When Will Medicaid Pay for Nursing Home Care?

Medicaid Eligibility

Medicaid, the joint federal and state program that covers health care for the poor, is the largest single payer of America's nursing home bills for seniors who do not have the resources to pay for their own care. Most people who enter nursing homes do not qualify for Medicaid right away. Instead, they pay out-of-pocket or through long-term care insurance until they deplete their savings and become eligible for Medicaid.

To qualify for Medicaid, your mother's income and assets will need to be under a certain level. This amount is determined by the state where she resides. In most states, individuals cannot have more than approximately $2,000 in countable assets, which includes cash, savings, investments and other financial resources that can be converted into cash.

Assets that are not taken into account when determining an applicant's Medicaid eligibility include personal possessions, household goods, one vehicle, prepaid funeral plans and a small amount of life insurance. Also, the applicant's principal residence is non-countable to the extent that the home's equity is less than $560,000, or in some states $840,000.

Be aware that your mother's home is not considered a countable asset to determine her eligibility so long as she intends to return home. If she cannot return home, Medicaid may be able to go after the homes sales proceeds to help reimburse her nursing home costs, unless a spouse or other dependent relative lives there or a different exception applies.

If your mother does qualify, all of her income sources, including Social Security and pension checks, must be turned over to Medicaid to pay for her care, except for a small personal needs allowance. This allowance is usually between $30 and $90 a month.

You also need to be aware that your mother cannot simply give away her assets to qualify for Medicaid faster. Medicaid officials will look at her financial records going back five years to root out suspicious asset transfers. If they find one, her Medicaid coverage will be delayed a certain length of time, according to a formula that divides the transfer amount by the average monthly cost of nursing home care in her state.

For example, if your mother lives in a state where the average monthly nursing home care cost is $5,000 and she gave away cash or other assets worth $50,000, she would be ineligible for benefits for 10 months ($50,000 divided by $5,000 = 10).

Spousal Protection

Medicaid also has special rules for married couples when one spouse enters a nursing home and the other spouse remains at home. In these cases, the spouse who is still residing at home may keep one half of the couple's assets up to $120,900 (this amount varies by state), the family home, furniture, household goods and one automobile. This spouse is also entitled to keep a portion of the couple's monthly income, which may be between $2,030 and $3,022 depending on the state. Any income above that amount goes toward the cost of the nursing home recipient's care.

What about Medicare?

Medicare, the federal health insurance program for seniors 65 and older and individuals with disabilities, does not pay for long-term care. It only helps pay for up to 100 days of rehabilitative nursing home care, which must occur immediately after a hospital stay.

Find Help

For more detailed information, contact your state Medicaid office (see Medicaid.gov for contact information). You can also receive help from your State Health Insurance Assistance Program (see ShiptaCenter.org), which provides free counseling on all Medicare and Medicaid issues.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.