Medicaid Coverage for Nursing Homes

February 29, 2020

As adults age, many of them need more assistance, and there may come a point where it is no longer practical or safe for them to live on their own. Long-term care facilities, including nursing homes and assisted living facilities, provide their elderly residents with the level of care that they need. These homes can be expensive, which is especially challenging for older adults that have limited income. Understanding Medicaid eligibility and benefits can help ease the financial burden for lower income adults who need long-term care.

Medicaid is a federal and state program that provides medical coverage for adults with low earnings. Medicaid is the largest single payer for nursing home care in the country, covering between 45 and 65 percent of nursing home costs at any given time. Seniors who require long-term care and meet the financial eligibility criteria for Medicaid typically have 100 percent of their nursing home costs covered, including room and board and meals. Medicaid is not to be confused with Medicare, which provides limited benefits for nursing home care and typically only covers short-term stays of 100 days or less. It should also be noted that not every facility accepts Medicaid payments, and some may have a limit on how many Medicaid recipients they will accept.

Understanding Medicaid Eligibility

In order to be eligible for Medicaid, a person’s monthly income and available assets cannot exceed a certain level. This level varies by state, but in most states, the limit for 2020 is $2,349 per month and $2,000 in countable assets. There is a higher limit for married couples who are applying together, but if only one spouse is applying, the non-applicant can have their own income and up to $128,640 in countable assets under their name. There are certain types of assets that can be excluded from their countable assets, and seniors have the option of spending down some of their assets to help them meet the eligibility requirement. An experienced elder law lawyer can help seniors examine their financial situation and determine their eligibility.

Before Medicaid will cover nursing home care, it must also be established that long-term care is medically necessary. Each state has its own guidelines for determining medical necessity, but if a person’s health condition makes it dangerous for them to live on their own, whether they have limited mobility, a cognitive defect, or they need consistent care such as IV treatments, then they are likely to qualify. This applies not only to seniors, but to younger adults and children who may require long-term care as well. Many nursing home residents suffer from dementia, but a dementia patient would not be eligible for Medicaid nursing home benefits until the condition progresses to the point that it impacts their ability to function.

Brooklyn Elder Law Attorneys at Korsinsky & Klein, LLP Help Seniors Navigate the Medicaid Process

Qualifying for and receiving Medicaid benefits can be a complicated process. The Brooklyn elder law attorneys at Korsinsky & Klein, LLP have the knowledge and experience to help seniors with every step of the process and will work to ensure they receive the full benefits to which they are entitled. We are dedicated to giving our clients the best possible outcome and restoring their peace of mind. Located in Brooklyn, Manhattan, and Lakewood, New Jersey, we help seniors and their families throughout Manhattan, Long Island, and Westchester, New York. Call us today at 212-495-8133 or contact us online for an initial consultation.