Medicaid Coverage Nursing Home

For better and for worse, Medicaid is the primary method of paying for nursing home care in the United States. But navigating the Medicaid system is complicated and confusing. Here are the basics.

Medicaid covers long-term care for those who qualify. This coverage has traditionally meant care in a nursing home, although coverage of care in an assisted living facility or at home are possible as well.

In the absence of any other public program covering long-term care (Medicare provides only very limited rehabilitation coverage) Medicaid has become the default nursing home insurance of the middle class. Lacking access to alternatives such as paying privately or being covered by a long-term care insurance policy, most people pay out of their own pockets for long-term care until they become eligible for Medicaid.

To qualify for coverage, applicants must have limited assets and income. You typically cannot have more than $2,000 in assets. To lower your assets, you would need to either spend them down by paying for things that benefit the Medicaid applicant, or speak with a Medicaid Attorney and create a strategy to avoid the five year look back period.  You cannot simply give away your resources in order to qualify for Medicaid.

In addition to the strict income and asset limits, you must meet level of care requirements in order to qualify for nursing home coverage. Florida looks at an applicants’ functional, medical, and cognitive abilities to determine if they need care in a nursing home. You are usually determined to need long-term care if you need help with two or more “activities of daily living”  (such as bathing, dressing, eating, moving, and going to the bathroom). But to need a nursing home level of care, you may also need frequent medical care, such as assistance with medication, injections, IVs, or other medical treatment. The state may also consider your cognitive abilities—i.e., whether you have the ability to make decisions on your own.

Once you qualify for Medicaid, the program pays for all your basic expenses.

In addition to nursing home care, Medicaid may cover some home health aide services or care in an assisted living. Home care is typically provided through home- and community-based services “waiver” programs to individuals who need a high level of care, but who would like to remain at home.