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Functional Requirements

A medical specialist (nurse/social worker) in your state must evaluate your needs and decide if you need long-term care services. Usually, the specialist will make the decision based in part on whether you need assistance performing certain activities of daily living (ADL), such as:

This link provides an example (state of Colorado) of the kind of form frequently used by State Medicaid programs to assess limitations in Activities of Daily Living.

Good To Know

If you do not meet Medicaid’s functional eligibility criteria, Medicaid will not cover long-term care services, regardless of financial eligibility.  But, if you meet the general and financial requirements for eligibility, Medicaid will still cover other services such as doctor visits and prescription drugs.