Medicaid assistance is available to pay for a Medicaid applicant’s nursing home care and other long-term care services. In order to qualify for Medicaid for nursing home Medicaid benefits, the Medicaid applicant must meet eligibility requirements related to the applicant’s countable assets and level of care needs.
Medicaid assistance is available to pay for a Medicaid applicant’s nursing home care and other long-term care services when a nursing home level of care is needed. In order to qualify for Medicaid for nursing home Medicaid, the Medicaid applicant must meet eligibility requirements related to the applicant’s countable assets and eligibility criteria regarding the level of care needs of the applicant.
With respect to financial Medicaid eligibility requirements, the asset limit for countable assets (as opposed to non-countable assets) are under $6200 (in Missouri). If the prospective applicant’s assets are above this limit, then the long-term care recipient would be expected to spend down their assets through private pay until their countable assets are below the asset limit Medicaid will pay for nursing home costs for room and board (there is no income limit for Medicaid qualification in a skilled nursing facility).
In addition to being under the applicable resource limit for Medicaid benefits, the applicant must also fully require a nursing home level of care in order to receive Medicaid long term care assistance. Assessments and medical records can be used to make this determination and are part of the Medicaid application process.
Finally, the nursing home’s resources are part of the equation as well. The nursing home must have a “Medicaid bed” available to bill the Medicaid recipient’s room and board to the state agency. Each nursing home has a certain number of beds available to bill to the state (some nursing home’s beds are all Medicaid beds).
Once the applicant has qualified for Medicaid, the state will pay for the care recipient’s room and board, less the person’s income. The care recipient’s income is due to the nursing home each month as care recipient’s co-pay for care. Medicaid will, however, reduce the amount of income due to the home by a small amount for a monthly personal needs allowance. Typically, the Medicaid recipient will share a room with a roommate; private rooms are rarely available for Medicaid recipients.
Prior to applying for Medicaid, or for requiring care, Medicaid planning should be initiated. Adjusting estate planning, determining if any previous gifts within the Five Year Look Back Period have been made causing a Penalty Period before Medicaid benefits will begin, should all be analyzed as early as possible.
It should be noted that most of these requirements will also come into play if the applicant is applying for home and community based services (HCB) for in home care. In some cases, the use of a qualified income trust will need to be utilized (a tool not required for nursing home Medicaid).
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