Strategies to Achieve Medicaid Eligibility for Nursing Home Care in the United States
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NF services for are required to be provided by state Medicaid programs for individuals age 21 or older who need them. States may not limit access to the service, or make it subject to waiting lists, as they may for home and community based services. Therefore, in some cases NF services may be more immediately available than other long-term care options. NF residents and their families should investigate other long-term care options in order to transition back to the community as quickly as possible. The level of care requirement for nursing home admission or for assistance via a HCBS Waiver might be referred to in a number of ways depending on one’s state of residence. One might hear it called Nursing Facility Level of Care , Nursing Home Level of Care , or simply Level of Care .
By using one set of income counting rules and a single application across programs, the Affordable Care Act made it easier for people to apply and enroll in the appropriate program. In all states, persons can “spend down” their assets that are over Medicaid’s limit. Medicaid has a 60-month look back period in which assets transferred for less than fair market value result in a penalty period of Medicaid ineligibility.
When a State Can Recoup Benefits
In most states, the home equity interest limit is $688,000 or $1,033,000. California is the only state that does not have a home equity interest limit. Furthermore, if the applicant does not live in the home, there must be “intent to return” for it to maintain its exempt status. To be clear, there is no home equity interest limit for ABD Medicaid.
The webinar lays out how management for these populations fits into the broader managed care transition, the key elements of each program, and the infrastructure for program oversight and accountability. After an applicant has been approved for Nursing Home Medicaid through Michigan Medicaid, they need to choose which Medicaid-approved nursing home they will live in. Even though Nursing Home Medicaid is an entitlement, Michigan Medicaid will only cover stays and care in approved nursing homes. Michigan residents can find and compare nursing homes using this Health Care Association of Michigan Facility Finder.
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Michigan residents have to meet an asset limit and an income limit in order to be financially eligible for Nursing Home Medicaid. For a single applicant in 2022, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset , and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
In approximately half of the states, ABD Medicaid’s income limit is $914 / month for a single applicant and $1,371 for a couple. In the remaining states, the income limit is generally $1,133 / month for a single applicant and $1,526 / month for a couple. (These are 2022 figures. The 2023 figures have yet to be released.) To be clear, there is no Minimum Monthly Maintenance Needs Allowance for non-applicant spouses of ABD Medicaid beneficiaries. A single individual, 65 years or older, must have income less than $2,742 / month. This applies to nursing home Medicaid, as well as assisted living services and in-home care in states that provide it through HCBS Waivers.
What Does Medicaid Cover
It's important to note that Medicare does not help with long-term care costs. In the past, to avoid exceeding Medicaid's income limits, some families would transfer a patient's assets into the names of other relatives, such as the children. The Deficit Reduction Act of 2005 made such maneuvers much harder to manage. Now, when you apply for Medicaid, there is a five-year “lookback” at all asset transfers. If Medicaid finds money was transferred within the past five years, a penalty period is imposed, delaying the onset of Medicaid coverage. Medicaid was created in 1965 as a social healthcare program to help people with low incomes receive medical attention.
Nursing homes prefer residents that are “private pay”, meaning the family pays the cost out-of-pocket. This is because private pay residents pay approximately 25% more for nursing home care than Medicaid pays. In 2022, the nationwide average private payer pays approximately $255 / day for nursing home care while Medicaid pays approximately $206 / day. Some states allow one to meet the income limit via a medically needy pathway, which allows persons to spend “excess” income on medical expenses.
Does Medicaid Pay for Nursing Care?
The Medicare Part B premium is a monthly fee parfticipants pay for subsidized insurance coverage of outpatient healthcare services. Don't forget that asset transfers must be in place at least five years prior to your application to avoid Medicaid's lookback period. Even so, plan to have enough assets to pay a facility privately or through private long-term care insurance, at least for the initial six months to a year. Medicaid can help to pay the costs of long-term care in a nursing care facility. To qualify for assistance, you must meet the Medicaid eligibility guidelines established by your state.
A Medicaid expert can assist these persons in re-structuring their finances to help them become eligible. We’ve written extensively about the Pros and Cons of Medicaid Planning and the Different Types of Medicaid Planners. One should also consider reading the New York Times piece, Is Medicaid Planning Ethical? For married couples with both spouses as applicants, each spouse is allowed up to $2,742 / month or a combined income of $5,484 / month. Applicants must participate in a medical assessment in which their need for a nursing home level of care will be confirmed.
Medicare Part A, or Medicare hospital coverage, is one of the four parts of Medicare, the government’s health insurance program for older adults. In all states, Medicaid is available to low-income individuals and families, pregnant women, people with disabilities, and aging adults. Medicaid programs vary from state to state, and the Affordable Care Act allows states to provide Medicaid to adults without minor children or a disability. A medical diagnosis of Alzheimer’s Disease, Parkinson’s Disease Dementia, or a related dementia does not automatically mean an individual will meet Medicaid’s level of care requirements. Typically the accompanying symptoms are adequately severe that persons with these conditions meet the requirements as their conditions progress.
Many Waivers, especially those intended to help persons in assisted living, have waiting lists. To be clear, one can be financially and functionally eligible for an assisted living waiver, but be unable to enroll due to a wait-list. Michigan residents have to meet an an asset limit and an income limit in order to be financially eligible for Home and Community Based Service Waivers. For a single applicant in 2022, the asset limit for HCBS Waivers in Michigan is $2,000, which means they must have $2,000 or less in countable assets. While ABD Medicaid will cover services in all of those settings, it will not cover room and board costs.
During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Michigan Medicaid applicant. These documents will be needed for the official Michigan Medicaid application. PACE is intended to help Michigan residents who need a Nursing Facility Level of Care but want to keep residing and receiving care in their home or somewhere else in the community.
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