Who’s eligible for Medicaid Nursing Home Coverage?
Medicaid nursing home coverage is available only to people who are unable to care for themselves at home. They must meet their state’s eligibility limits regarding income and assets, which differ depending on whether the resident is single or part of a married couple. They may reside in any level nursing home that’s certified Medicaid and that accepts Medicaid payment. Be aware, however, that some nursing homes only accept Medicaid payment for a limited number of residents.
Unlike Medicare coverage of nursing home care, there’s no Medicaid requirement of a prior hospital stay, no restriction to skilled nursing facilities, and no requirement that the person need skilled nursing home care or still be recovering from an illness or injury in order for Medicaid to continue coverage. In other words, Medicaid — unlike Medicare — will cover residence in a nursing home purely to provide help with the nonmedical activities of daily living — what’s called “custodial care.”
Types of nursing home costs Medicaid covers
For eligible beneficiaries, Medicaid pays the full cost of room and board in a nursing facility, plus any therapies that are part of the nursing home’s regular resident care. Medicaid’s payment also includes personal care items such as incontinence supplies and toiletries, as well as services such as bathing, grooming, and laundry.
There’s no time limit on Medicaid nursing home coverage, and the Medicaid beneficiary has no co-payments to make.
The income limits eligibility are different for an unmarried, divorced or widowed person than for a married couple.
What are the eligibility requirements for Medicaid?
Medicaid’s eligibility requirements vary depending on the age, marital status, and state of residence of the applicant. In addition, they change each year. Certain resources, such as one’s home, are considered exempt from Medicaid’s asset limit, and other resources can be allocated to a non-applicant spouse. There are similar exceptions made for the applicant’s income, in which the applicant spouse can transfer income to their non-applicant spouse. These spousal impoverishment rules (community spouse resource allowance and monthly maintenance needs allowance) are in place to protect a non-applicant spouse from having too little from which to live, while also effectively lowering an applicant spouse’s countable assets and income.
Contact a Medicaid nursing home coverage insurance expert
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