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Qualifications to Receive Medicaid for Nursing Homes

Funded through federal and state governments to provide health care insurance for low-income groups who are medically needy, Medicaid's income eligibility rules are very strict. Certain requirements exist to meet eligibility for Medicaid coverage, and each state sets its own regulations. Generally, Medicaid coverage extends to the blind, disabled and elderly, and to pregnant women and their children. Medicaid only covers U.S. citizens and legal immigrants.

  1. Medicaid Coverage and Low-Income Requirement

    • Medicaid covers medical costs for hospital visits, doctor visits, dental costs and vision care, in most cases to select providers. Most states' Medicaid programs base their income limit amounts upon federal poverty guidelines. Coverage for Medicaid begins upon approval of the applicant's limited income and resources certification by the local Medicaid office. Coverage can be retroactively applied for up to three months, if the applicant was eligible for that period. Coverage ends at the end of the month when the recipient's financial or medical circumstances change.

    Spend-Down Income Requirement

    • Elderly and disabled individuals may need to enter a long-term nursing home or assisted living facility. Prior to admission, the facility's patient care manager or caseworker will determine whether the individual's financial resources are sufficiently limited for Medicaid coverage. If the applicant's assets and resources exceed the income limitation, then the state's Medicaid rules may require spend-down. If a patient is required to spend-down available assets, he pays for some care with his own funds, exhausting a significant portion of his estate. The spend-down period lasts six months and is simply the program's process of subtracting medical bills, in this case, nursing home bills, from the individual's total income. Only those nursing home costs and expenses that exceed the Medicaid resource limit are eligible for coverage. Each state sets its own rules to establish income limits for Medicaid spend-down eligibility.

    Spousal Impoverishment Exception

    • If the applicant is married, and the spouse is living within the marital home, then Medicaid's financial hardship exceptions can apply. Medicaid will allow the spouse to remain in the home so long as the home serves as the spouse's primary residence. Medicaid rules also allow an asset exception for one personal vehicle.

    Look-Back Transfer Rules

    • Medicaid programs do not allow applicants to transfer funds to relatives or friends in an effort to exhaust resources. Medicaid uses a "look-back" method, which scrutinizes all financial transfers during the last several years.

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