Medicaid is federally funded program administered at the state level that provides health care for low income individuals. It's not surprising that anything run by the federal government is going to be complex and detailed, and the rules and circumstances involving Medicaid are no exception. The rules vary by state, but applicants must generally meet physical, income and asset guidelines. The good news is that nursing homes that accept Medicaid, and not all do, will help potential residents and their families with the application process.
Not all nursing homes are approved by Medicaid. However, in our nursing home directory we offer a comprehensive listing of over 15,000 nursing homes in the United States which are covered by Medicaid (and Medicare) and includes 5-Star Quality Ratings to help you make an informed decision.
In general, when someone applies for Medicaid to cover the costs of nursing home care, then a social worker is assigned to the case to investigate the person's financial status to help make a determination if the applicant meets the qualifications for nursing home care coverage.
Medicaid will pay for room and meals, the nursing home staff, nurses, therapists, doctor's visits, some prescription drugs, dental care, medical equipment such as wheel chairs, eyeglasses and hearing aids. It won't cover a private room, television, or telephone expenses or most physical therapy services.
The most important rule for the public to understand is that there is a 5 year look back concerning the transfer of assets. Elliot S. Schlissel, an attorney who specializes in Medicaid and estate planning explains, "If you have assets and you wish to protect them for future generations, it is important that you see an attorney that handles estate work. Planning can be done to insure that if you do end up in a nursing home, all of your assets including your home, stocks, bonds, pensions, 401(k) and savings won't be utilized to pay for long term nursing care. You cannot wait until you are very elderly and sick to use this type of estate planning. It must be done a minimum of 5 years prior to the need for nursing home or rehabilitation care."
In the past, Medicaid required the spouse still at home to be left virtually penniless with virtually no assets. Currently, Medicaid rules include certain "spousal impoverishment" provisions. Under the "spousal impoverishment" provisions, the spouse at home gets to preserve certain resources when the other spouse enters a nursing facility. Besides allowing the healthy spouse to preserve assets, there are also "maintenance allowance" rules that make sure the healthy spouse has sufficient income to live on. Typically, the healthy spouse can keep when it comes in under their name, including: