Many families struggle understanding the complex requirements to qualify for Medicaid nursing home care. The language can be confusing, nursing home regulations are complex, and requirements vary by state. Specific requirements will vary by individual but that being said, here are the basic qualifications for Medicaid nursing home care:
Eligibility Requirements
The Medicaid program is a joint federal and state effort representing the largest source of retirement home revenue in the United States. This program offers care options for those in need due to health or financial position. Medicaid eligibility begins with a valuation of income, savings, and assets. The valuation process will vary by state, and several calculations are considered when determining eligibility.
- Complicated math. The math to qualify can become tricky. In some states, qualification begins once personal worth dips below $2000.00. Housing factors separately, with calculations changing based on home value. Some personal property and household goods are counted separately, and life insurance policies may be independently factored. Bear in mind that while home values may be viewed separately, applicants deemed unable to return home may have potential home sales values taken into effect. There are exceptions, of course, speak to a health insurance carrier for more detailed information.
- Medicaid is a supplement. Once all sources of income (including investments, retirement pensions, social security and others) are tallied, prepare to still spend 80-90% of personal income on nursing home care. Medicaid is used in conjunction with personal income. An allowance of 10-20% of personal income is typical for those residing in nursing homes.
- Financial records. The net-worth requirements are investigated dating back five years. For those planning to quickly give away possessions to qualify, think again. Medicaid officials are thorough, exploring bank records for the past five years. Suspicious activity, including a rash of gift-giving, may raise red flags suspending care upon investigation. Using determined formulas, officials can help identify those trying to expedite Medicaid eligibility. For example, gifts totaling $50,000 in a state where typical monthly nursing home costs are $5,000 would disqualify eligibility for ten months ($5,000 x 10).
Spousal Security
Medicaid has specific guidelines for couples. When one person goes into a nursing home and the other continues to live at home, the healthy spouse can keep 50% of the couple’s possessions. There is a cap on this amount which will vary by state. Assets included in this calculation include the house, furnishings and household goods, as well as one car. The person living at home can also receive a portion of the other’s income, usually between $2,030-$3022. Income beyond the allowable amount will go towards paying nursing home costs.
Medicare is Different
Medicare is the government medical insurance program for adults aged 65 and older. The program also serves some younger individuals with serious health problems. Medicare is structured for medically-necessary, short-term rehabilitative care. Nursing home care is unavailable through the Medicare program.
Finding More Information
For more information on Medicaid contact the state Medicaid office. Contact information can be found at www.Medicaid.gov. The State Health Insurance Assistance Program (Shiptacenter.org) can help with any Medicare or Medicaid questions.
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