At what point does Medicaid pay for my nursing home?

Many do not understand that Medicaid is not there to pay for nursing or other long term care for everyone. There are many very significant limits that come into play with Medicaid and its coverage of long term care needs.  This is one reason it is important for those with assets to make plans and consider the use of various insurance products to ensure you have adequate coverage to pay for or at least help cover the cost of long term care.

Medicaid is a program established thru joint funding by the US Federal and each State’s government.  The program is tax payor supported and as a result has a somewhat limited budget. Couple that with the fact not all providers agree to accept payment from Medicaid. That may significantly limit your ability to find a place to secure a nursing home room. A further consideration related to government paid care is that Medicare does not cover long term care.

When you get to the point you need long term care, you have to decide what facility you want to use.  You will need to know how the care will be paid in order to truly assess what facility you can use. Most facilities accept only select forms of payment.  Thus, generally to get into a facility you need to be paying cash or have a long term care policy.  Once you are in and are depleting your cash and other assets to pay for your care you “spend down” towards Medicaid eligibility.

Medicaid Eligibility varies by state but generally speaking is only a couple thousand in assets plus a house and auto. Generally speaking that is not enough assets for folks to maintain their living standard.  It is a bigger issue when this involves a couple because the, spend down or Medicaid eligibility level will impoverish the spouse.  There are also laws on the books that prohibit giving away the assets to others within five years of when one wants to be deemed eligible for Medicaid.  Thus spending down to Medical eligibility is one way to get Medicaid to kick in.

Once you have met the poverty requirements to get Medicaid, then you meet the medical requirements to require nursing home care and then you have to begin looking for a nursing home bed available for Medicaid payments. These beds are scarce as few facilities want to accept the low rates paid by Medicaid and the other associated requirements set forth by the government.  So now you are eligible for Medicaid to pay for your care but are not necessarily able to find a bed in which to live.

The question most asked is when will Medicaid begin paying for my nursing home care, the answer a bit long but comes down to when you meet poverty requirements and when you can find a Medicaid certified bed that is available. Getting both to fall into place is not as simple as it sounds, but is achieved.