Can one have Medicaid and Medicare at the same time? Which would be the primary insurance? Also, people tell me that you cannot have Medicaid if you stay at home and receive home care. You'd need to be in a nursing home or some facility to receive Medicaid. But doesn't it cost more for Medicaid to pay someone to stay in a NH or facility than to pay for home care with a 24/7 aide? It does not make economic sense to me.