Email FacebookTwitterMenu burgerClose thin

What Is the Functional Assessment for Long-Term Care Benefits?


Many seniors seek long-term care benefits from Medicaid because they don’t have a long-term care policy or the money to pay for care themselves. In order to qualify for benefits, Medicaid requires a functional assessment of a senior’s health and abilities to determine if you need care. So, what is the functional assessment for long-term care benefits? Here’s what you need to know about this test, what it includes and how to pay for it.

A financial advisor could help you put a financial plan together for your long-term care needs and goals. 

How to Gain Access to Long-Term Care Benefits

Patients with mental or physical impairments may qualify for long-term care benefits. Additionally, the impairment must require certain levels of assistance. Generally, elderly, chronically ill, physically disabled, or intellectually disabled patients receive long-term care benefits. Long-term care benefits are usually paid for out of personal savings, a long-term care insurance policy, or through government benefits.

Long-term care benefits provide assistance in one or more of the basic functions of everyday life and related activities:

  • Bathing. Cleaning yourself and performing personal grooming activities like shaving, brushing teeth, and combing hair.
  • Dressing. Get your clothes on without struggling with buttons, zippers, and buckles.
  • Eating. The ability to feed yourself.
  • Transferring. Are you able to move without assistance?
  • Toileting. Using the bathroom and cleaning up after yourself.
  • Continence. Holding bodily fluids long enough to reach the restroom.

What Is the Purpose of a Functional Assessment?

To qualify for long-term care benefits, the benefits provider typically requires a functional assessment to determine your current physical and mental state. These tests not only determine if you need care. They also serve as a benchmark to monitor your progress or decline over time. Additionally, if you need care, they also help the provider understand what types and how much assistance you need.

What Does a Functional Assessment Include?

SmartAsset: What Is the Functional Assessment for Long-Term Care Benefits?

The functional assessment tests the level of care necessary for patients who require long-term care. Most functional assessment tests are face-to-face interviews in the patient’s home. This allows the provider to determine if home modifications are necessary if the patient is able to stay in their home versus living in a care facility.

States use a variety of tools in their functional assessments. And many of these tests are state-specific instead of nationwide standardized tests. However, all of these tests are used to determine your current physical and cognitive ability to handle the basic functions of everyday life.

How to Pay for Long-Term Care

Does it make sense to buy long-term care insurance, use savings, or rely on government benefits? Some investors expect that government benefits will take care of them when they require long-term care support. While you may qualify for Medicaid benefits eventually, typically you must spend down your assets before you’re approved for benefits. Additionally, you have little control over the facility that you’re assigned to when government benefits pay for your care.

According to Genworth, the national median assisted living facility costs $4,500 per month. A private room at a nursing home facility costs twice as much at $9,034 monthly. While some investors are able to cover these costs from their savings, many would rather leave a legacy to their heirs instead.

Long-term care insurance covers some or all of the costs of long-term care when you need it the most. Buying a long-term care policy covers the risk of these costs to protect your finances and ensure that you maintain your quality of life. While long-term care insurance is not cheap, the cost is generally much less than paying for care. Learn more about the cost of long-term care insurance.

Bottom Line

SmartAsset: What Is the Functional Assessment for Long-Term Care Benefits?

When it is time for long-term care assistance, providers require a functional assessment for long-term care benefits. These tests determine your eligibility for care, what functions you need help with and how much support you need. Providers use the results to develop a plan to maintain your quality of life that’s personalized to your situation. Additionally, results determine which long-term care facility is appropriate for your conditions. While some investors rely on the government or personal savings to pay these costs, many choose to buy a long-term care policy so they have more control over their care.

Tips for Long-Term Care

  • A financial advisor could help you incorporate long-term care coverage into your financial plans. SmartAsset’s free tool matches you with up to three financial advisors who serve your area, and you can interview your advisor matches at no cost to decide which one is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now.
  • Healthcare costs rise faster than overall inflation, which makes it critical to plan for long-term care now. Our inflation calculator can help you understand what long-term care costs may be in the future and why buying a long-term policy today can protect you against those risks.

Photo credit: © Trade, © Sanchez, © Trade