Frequently Asked Questions About Medicaid & Nursing Home Planning
1. What is the average cost of Nursing Home Care?
Answer: The average cost varies from state to state but with room & board, medication, etc., it
can easily run over $6,000 per month ($72,000 per year).
2. Doesn't Medicare pay for long-term care in a nursing home?
Answer: The first thing to remember is that Medicare will only pay for "Skilled" care in the
nursing home. Skilled care is the highest level of care generally preformed by physicians,
registered nurses, etc. Most care provided in a nursing home is "Custodial" care, meaning
assistance with "Activities Of Daily Living" such as bathing, eating, toileting, dressing,
walking, bladder and bowel control, taking medications, etc. Medicare pays nothing for the cost
of custodial care. Medicare will pay for 100 days of skilled care. However, Medicare only pays
100% of the cost for the first 20 days of "Skilled Care". For the next 80 days of Skilled Care,
Medicare only pays after the patient has first paid their daily co-payment of $128 per day (in
2008). If you have Medicare Supplement Health Insurance, it will pay the co-payment of$128
per day. But Remember, if at any time during the 100 day period, the care you are receiving
stops being "Skilled Care" and becomes only "Custodial Care", neither Medicare or your
Medicare Supplement will pay for the care. If that happens you will be on your own and will
have to private pay until you can qualify for some assistance in paying for Long Term Care.
3. How many "Countable Resources" can a "Single Person" have and still qualify for
Medicaid nursing home assistance?
Answer: Generally speaking, if a single person has more than $1,500 of "Countable Resources" he/she will not qualify for Medicaid unless they inform themselves about the Medicaid Rules and
engage in some Medicaid Planning.
4. How many "Countable Resources" can "A Couple" have and still qualify for Medicaid
nursing home assistance?
Answer: Generally speaking, the spouse at home (called the "Community Spouse") can retain
one-half of the couple's "Countable Resources" up to a maximum of $104,400 in 2008. The
other one-half, or all amounts in excess of $104,400, would have to be spent or repositioned into "Exempt Resources" before the "Nursing Home Spouse" can qualify for Medicaid.
5. If a single person or a couple have too many Countable Resources to qualify for
Medicaid, must they spend all of their excess Countable Resources on nursing home care
before they can qualify for Medicaid?
Answer: No. Depending on the circumstances of each case, there are Medicaid planning
strategies that can be utilized so that some (and sometimes all) of the excess Countable
Resources can be protected and still qualify for Medicaid.
6. Is it true that I can't do anything with my assets, including making gifts, within 5 years
of applying for Medicaid?
Answer: No. While it is true that Medicaid will inquire about any gifts or transfers of assets
within 5 years of applying for Medicaid, and may impose a transfer penalty for assets given
away, generally, with proper Medicaid planning, some gifting and transfers of assets can be
made.
7. If a person is already in the nursing home, is it too late to do Medicaid planning?
Answer: Definitely not! One always has the option of doing Medicaid planning to legally
qualify for assistance at the earliest possible time while protecting as many assets as the law
permits.
8. Will Medicaid take my/our home if we/I go on Medicaid?
Answer: No. The home is an "Exempt Resource" so long as the "Community Spouse" is living
there. For a single person, the home is exempt so long as there is a possibility the person may be
able to come back home. If the person can not come back home, then the home, in order to keep
Medicaid eligibility, will have to be offered for sale or rent. If the home can be sold, some of the
proceeds can still be protected.
9. Will all of my property and income be turned over to the Nursing Home or to Medicaid
if I go on Medicaid?
Answer: No. Nothing is automatically turned over to Medicaid or the Nursing Home. Once
Medicaid qualification is obtained, part of the "Nursing Home Spouse' s" income will have to be
applied to the nursing home bill and Medicaid will pay the rest. None of the "Community
Spouse's" income is required to be paid for the "Nursing Home Spouse's" nursing home
bill.
10. If I have received Medicaid benefits during my lifetime, will Medicaid take all of my
estate when I die?
Answer: While it is true that Medicaid can make a claim against the estate of a Medicaid
recipient, generally, in the process of Medicaid Planning the Medicaid recipient's estate will be
below $1 ,500 anyway. It is also important to recognize that Medicaid pays only about 66% of
what a "Private Pay Patient" would pay, so the amount Medicaid can claim against the estate is
going to be less than what you would have paid if you forgo Medicaid and just paid privately
until all of your assets were gone.
11. As the healthy female spouse, my monthly income from social security is small. My
husband gets more social security and also gets a pension. If my husband goes on Medicaid
will I lose all of his monthly income to the Nursing Home?
Answer: No. The Medicaid law permits enough of the "Nursing Home Spouse's" monthly
income to be given to the Community Spouse so the Community Spouse has a monthly income
between $1,712 and $2,610 (in 2008) depending on the expenses of the Community Spouse.
REMEMBER, with proper legal planning, the Medicaid applicant has many options available to preserve personal property and real estate for his or her future needs or the protection of his / her family. An attorney with expertise in Medicaid law can assist you in planning for the expenses of long term care as well as planning for the protection of resources for you and your family.