“If you are planning to move into long-term care, it would help if you understood how to line up your income and assets to meet the eligibility requirements. Getting your timing right can increase your odds of getting Medicaid to pay for your nursing home or assisted living costs.”
With the cost of nursing home care averaging $235 a day ($85,775 a year) in the United States, and some places as high as $800 a day ($292,000 a year), your life savings could quickly disappear. If you are planning to move into long-term care, it will help if you understood how to line up your income and assets to meet the eligibility requirements. Getting your timing right can increase your chances of getting Medicaid to pay your nursing home or assisted living costs. This article answers your question, when should I apply for Medicaid for long-term care?
When to Apply for Medicaid for Nursing Home Care
The short answer is that you should apply when you meet the qualifications. If you do not meet the requirements, it is pointless to apply. However, there are exceptions to the eligibility rules, and the exceptions are different in every state. Talk with a local elder law attorney to learn your state’s requirements. If you fall within a rules exception in your state, it may be a good time to start the application process.
Eligibility Requirements for Medicaid to Help Pay Your Long-Term Care Costs
Functional eligibility test. Medicaid will not pay for you to live in a nursing home, if you can physically and mentally take care of yourself at home. If you move into a nursing home because you do not want to live alone or for some other reason other than needing help with the functions of daily living, Medicaid will not help with your costs. Each state defines the functions of daily living differently, and has different standards for how much help you must need with functional tasks to qualify. Daily living functions include:
- Preparing meals
- Using the bathroom
- Getting in and out of a chair or your bed
Income and assets guidelines. You must not exceed the Medicaid income and assets limits for your state for Medicaid to pay your long-term care costs. These numbers differ from state to state, but you must have low income and few assets. In some states, the Medicaid income and assets limits are higher for nursing home benefits recipients than for getting Medicaid for non-nursing home services.
“Medically needy” or “spend down” programs. These programs allow people whose income is too high for Medicaid to qualify, if significant medical ongoing bills reduce how much of their income is available for other living expenses.
Spouse at home rules. It is possible to protect some of your income and assets for your spouse who lives at home in the community, and not in the nursing home. The rules for doing this sheltering vary by state.
Five-year “look back” period. Medicaid will examine your finances for the last five years to see if you gave away your assets to friends and family, rather than have to use them to pay your nursing home bills. If you did, Medicaid can impose substantial penalties on you. Therefore, the best time to apply for Medicaid is also when you have made no significant gifts during the last five years. Like many other guidelines, there are exceptions to this rule.
Medicaid nursing home benefits and requirements are different in every state, so talk with an elder law attorney in your area. This article discusses the general law.
Paying for Senior Care. “How to Pay for Nursing Home Care/Convalescent Care.” (accessed December 27, 2017) https://www.payingforseniorcare.com/longtermcare/paying-for-nursing-homes.html
Medicare Interactive. “How can I get Medicaid if I need nursing home care and have Medicare?” (accessed December 27, 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
Centers for Medicare & Medicaid Services. “Nursing Home Toolkit: Nursing Homes – A Guide for Medicaid Beneficiaries’ Families and Helpers.” (accessed December 27, 2017) https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/nursinghome-beneficiary-booklet.pdf
Nolo. “When Will Medicaid Pay for a Nursing Home or Assisted Living?” (accessed December 27, 2017) https://www.nolo.com/legal-encyclopedia/when-will-medicaid-pay-nursing-home-assisted-living.html