Unlike Medicare, Medicaid funds long term care for people meeting its strict financial cutoffs -although it typically covers nursing homes and other assisted living facilities. Medicaid, unlike Medicare, which is covered federally, is cover by the state. Because of that reason, Medicaid guidelines vary from state to state. Legislation is being reviewed that can actually give people more control over where their Medicaid funds are being spent for personal care- often refereed to as the "Cash and Counseling" model. More often than, not Medicaid funding goes directly to the providers and beneficiaries do not have much control in how the money is spent.

In several states including Florida, Arkansas and New Jersey, Cash and Counseling demonstration projects were conducted providing beneficiaries money directly to decide themselves how the money would be spent. In many cases the beneficiaries paid family members to provide care. This initiative is gaining popularity and several other states are starting to implement these Cash and Counseling programs.

Another initiative that seniors should watch is the "Money Follows the Person" program. The program provides funding for people moving from assisted living to a more community-based setting.

Assisted Living costs $55,000 a year and can be up to twice as much in major metropolitan areas. Because Medicaid is designed for low-income individuals that do not have money to spend on health insurance, middle income families are being caught in the middle with Medicare not able to fund long term care at all and not meeting the financial requirements to qualify for Medicaid. In fact, in an effort to make Medicaid a more equitable solution for middle-income families Congress has established rules to allow families to spend down in order to qualify for Medicaid. "Spending down" means depleting your assets qualifying you for Medicaid. In the past, a couple would spend down to the point where a spouse was left in poverty without enough income or assets to cover his or her needs. After the changes in 2007 to the Medicaid guidelines, community spouses are allowed $1,650 to $2,541 a month in income ad between $20,328 and $191,640 in assets, in addition to their car, house, and other person belongings, and still be eligible nursing home funding.

Medicaid, unlike Medicare, covers long term care services. Medicaid, unlike Medicare, which is funded federally, is covered by the state so guidelines vary from state to state. To meet the guidelines for Medicaid you must be under a certain income and asset cutoff. The problem facing many seniors is Medicaid typically covers nursing home and assisted living care costs but does not fund home health care. More often than not, these benefits go directly to the providers and the beneficiaries do not have much control over where the Medicaid funding goes. Legislation is being passed that gives family caregivers more control over where their Medicaid benefit go- oftern referred to as the "Cash and Counseling" method.

Several states including Arkansas, New Jersey, and Florida are implementing Cash and Counseling demonstrations that give beneficiaries direct control over where they choose to spend their Medicaid benefits. Many beneficiaries choose to pay family members and independent home health aides for care. The program has proven to be extremely successful and is expanding into many other states.

The cost for nursing homes in Orange County can easily run $55,000 per year with the cost more than doubling in major metropolitan and hard to reach cities. Middle income families are caught in a precarious position because Medicaid is designed for low income families that cannot afford health care insurance. They get no help from Medicare because Medicare doesn't fund long-term care.

To make Medicaid a more equitable alternative, In order to make Congress has passed legislation that allows families to spend down. By "spending down", Congress means the family can deplete their assets to qualify for Medicaid. In the past, for a couple to spend down enough to qualify for Medicaid, one of the spouses (often the wife) had to reach a point where she did not have enough income to spend on what she needed to live.

After the 2007 changes to the Medicaid guidelines, community spouses are allowed $1,650 to $2,541 a month in income and between $20,328 and $191,640 in assets, in addition to their car, house, and other person belongings, to be eligible for nursing home funding.