Legal expert at Fairfax Area Agency on Aging webinar: Medicare covers acute care; Medicaid is the main payer for long-term care

Lisa Pratt, a staff attorney at Legal Services of Northern Virginia, told a Fairfax Area Agency on Aging webinar that Medicare generally does not cover long‑term custodial care and that Medicaid is the primary payer for nursing‑home and other long‑term services.

“Medicare is designed to cover acute care … it doesn’t pay for long‑term custodial care,” Pratt said, adding that Medicare covers some skilled nursing services only for a limited period after a qualified hospital stay. She said Medicaid — and in Virginia the Commonwealth Coordinated Care Plus (CC Plus) waiver — are the programs caregivers should look to for long‑term supports and services.

Why this matters: caregivers and families commonly assume Medicare will pay for nursing‑home stays or long‑term home care. Pratt said misunderstanding program rules can lead to costly mistakes and recommended early planning to protect both care and finances.

Pratt described main options for long‑term care in Virginia. Medicaid covers institutional care (nursing homes) and, through the CC Plus waiver, can also pay for home‑based services for people who meet nursing‑home level‑of‑care criteria. “Medicaid is the primary…