Medicaid and nursing homes: a quick guide to the rules
Medicaid was created in 1965 as a social health program to help low-income people get medical care. Many seniors depend on Medicaid to pay for long-term nursing home care.
“most people pay out-of-pocket for long-term care until they become eligible for Medicaid. While Medicare is an entitlement program, Medicaid is a form of welfare—or at least that’s how it started. So in order to be eligible, you have to be ‘impoverished’ under the program’s guidelines,” said Laura M. Krohn, a Rhode Island-based elder law attorney.
important takeaways
- Medicaid is for individuals and families living on a limited income; many seniors use it to pay for long-term nursing home care.
- to be eligible for Medicaid, you must meet specific income and asset requirements.,
- to become eligible, seniors may choose to “pay down” or transfer their assets to meet Medicaid guidelines in their state.
- the transfer of assets must have occurred at least five years
before the application for Medicaid to avoid the program’s lookback period.
Medicare vs. Medicaid roles in nursing homes
Medicare covers nursing homes—up to a point.
If you are sent to a skilled nursing facility for care after a three-day hospital stay, Medicare pays the full cost for the first 20 days.,
For the next 100 days, Medicare covers most of the charges, but patients must pay $176.00 per day (2020) if they do not have supplementary insurance.
these rules apply to traditional Medicare. People on Medicare Advantage plans likely have different benefits
some nursing homes will not accept Medicaid patients outright,
but the law prohibits them from kicking you out if you become dependent on Medicaid while in their care.,
qualify for Medicaid
in all states, Medicaid is available to low-income people and families, pregnant women, people with disabilities, and the elderly.
Medicaid programs vary from state to state, and the Affordable Care Act (ACA)
allows states to provide Medicaid to adults (under age 65) without minor children or disabilities.
Income standards are usually based on the Federal poverty level.
Each state has its own guidelines and eligibility requirements.,
For example, in New York state there is an income limit of $15,750 (2020) for individuals, but in Mississippi, the limit is much lower – $4,000.
since these rules vary by state,
it may be best to speak directly to a regional office to get the correct set of guidelines for your home state. You can find a link to join through the Medicaid website.
