare needs. However, there are some notable gaps in coverage to consider. These include private nursing, bandages, adult diapers, and other disposable items. Again, Medicaid may vary from state to state. However, Medicaid always provides more coverage compared to Medicare, especially when it comes to nursing home expenses.

Eligible Medicaid expenses fall into four categories:

  • Part A: Covers all costs related to hospital visits. This includes not only emergency room care, but also emergency transport.
  • Part B: Covers a range of testing services, such as laboratory services and X-rays. Part B also covers certain medical equipment and outpatient treatment.
  • Part C: Represents the Medicare Advantage Plan, which is provided by private companies.
  • Part D: Solely covers prescription drugs.

If you are already enrolled in Medicare, you could receive additional financial assistance from Medicaid.

Am I Eligible for Medicaid?

You need to consider a few factors when determining Medicaid eligibility. First, you need to consider your Modified Adjusted Gross Income or “MAGI.” This is essentially your taxable income. If your eligibility is based on blindness, disability, or age, you may not need to worry about MAGI. Remember, eligibility also depends on your specific state. Some states use more strict eligibility requirements, while others are more generous.

Aside from your income, you should also consider a few other factors. First, you must be a resident of the state in which you’re applying. In other words, you must reside in the state for a certain period of time before applying. Secondly, Medicaid is mostly reserved for US citizens. However, some non-citizens qualify – such as lawful permanent residents.

Medicaid Across the Nation’s Four Most Important States

Florida, Texas, California, and New York have the highest populations in the country. These states all handle Medicaid in slightly different ways, particularly when it comes to “expanded eligibility.” Ten states, including Florida and Texas, have not expanded eligibility under the Affordable Care Act. The differences between individual states highlight the need for personalized Medicaid planning. An online article can only provide broad information and not specific eligibility information based on your state of residence.

Strategies for Getting Approved for Medicaid

Because Medicaid is reserved for the financially needy, some applicants choose to strategically restructure their assets and wealth before applying. In many cases, this causes individuals to qualify for Medicaid despite their high wealth.

One option is a Qualified Income Trust, also known as a “QIT.” This option moves your wealth out of your direct control, establishing a separate legal entity. With no direct ties to your own wealth, you may subsequently qualify for Medicaid.

Another option is a Pooled Income Trust, which holds surplus income to ensure Medicaid qualification. However, only disabled individuals may establish this type of trust.

Asset Protection Trusts are also helpful, as they prevent creditors from seizing your assets. These trusts are also known as “Medicaid Trusts.”

Another popular strategy is a spousal transfer, and it involves one spouse moving assets to the other. With no assets on paper, the spouse who transferred the funds suddenly becomes eligible for Medicaid. Spouses may even legally refuse to support their partners in some states, and this can also lead to eligibility.

Medicaid strategies are highly situational, and an elder law attorney can help you choose the most appropriate option based on your unique circumstances.

Find an Experienced Elder Law Attorney Today

If you have been searching for a legal professional who can help with Medicaid, look no further than The Elderly Care Law Firm. As the name suggests, this law firm is all about assisting American seniors with elder law needs. Medicaid is just one example of a federal program that could be beneficial, and there are many others worth discussing. The best way to begin this discussion is by booking a consultation with us today. While internet research is a positive first step, it cannot provide you with personalized advice. Reach out now to speak with a real elder law attorney.

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Sherrie Lim

Client Services Coordinator

Sherrie Ann Lim brings over twelve years of customer service experience and a strong background in team leadership and client support. Although she holds a Bachelor of Science degree in Physical Therapy, her career path led her to the dynamic world of the contact center industry, where she discovered a deep passion for service, communication, and operational excellence. 

Sherrie is known for her perseverance, enthusiasm, and confident sense of responsibility. She consistently delivers high-quality results, efficiently managing tasks while remaining flexible to the evolving needs of her clients. Her commitment to continuous improvement and excellence positions her as a trusted ally for businesses seeking proactive and reliable virtual support. 

Drawing from her college background, Sherrie has a deeper understanding of the physical and emotional needs associated with aging, making her especially attuned to the importance of compassionate and informed care for the elderly. She recognizes that elder care isn’t just about physical support, it also involves emotional presence, patience, and clear communication. Her strong appreciation for family ties fuels her commitment to helping clients manage the intricacies of elder care with empathy and attentiveness, ensuring that elderly loved ones feel respected, safe, and truly cared for. 

 

She loves taking care of her family during her rest days and free time, finding joy in the simple yet meaningful routines of home life. Whether it’s preparing home-cooked meals, baking sweet treats for her kids, or tackling household projects, Sherrie finds fulfillment in creating a nurturing and organized environment for her family. Whenever time and opportunity allow, she also enjoys traveling with her family, exploring new places, creating lasting memories, and embracing experiences that strengthen their bond and bring joy into their lives. 

Fun Fact: Sherrie’s two kids were born on the exact same date—two years apart! 

May Cruz

Client Services Coordinator

May began her community service career with the Philippine Department of Health as a Computer Operator, providing vital technical support to healthcare workers across island provinces and helping to bridge technology gaps in remote medical settings. Her commitment to service extended beyond her official duties—she also volunteered in medical missions, assisting indigenous communities and contributing to the delivery of essential healthcare with empathy and cultural sensitivity. 

Continuing her dedication to public service, May later worked at a law firm as a Disability Service Coordinator, assisting military veterans in navigating disability services. She brought empathy, compassion, and heart to the role, ensuring that each veteran felt heard, respected, and supported throughout the process. 

With a unique blend of technical expertise and human-centered care, May remains deeply committed to using her skills to uplift underserved and vulnerable communities. 

Fun Fact: Despite not knowing how to swim, May is a certified open water diver. Her adventurous spirit and determination push her beyond her comfort zone—both in life and under the sea.