Nursing Home Medicaid: All You Need To Know
Every state has it’s own Medicaid program, each with slightly different eligibility rules. These programs provide general health coverage and coverage for nursing home services. In some states, Medicaid pays some of the cost of assisted living for eligible residents in participating facilities. In other states, this may not be the case.
So who exactly is eligible for Medicaid nursing home coverage? What are some things you should keep in mind before applying for Institutional Medicaid?
Who Is Eligible?
Medicaid nursing home coverage is available only to people who are unable to care for themselves at home. In order to apply, you must meet your state’s specific eligibility limits regarding income and assets. However, these limits vary depending on whether the resident is single or part of a married couple.
Additionally, states have different standards for determining whether you need a nursing home level of care. Generally, states assess your ability to function, as measured by your need for help with activities of daily living (such as toileting, bathing, and dressing).
When you have institutional Medicaid, Medicare still covers medical services you may need beyond your nursing care. For example, if you need to go to a doctor or specialist’s office, Medicare will pay first for most of these services, and Medicaid will pay second by covering your remaining costs, such as coinsurances, copayments, and deductibles.
Things To Keep In Mind
So now that we have an understanding of the basics of nursing home Medicaid, there are a few things you should keep in mind before applying. This includes:
- The program will consider you and your spouse together when counting your income and assets, but you typically will be able to set aside a certain amount of your income and assets for your spouse to keep. This amount will not be counted when you apply for Medicaid.
- If you qualify, you will be able to keep a small amount of your income for a personal allowance. This amount varies by state, so contact your local Medicaid office to learn more. You will have to pay the remainder of your income to the nursing home.
- In most states, Institutional Medicaid has a look-back period of up to five years. This means that your state will count any assets you transferred in the past few years when determining your eligibility. If Medicaid determines that you transferred assets in violation of the Medicaid rules, it can penalize you by not paying for part or all of your nursing home stay.
- If you own your home, be sure to talk to an elder law attorney about how it will affect your Medicaid eligibility and coverage. Depending on your circumstances, the equity from your home may count as an asset. When you no longer need long-term care, or when you are deceased, such assets may be used to repay Medicaid for care that it covered for you
In short, all states have a Medicaid program for individuals who need nursing home or long term care. However, each of these states have their own program with slightly different eligibility rules. So it’s important to keep that in mind when applying for a nursing home medicaid program.