Medicaid Nursing Home Qualifications
Medicare will only pay for nursing home care for short-term, health-related conditions. Most government funding for nursing home care is paid by Medicaid. This is a program to assist low income individuals.
Other People Are Reading
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Spending on Nursing Homes
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According to Georgetown University statistics, most long-term care produced without government support is provided by families. (http://www.ltc.georgetown.edu/pdfs/nursinghomecosts.pdf) Three fourths of United States long-term care spending is for nursing home care.
About half of all nursing home cost is paid by Medicaid. Slightly more than 25 percent is paid by families. Less than ten percent is from private insurance. Medicare pays about 12 percent for short-term, health-related care only.
Centers for Medicare and Medicaid Services
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The Centers for Medicare and Medicaid Services unit of the Department of Health and Human Services determines the eligibility of individuals who meet the requirements for government-funded nursing home care. (http://cms.hhs.gov/medicaideligibility) While low income is the main eligibility requirement, it is not the only requirement for government support. This agency pays the providers of services directly.
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Eligibility
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In addition to low-income, Medicaid has means tests for assets and resources.
People who don't qualify for Medicaid assistance at first probably will eventually. Entering a nursing home at a "private pay" rate will usually cost thousands of dollars a month. When the individuals asset's fall below the maximum allowable amount, Medicare will begin to pay for the care.
Eligibility for Medicaid support requires reduction of "countable" assets to $2,000, or less. In addition, the resident must contribute all her monthly income, including social security, except for a $30 to $90 "personal needs allowance."
It is not wise to try to hide assets. This constitutes fraud and can have serious penalties.
Care managers and some social workers are knowledgeable about these financial issues and offer assistance. A care manager near you can be found at http://www.caremanager.org.
If you have been paying for care with your own funds, some states will not let a nursing home put you out if you become eligible for Medicaid.
State Programs
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Rules for eligibility vary by state as does the coverage they provide. Most states have "state-only" programs to help people who meet their state's income and other requirements but who do not meet the Medicaid requirements. To see your state's programs and requirements go to the National Association of State Medicaid Directors website (http://www.nasmd.org/links/State_medicaid_links.asp) and click on your state.
Users
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The Health and Human Services Agency for Healthcare Research and Quality states that four in ten people 65 years old or older will need nursing home care at some point in their lives. Over 75 million baby boomers will reach the age of 65 between 2011 and 2029.
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