“An elder law attorney can guide you through the intricate Medicaid application maze and prepare a trust or other legal product that can help you retain some assets, without incurring a Medicaid penalty.”
Nursing home care is expensive – thousands of dollars a month – but if you need it, you have to figure out a way to pay for it. Most of us cannot afford to shell out $6,000 or $7,000 a month or more to a nursing home. If you do not have long-term care insurance or other funding, you may be wondering, How can I qualify for nursing home care?
Although every state’s Medicaid rules are different, the general rule is that you may be eligible for Medicaid nursing home benefits if you:
- Have a medical condition that makes nursing-home care necessary, and
- Meet the financial requirements for Medicaid
Functional Eligibility for Nursing Home-Level of Care
If you need help with the activities of daily living, you might meet the first requirement. The state will evaluate your ability to perform tasks, such as dressing, bathing, toileting, feeding yourself and getting in and out of bed and chair. The standards will vary by state, but the more help you need with these basic functions, the more likely you are to meet your state’s threshold for needing nursing home-level of care.
Medicaid Financial Requirements
Although there are no income or asset restrictions for Medicare eligibility, you cannot receive Medicaid benefits unless your income and assets are below the set limits. These limits can change every year. Your income and assets will have to meet the guidelines on the first day of every month to retain your Medicaid funding.
What to Do if Your Income is Too High
If you are not able to live at home safely because of your medical condition, some states will apply a different income limit for Medicaid nursing home qualification. In other words, the income limit can be higher based on your medical needs.
Many states have “spend-down” programs for people who have significant medical expenses and too much income to meet the Medicaid income guidelines. If you have to spend a lot of money every month on medical expenses, you have less money available to pay for your nursing home care. Spend down programs, also called “medically needy” programs, deduct your medical expenses from your income, which can bring you below the Medicaid income level.
When Your Assets Are Too High
Many common assets, such as your home, are not counted for purposes of Medicaid qualification. Be very careful about giving away some of your assets to fall below the Medicaid countable asset limit. Medicaid will look at your bank statements and other assets for the last five years before you applied for Medicaid. This is called the “look-back” period.
Medicaid has strict rules about giving away assets or selling them at below market value during the look-back period. If any of your transfers break the Medicaid asset transfer rules, they can impose a harsh financial penalty on you. The penalty can mean that Medicaid will not pay for your nursing home expenses for many months. They will use a formula to calculate the number of months you will have to pay for yourself, before Medicaid starts to cover you.
An elder law attorney can guide you through the intricate Medicaid application maze and prepare a trust or other legal product that can help you retain some assets, without incurring a Medicaid penalty. The Medicaid programs in every state are different, so you should talk with an elder law attorney in your area. This posting discusses the general law.
Centers for Medicare & Medicaid Services. “How can I get Medicaid if I need nursing home care and have Medicare?” (accessed December 6, 2017) https://www.medicareinteractive.org/get-answers/programs-for-people-with-limited-income/medicaid-and-medicare/how-can-i-get-medicaid-if-i-need-nursing-home-care-and-have-medicare