What does it take to qualify for Medicaid status in nursing homes?

Elderly woman, aged 93, sitting in a wheelchair talking to a nurse in a private retirement home
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Question: What does it take to qualify for Medicaid status in nursing homes?

Answer: Medicaid is a federal program​ administered at the state level that provides health care for low-income individuals. It also pays for nursing home care for low-income elderly and disabled Medicare recipients who require that type of care.

To qualify for Medicaid, you must meet a 'means test.' Your income and assets must be under a certain level, as determined by your individual state.

Most states use a percentage of the Federal Poverty guidelines as the measuring stick to determine eligibility.

When someone applies for Medicaid to cover the costs of nursing home care, a case worker will investigate the financial status to help make a determination as to if the applicant meets the qualifications for coverage. Income includes wages and pension payments, and assets can include items such as savings, cars, homes and valuables that may be owned by the applicant.

If assets are determined to give the applicant income that exceeds the set amount in the guidelines, he or she may have to enter the nursing home as a private pay resident and "spend-down" those assets. This may involve selling those assets for cash to pay the nursing home bill.

Most nursing homes that accept Medicaid payment will be able to help the patient or family with the application process.

If there is a spouse who will not be living in the nursing home, they will not be required to become destitute in order to pay for the care (for example selling a home to pay for care), but Medicaid can require some "payback" for care after that spouse has passed on by billing the estate.

Be aware that Medicaid rules do not allow you to give away your money (for instance, to your children or grandchildren) in order to qualify for Medicaid. In fact, Medicaid now implements a five-year "look-back" period, which means that Medicaid will examine all your financial dealings for at least the past five years.

If you transferred or gifted money to anyone during those five years, you will be penalized with a delay in your Medicaid eligibility.

Disclaimer: Be aware that laws and federal guidelines change frequently and without notice, and the advice given in this article may not be entirely applicable when you apply for Medicaid. Up-to-date rules on Medicaid eligibility may be found on the CMS website."

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