Market reference note: This article covers information from both Korea and the United States. Each section is labeled 🇰🇷 Korea or 🇺🇸 U.S. to indicate which country's standards apply.
When a parent's mobility has noticeably declined, the first administrative hurdle a family typically faces is applying for a long-term care grade. It's completely natural to feel anxious while waiting for the assessment result. Yet many families only realize after receiving the letter that they don't know how the score was calculated or what to do if they disagree with the outcome. Understanding the assessment criteria, the process, and your right to appeal in advance will help you respond with greater composure.
🇰🇷 Korea Those eligible to apply for a long-term care grade include 국민건강보험 (National Health Insurance) subscribers or their dependents aged 65 or older, as well as individuals under 65 who have an age-related disease specified by presidential decree — such as dementia, cerebrovascular disease, or Parkinson's disease. The core requirement, as set out in Article 12 of the 노인장기요양보험법 (Long-Term Care Insurance Act for the Elderly), is that the person must be recognized as having difficulty performing daily activities independently for six months or more. Applications can be submitted by visiting a 국민건강보험공단 (National Health Insurance Service) branch in person, or by mail, fax, internet, or mobile app, and must include the application form together with a physician's opinion statement. However, first-time applicants under 65 and foreign nationals cannot apply online or through the app.
🇰🇷 Korea After submitting an application, the process unfolds in four broad steps. A 공단 (National Health Insurance Service) staff member — typically a nurse or social worker — visits the applicant's home and evaluates 52 items covering physical function, cognitive function, behavioral changes, nursing care needs, and rehabilitation. Based on those findings and the physician's opinion, the 등급판정위원회 (Long-Term Care Grade Determination Committee) — a municipal- or district-level body comprising 15 members including physicians, nurses, and social workers — issues the final grade. The entire process, from submission to notification of results, is generally completed within 30 days. Long-term care benefits may be used from the date the assessment letter is received.
🇰🇷 Korea Grades are divided into six levels based on the 장기요양인정점수 (long-term care recognition score) derived from the home visit assessment: Grade 1 through Grade 5, plus the 인지지원등급 (Cognitive Support Grade). Grade 1 (95 points or above) indicates a condition requiring full assistance with virtually all daily activities, while Grade 4 (51 points or above but below 60) indicates a condition requiring assistance with certain activities. Grade 5 (45 points or above but below 51) and the 인지지원등급 (below 45 points) apply only to individuals with a dementia diagnosis. A higher score indicates a more severe condition, and a higher grade corresponds to a larger monthly benefit ceiling. As of 2026, the monthly ceiling for home-based benefits at Grade 1 is 2,512,900 원, an increase of approximately 206,500 원 from the previous year. According to data published by the 국민건강보험공단 (National Health Insurance Service), approximately 1,235,000 people were recognized as long-term care recipients in 2025, with roughly 90% of applicants receiving a grade.
🇺🇸 U.S. To receive long-term care support through Medicaid in the United States, three conditions must be met simultaneously. The first is a functional need: there must be a medical determination that the individual requires nursing-facility-level care, and most states require that the person need assistance with at least 2 to 3 activities of daily living (ADLs). The second is an income condition: as of 2026, most states set the individual monthly income limit at approximately $2,982. The third is an asset condition: in most states, the asset limit for a single applicant is approximately $2,000; however, New York sets it at $33,038, and California raised its limit to $130,000 as of January 2026. All three conditions must be satisfied before nursing facility or home- and community-based services (HCBS waiver) support becomes available.
🇰🇷 Korea If you disagree with a grade determination, you may file a written appeal — including electronic documents — with the 국민건강보험공단 (National Health Insurance Service) within 90 days of the date you confirm the contents of the decision. Note that appeals are not accepted more than 180 days after the decision, unless there is a legitimate reason for the delay. It is advisable to describe the original determination and the grounds for your objection in specific detail, and to submit supporting materials that document the person's usual condition — such as medical records, medication histories, and care logs. Appeals are reviewed by the 장기요양심사위원회 (Long-Term Care Review Committee). That said, the rate at which appeals are upheld is low in practice, and some advisors suggest that if the individual's condition has genuinely worsened, re-applying after three or more months may be a more realistic path. It is also worth noting that re-applying (results within 30 days) can sometimes be faster than the formal appeal process (60 to 90 days for a decision).
🇺🇸 U.S. If you disagree with a Medicaid long-term care decision in the United States, federal law guarantees the right to a Fair Hearing. If services are being received through a managed Medicaid plan, the first step is to file an internal appeal with the plan. The plan must reach a decision within 30 days for a standard appeal and within 72 hours for an expedited appeal (42 CFR § 438.408). If you are still dissatisfied with the plan's decision, you may request a Fair Hearing from the state Medicaid agency; the filing deadline is 90 to 120 days after notification of the plan's decision, varying by state. Family members may serve as the official representative of the individual, and if you wish to maintain existing services while the appeal is pending, you must request continuation of those services before the original decision takes effect.
Sources: 국민건강보험공단 경영공시 (National Health Insurance Service Management Disclosure — Long-Term Care Grade Determination Status, 2026); 국민건강보험공단 노인장기요양보험 인정 신청 안내 (National Health Insurance Service Long-Term Care Insurance Application Guide); 보건복지부 노인장기요양보험법 Articles 12 and 55 (Ministry of Health and Welfare, Long-Term Care Insurance Act for the Elderly); 찾기쉬운 생활법령정보 (Easy Life Legal Information) — Appeal Procedures; Medicaid Long Term Care Eligibility Criteria (medicaidlongtermcare.org, 2026); 42 CFR § 438.402 and § 438.408 (U.S. Federal Medicaid Regulations); Medicaid Fair Hearing Guide for Providers (muni.health, 2026).
Sierra Care Advisor is here to walk alongside Korean-American family caregivers as they work to understand both the Korean and U.S. long-term care systems and prepare for the next steps ahead.
Note: This article was compiled by AI from the sources cited above. We strive for accuracy, but for decisions about your specific situation, please confirm the latest guidance from a professional or the relevant agency.