ON
THIS PAGE: What
You Should Know | For More Information
If you're thinking about nursing home care, you probably wonder how much
it costs -- and how you will pay for it. You probably already know that nursing home care
is expensive. The average cost is close to $50,000 a year. Like many people, you may think
Medicare pays for it, but unfortunately it dosen't. Medicare covers only short
periods of skilled nursing home care after a hospital stay. So how do people manage the
cost of nursing homes?
 | Many have private
long-term care insurance.
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| Almost a third pay all the costs out of their own pockets.
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| Many
receive help from Medicaid, the government health care safety net program for lower-income
people or those impoverished by high medical expenses.
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Many nursing home residents pay the full cost of their care when they are
admitted, but they deplete their savings and other assets paying for care and then qualify for Medicaid.
Medicaid
is funded and regulated by both federal and state governments. As a result, Medicaid
rules are different from state to state. This fact sheet provides general information on
minimum benefits and requirements set by federal law. It is important for you to learn
your state's specific requirements.
What does Medicaid pay for?
| Medicaid will pay the part of your nursing home costs
that your own income doesn't cover. In most states, you cannot keep more than $30
to $50 a month for personal needs.
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| Medicaid will cover all your
nursing home care as well as some basic needs, such as toiletries and over-the-counter
medications. It will not pay for clothing.
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| Medicaid
will pay for prescription drugs and some other services not paid for by Medicare.
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| The bottom line: |
Medicaid coverage
of long-term care varies by state. Learn your state's rules. |
As
a Medicaid beneficiary, will I be treated the same as if I paid out of my own pocket?
You have a right to the same basic care and services that private pay residents receive.
However, the federal government and a majority of states let nursing homes restrict the
number of people they serve who are eligible for Medicaid so you could have a problem
finding a Medicaid placement. Nevertheless, the law guarantees Medicaid beneficiaries
certain rights.
Nursing homes:
| Cannot make you agree to pay privately for care for a period
of time before you apply for Medicaid or make a "donation" in order to be
admitted.
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| Cannot require a third party
(for example, a son or daughter) to guarantee to pay for your care.
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| Cannot make you pay privately
for any services or products that are covered by your state's Medicaid program.
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To qualify for Medicaid,
generally you must:
| Have $2,000 or less in savings and other assets. Some assets are
not counted, such as your home or a burial fund.
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| Meet the income requirements
set by the state. You may also qualify for Medicaid if your income is higher than this
limit but your nursing home bills and medical expenses exceed it.
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| Undergo a screening to make
sure you meet the state's medical and functional criteria for nursing home care.
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To use Medicaid, you must be in
a nursing home that accepts Medicaid. Most, but not all, nursing homes do.
Can I be forced to sell my home if I get
Medicaid?
Your state is required to recover money from your estate to cover
what it spent on your nursing home care. Therefore, the state may place a lien on your
home. However, it cannot require you to sell your home while you are living if there is a
reasonable chance you will go back there, or if you have a living spouse or dependents.
Ask a lawyer, the long-term care ombudsman, (see "For More Information" below),
or your local Medicaid office for details about your state's laws and practices on
"Medicaid estate recovery."
Should I try to protect my assets or give some of my money to
relatives before I qualify for Medicaid? You
may have heard of people giving their assets to relatives or using legal loopholes to
qualify for Medicaid without "spending down" their savings. Congress has
closed most of the loopholes, and there are penalties for improperly transferring
assets. Unfortunately, the law sometimes punishes good deeds.
If you are considering giving money or other assets
to help out a family member -- for example, to buy a new home or finance a college
education -- your gift could affect your eligibility for Medicaid. If the gift
occurs within three years of the date you apply for Medicaid, the amount you give away
could be considered assets you should have spent toward your care.
Consult a qualified financial advisor or an attorney
trained in "elder law" if you are considering protecting assets through a
trust or another means, or giving some of your assets to others.
What will my spouse live on if I'm in a nursing home
on Medicaid? If you are married, you can ensure that your spouse's resources are
protected to the maximum extent allowed by the law. If you're considering Medicaid, it is
important to know your state's policies on spousal protection.
Generally:
| Your spouse can keep at least $1,382 a month in income,
though your state may allow him or her to keep up to the federal maximum of $2,049.
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| Your spouse can keep between
$16,392 and $81,960 in assets (in addition to your home and some other assets).
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| Your state cannot force you
to sell your home while your spouse or dependent children are living, if they do live in
the home.
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The long-term care ombudsman is an
advocate for all nursing home residents. The ombudsman in your state or local
community can inform you about your Medicaid rights and help with any problems you have.
State and local agencies on aging also can provide
information about eligibility and residents´ rights in your state. You can obtain
Medicaid information from your local or state Medicaid agency.
For the phone numbers of these offices in the state
or area in which you want Medicaid assistance, call the Eldercare Locator, 1-800-677-1116,
Monday through Friday, 9 a.m. - 11 p.m. Eastern time.
Web Resources
Health Care Financing Administration (HCFA)
Legal Services Corporation
Legal
Services offices can inform you about Medicaid rights and help you resolve Medicaid
problems. You can locate the nearest you on their website.
URL: www.ain.lsc.gov/pguide/pdir.htm
National Academy of Elder Law
Attorneys (NAELA)
NAELA has prepared a guide,
Questions & Answers When Looking for an Elder Law Attorney, for individuals who are
considering hiring an attorney. URL: www.naela.org/naela/questions.htm
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