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Will Medicaid Cover Nursing Home Expenses?

Many people in need of nursing home care simply do not apply for Medicaid because they think they are ineligible. They think that Medicaid is only for poor people and they do not understand that Medicaid may actually provide them with coverage.

Many more people apply for Medicaid to cover nursing home care and get denied on their first attempt. Instead of trying again and appealing the denial, they simply give up and take it for granted that they are not eligible. In reality, they may be able to appeal successfully.

Understanding Medicaid Eligibility Requirements

Medicaid eligibility requirements are complex. There are four eligibility requirements that must be satisfied in order to get coverage of a nursing home stay: categorical requirements, medical necessity, income eligibility and asset eligibility.

Categorical requirements state that a person must be at least 65 years old, blind or disabled. Medical necessity means that a person must have a medical need to stay in a nursing home. These two categories may seem straightforward, but issues could arise over proving disability or medical need for nursing home residency. There are specific documents and pieces of information that are looked for, and if they are not found a Medicaid claim may be denied on that basis even if a person is actually eligible.

Income eligibility and asset eligibility are perhaps the most confusing aspects of Medicaid eligibility. There is an income cap of $2,199 per month. However, pensions, retirement income and other income may be handled in a way that does not block eligibility. Another major stumbling block is asset eligibility. There is an asset cap of $2,000 for an individual going into a nursing home or $3,000 for a couple going into a nursing home. However, there are exceptions, including the family home. Furthermore, how assets are owned can impact whether they go toward the cap or not.

Ultimately, if you are interested in getting Medicaid coverage for a nursing home stay for yourself, for your elderly parents or other elderly relatives, you may benefit from a discussion with an elder law and Medicaid planning attorney.

At Wright Abshire, we are trusted for our ability to help people get the Medicare coverage they are entitled to in order to pay for nursing home costs. Whether you have not yet applied or you have been denied, we encourage you to contact us to learn more about your options for getting Medicaid benefits.