Medicaid Nursing Home Requirements

Round-the-clock nursing home care is expensive. State Medicaid funds kick in to cover costs for many patients, but only after individuals have "spent down" their assets.
  1. Cost

    • For private pay patients, the average annual cost is about $79,935 for a private room, according to the 2009 MetLife Market Survey of Nursing Home. Medicaid funds cover facilities certified by the federal government, according to the Centers for Medicare & Medicaid Services.

    Individual Spend Down

    • The funds pay for care when a nursing home patient's overall monthly income falls below a certain level, for example $2,022 in Alabama, according to the state's Medicaid division. More information may be found from your state's Medicaid office.

    Couple Spend Down

    • When only one member of a married couple enters a nursing home, certain assets are protected. Most states consider a spouse's home and car exempt from the income requirements, according to CMS.

    Protecting Assets

    • Individuals with too much monthly income commonly set up a qualifying income trust, which comes with strict conditions. Many individuals consult an attorney or contact a local Area Agency on Aging for guidelines, according to CMS and state Medicaid divisions (see Resources).

    Medicare Payments

    • While state Medicaid programs cover the majority of nursing home care, the federal Medicare program pays in some cases. A State Health Insurance Assistance Program can provide information on specific cases.

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