All states have a Medicaid program for individuals who need nursing home or long-term care—also called Institutional Medicaid—that provides general health coverage and coverage for nursing home services. These services include room and board, nursing care, personal care, and therapy services. Medicare does cover some skilled nursing facility (SNF) care: up to 100 days per benefit period. If you do not meet Medicare’s requirements for the SNF benefit or you have reached Medicare’s limit of covered SNF care, Medicaid may pay for this care.
Institutional Medicaid may pay for a stay in a nursing home if you:
- Need a nursing home level of care or meet nursing home functional eligibility criteria
- And, have income and assets below certain guidelines (remember, your state may have higher Medicaid income guidelines if you need nursing care or a spend-down program to help you qualify)
States have different standards for determining whether you need a nursing home level of care. Generally, states assess your ability to function, as measured by your need for help with activities of daily living (such as toileting, bathing, and dressing).
There are a few things you should keep in mind before applying for Institutional Medicaid:
- The program will consider you and your spouse together when counting your income and assets, but you typically will be able to set aside a certain amount of your income and assets for your spouse to keep. This amount will not be counted when you apply for Medicaid.
- If you qualify, you will be able to keep a small amount of your income for a personal allowance. This amount varies by state, so contact your local Medicaid office to learn more. You will have to pay the remainder of your income to the nursing home.
Also, if you own your home, the equity may count as an asset. If you have questions or concerns, there are lawyers dedicated to issues confronting seniors who can help you understand all the different terms and conditions.