By Katy Hebebrand, WebMD
Medicaid is a government-run insurance benefit available to low-income people. You must be at least 21 years or older and meet income requirements to qualify for a policy for nursing homes. Learn how much Medicaid pays for a nursing home for individuals or spouses.
Medicaid Nursing Home Benefits
Medicaid pays 100% of nursing home costs in most cases if you meet eligibility requirements. In most states, the monthly income limit is $2,382 for individuals or $4,764 for spouses. Your countable resources must be less than $2,500. Income and resources that count toward the limit include:
- Social security benefits
- Veteran benefits
- Bank accounts
- Stocks and bonds
- Trusts and annuities
- Life insurance
In most states, Medicaid looks at your income over the last 5 years. Any assets you transferred out of your possession within that time may still count toward your income. Do not try to transfer financial assets in order to qualify for Medicaid.
You may be penalized for violating Medicaid rules. This can result in having to pay for your nursing home care out-of-pocket until you meet eligibility requirements.
Keep in mind that eligibility is on a rolling basis. It is possible to make as little as $1 over the monthly income limit and not qualify for the entire month. If this happens, you may have to pay for your nursing home care and related expenses yourself.
Types of nursing home coverage. You have three nursing home options with Medicaid:
- Skilled nursing – care related to medical issues and related services
- Rehabilitation – staying in a facility short-term following an illness, injury, or surgery
- Long-term care – around-the-clock care at a facility because of a mental or physical condition
Paying for a Nursing Home With Medicaid
Your Medicaid policy pays a fixed daily rate to nursing homes, so you owe nothing out of pocket. Items covered by this daily rate include:
- Cost of nursing care
- Specialized rehabilitation needs
- Social services
- Room and board
- Meals, including unique dietary needs
- Prescriptions and over-the-counter medication
- Personal hygiene items
Nursing home residents may have to pay extra for:
- A private room
- Special meals aside from dietary needs
- Electronics like phone, TV, internet, and radio
- Comfort items like tobacco products and snacks
- Cosmetic items
- Magazines and books
- Gifts for self or others
- Flowers or plants
- Outside social events
The tradeoff is that you must give up most of your income to Medicaid. As a nursing home resident, Medicaid allows a $130 a month stipend. You pay your state your monthly income minus the $130 stipend each month. For example, if you make $1,500 per month, you pay your state $1,370 and keep $130.
If you have to pay out-of-pocket deductibles for doctor and hospital visits, you can deduct them from your monthly income. This empowers you to pay for long-term care. You pay the state less based on your monthly medical expenses.
New Medicaid eligibility. Many times, people move to a nursing home and exhaust their income paying for care. After using your assets, you may be eligible for Medicaid regardless of past denial. If you already live in a nursing home but it is not Medicaid certified, you may have to move. Medicaid only pays for certain nursing home facilities.
Before making any Medicaid nursing home decisions, talk to an attorney. If you own your home, Medicaid may count that as an asset to use for nursing home payment. When you pass away, Medicaid may have rights to claim the property to cover part of your long-term care expenses.
Choosing a Nursing Home
Lifestyle. Think about aspects of your care that are important to you. Can you maintain a lifestyle similar to what you would at home? If you follow a religion, consider whether you can attend or watch worship services.
Location. You may want to live near family so they can visit easily. If you live in a town with no relatives, consider moving to an area closer to someone in your family.
Ask for recommendations. Talk to your friends and family about what they think. Chances are, they know other people in nursing homes who can share pros and cons.
Call ahead first. Before visiting, call and ask questions over the phone. Make a list of answers for each facility to compare notes easily. Write down any remaining questions you have so you can address them in person or when you call again.