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Medicaid Eligibility & Nursing Homes

Nursing home care costs can be prohibitive, particularly for individuals who do not have savings set aside or adequate insurance coverage. Learning more about the rules that govern Medicaid eligibility and nursing homes can help determine if someone qualifies for Medicaid and if nursing home-related expenses can be covered by this program.

  1. Medicaid Certification

    • Not all nursing homes, assisted living, and managed care facilities are automatically covered by Medicaid. To be covered, the facility must be classified as a Medicaid certified facility by the state.

    Qualifying For Medicaid

    • Individuals must meet both the federal and state eligibility requirements. State requirements vary and may be complex. In general, Medicaid eligibility is determined by three factors: age or disability status, income, and assets. The minimum age to apply for Medicaid is 65, but individuals who are blind or disabled may qualify regardless of age.

    Income Rules For Medicaid

    • For married couples, the income of both spouses is taken under consideration, regardless of whether one or both are applying for Medicaid. Income eligibility guidelines are determined by the federal government, but how that income is determined varies by state.

      Some states allow individuals to qualify for Medicaid based on their income and the amount of medical bills that they owe. In other states, income only is considered.

    Asset Rules For Medicaid

    • When determining Medicaid eligibility for nursing home assistance, countable assets including second vehicles, vacation and investment property, bank accounts, stocks, bonds, and related assets are taken into account. In some, but not all states, selling off assets is permitted to become eligible for Medicaid.

    Considerations

    • Because the rules governing Medicaid eligibility and nursing homes vary by state and can be complex, anyone who is considering applying for Medicaid should do so as soon as possible. Then, if they qualify, they will have their benefits in place before the need for nursing home care arises.

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