Why This Matters for Black Families Specifically
Black seniors are disproportionately likely to rely on Medicaid for long-term care coverage due to the racial wealth gap. Understanding how Medicaid and Medicare work — and critically, how they differ — is not just financial literacy for Black families. It is the difference between having options and having none when a senior family member needs care. This guide explains both programs clearly and addresses the specific planning challenges Black families face.
Medicare: What It Covers
Medicare is federal health insurance for Americans aged 65 and older, regardless of income. It has four parts. Part A covers hospital care and short-term skilled nursing facility stays — but only for a limited time and only after a qualifying hospital stay of at least three days. Part B covers outpatient services, doctor visits, and preventive care. Part C (Medicare Advantage) combines Parts A and B through private insurers. Part D covers prescription drugs.
The critical thing families need to understand: Medicare does NOT cover long-term custodial care — meaning the ongoing assistance with daily living that most seniors eventually need. Medicare may cover a short nursing home stay after a hospitalization, but once skilled care is no longer required, Medicare coverage ends. For ongoing assisted living or nursing home care, families must turn to Medicaid, long-term care insurance, or private payment.
Medicaid: What It Covers
Medicaid is a joint federal-state program for people with limited income and assets. Unlike Medicare, Medicaid does cover long-term custodial care in nursing homes and, in many states, assisted living facilities and home care. Medicaid is the primary payer for over 60% of nursing home residents in America — and Black seniors are significantly more likely to rely on Medicaid than white seniors due to lower median wealth.
Medicaid eligibility requirements vary by state, but generally require both low income and limited assets. The specific asset limits and income thresholds depend on your state, the type of care needed, and the applicant's household situation.
The Medicaid Planning Challenge
Medicaid requires that applicants "spend down" their assets to qualify — meaning they must exhaust most of their savings before Medicaid will begin paying for care. This creates a painful dilemma for families who have worked to build intergenerational wealth: spending it on nursing home care that could exhaust everything before Medicaid kicks in. This is why Medicaid planning — ideally done years before care is needed — is so important.
Medicaid also has a "look-back" period of five years, during which any transfers of assets may be scrutinized and could result in a period of Medicaid ineligibility. Black families who have transferred property or money to children or grandchildren need to understand these rules before applying for Medicaid.
Finding Medicaid-Accepting Facilities
Not all senior care facilities accept Medicaid. Nursing homes must be certified to accept Medicaid, but many facilities have limited Medicaid beds and maintain waiting lists. Assisted living facilities vary widely in Medicaid acceptance — some states have Medicaid waiver programs that pay for assisted living, while others do not. When searching for facilities on BlackSeniorCare.com, check directly with each facility about their Medicaid acceptance policies.
The Role of a Medicaid Planning Attorney
For families with any meaningful assets — including a home — consulting a Medicaid planning attorney before a senior enters long-term care is one of the highest-value financial decisions available. A qualified elder law attorney can help structure assets to protect as much family wealth as possible while ensuring Medicaid eligibility when needed. The cost of this planning is a fraction of what an uninformed approach can cost a family.