Market Reference Note: This article covers information from both Korea and the United States. Each piece of information is marked in the text with 🇰🇷 Korea or 🇺🇸 U.S. to indicate which country it applies to.
When a parent begins to need a little more help with daily life, the first administrative hurdle caregivers face is the long-term care level assessment. Only after receiving a care level can families access government-supported care services. Many families still miss out on benefits simply because the process feels unfamiliar and they hesitate to begin. This article walks you through every step — from application to assessment to what you can do if you disagree with the result.
🇰🇷 Korea To be eligible to apply, you must be enrolled in the Long-Term Care Insurance program, a dependent of an enrollee, or a Medical Aid recipient. You may apply if you are 65 or older, or if you are under 65 but have a geriatric disease. The key condition is being recognized as unable to carry out daily activities independently for six months or longer. Applications can be submitted in person at a branch of the 국민건강보험공단 (National Health Insurance Service, ☎ 1577-1000) or online through the 노인장기요양보험 (Long-Term Care Insurance) website at longtermcare.or.kr.
🇰🇷 Korea Once your application is received, a trained National Health Insurance Service employee will visit your home to evaluate the senior's physical and cognitive condition using the 장기요양인정조사표 (Long-Term Care Recognition Survey), which consists of 90 items. You will be notified of the visit in advance, and the date and time can be coordinated with the service employee. After the home visit, a physician's opinion letter is required; for those 65 or older, this letter may be submitted before the case materials are presented to the 등급판정위원회 (Care Level Certification Committee). You will typically receive the result within 30 days of submitting your application.
🇰🇷 Korea Care levels are divided into six tiers: Levels 1 through 5 and a Cognitive Support Level. The key measure is the 장기요양인정 점수 (Long-Term Care Recognition Score), calculated by combining assessments across five domains: physical function, cognitive function, behavioral symptoms, nursing care, and rehabilitation. Level 1 requires a score of 95 or above and applies to those in the most severe condition who need full assistance from others; Level 2 covers scores of 75 or above but below 95. The Cognitive Support Level may be applied to individuals with a dementia diagnosis and a history of medication prescriptions even if their score is low, and allows them to use day and night care services. Once the assessment is complete, the National Health Insurance Service notifies the applicant of the 장기요양인정서 (Long-Term Care Recognition Certificate) and a personalized care plan by mail or online. The certificate is valid for a base period of one to three years.
🇺🇸 U.S. In the United States, Medicaid is the primary public funding source for long-term care. There are three programs: Nursing Home Medicaid, Home and Community-Based Services (HCBS) waivers, and Aged, Blind, and Disabled Medicaid. All three programs assess both financial eligibility and medical need. As of 2026, the asset limit for a single applicant in most states is $2,000, and the income limit is 300% of the Federal Benefit Rate (FBR), or $2,982 per month (with state-by-state variation — California, for example, allows asset limits up to $130,000). Because Medicare only covers up to 100 days of skilled nursing care, families who need long-term care must separately verify Medicaid eligibility requirements.
🇰🇷 Korea If you disagree with the assessment result, you may file an appeal with the 국민건강보험공단 (National Health Insurance Service) within 90 days of receiving the result notice. If 180 days have passed since the original decision, you cannot file an appeal for review unless you can demonstrate a justifiable reason, so it is important not to miss this deadline. If the senior's physical condition changes at any time, you can request a reassessment through a care level change application. 🇺🇸 U.S. If Medicaid is denied or services are reduced, you have the right to request a Fair Hearing. If you receive services through a Medicaid managed care plan, you must first go through the plan's internal appeals process before requesting a state-level Fair Hearing, and you may file the second-level (Fair Hearing) appeal within 120 days of receiving the final adverse decision notice. If you appeal a reduction or termination of services, your existing services may continue until the Fair Hearing decision is issued — so it is to your advantage to file an appeal as quickly as possible.
It is completely natural to feel overwhelmed even after receiving a care level. Whether you are wondering if the assigned level truly reflects your parent's actual condition, what documents to gather for an appeal, or how to navigate choices between the Korean and U.S. systems — Sierra Care Advisor is here to think through those questions with you.
Sources: 국민건강보험공단 (National Health Insurance Service) Long-Term Care Insurance official guidance (nhis.or.kr), 보건복지부 (Ministry of Health and Welfare) Long-Term Care Insurance for the Elderly policy guidance (mohw.go.kr), 찾기쉬운 생활법령정보 (Easy Law) Long-Term Care Insurance for the Elderly (easylaw.go.kr), Medicaid Long Term Care Eligibility Overview (medicaidlongtermcare.org), Medicaid Planning Assistance — 2026 Eligibility Criteria (medicaidplanningassistance.org), NY Health Access — Medicaid Fair Hearings, ICANNYS — Appeals in Medicaid Managed Care Plans.
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.