If I Leave The Nursing Home For A Short Time To Go To Hospital Or For Other Medical Treatment Or To Visit Family Will I Lose My Bed In The Home Or My Medicaid Coverage
There are a couple of answers here.
First, it depends on the nursing homes policy. If the nursing home has a lot of vacancies, it might not charge to hold the bed during every absence. But most of the time the nursing home will want to be paid to keep the bed empty instead of giving it to another paying customer. Most nursing homes operate very close to no vacancy status. In that situation they feel they can always find another resident to fill an empty bed. You should ask your nursing home what bed hold policy it uses.
Second, assume that the nursing home does want payment to hold an empty bed while the resident is temporarily absent. Will Medicaid pay to hold your bed while youre away? Yes, but only for a short time.
- Suppose there are Medical Reasons for the Absence, such as being sent to the hospital for an operation. West Virginia Medicaid will cover up to 12 days of bed hold per calendar year for medical reasons.
- Suppose there are Non-Medical reasons for the Absence, such as visiting relatives. West Virginia Medicaid will pay for only six days per year.
How To Find Nursing Homes That Accept Medicaid Near Me
Below are a few resources and tips for finding a Medicaid-approved nursing home in your area.
- Use Medicaid’s search tool. This online tool lets you look for pre-vetted facilities by Zip Code.
- Ask your doctors if they service any Medicaid-certified nursing homes.
- Ask friends, family, and colleagues you trust.
- Contact an Aging and Disability Resource Center .
- If you’re in the hospital, talk to a social worker about post-discharge care planning.
- They may be affiliated with or know reputable, certified Medicaid nursing homes.
Don’t Leave Your Hard-Earned Benefits Behind. Call to get connected with a licensed agent.
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There Are Medicaid Asset Limitations
Just as there are income caps, your assets cannot exceed a certain amount. This is usually the real shocker for people when applying for Medicaid. The limits differ depending on whether you are single or married.
If you are single, here are the most common assets you get to exclude from your asset calculation:
- Your home, furnishings, and personal belongings,
- Certain retirement funds
- Income-producing property
- Medicaid qualified annuities
- An additional $2,000
Therefore, if, for example, you have $20,000 in a checking account, $30,000 in a CD, and $50,000 in stocks and bonds for total non-excluded assets of $100,000, after deducting the $2,000 you get to exclude, you would have to pay out $98,000 to the nursing home before you would qualify for Medicaid benefits.
If you are married, you also must include ALL of your and your spouses combined assets and the total assets your spouse can then exclude is $137,400. Therefore, if your spouse has an additional $100,000 in cash, savings, and stocks and bonds in the above example, you would have combined non-excluded assets of $198,000. Deducting the $137,400 exclusion leaves $60,600 to be paid down before the applying spouse qualifies for Medicaid benefits. We will discuss how you can protect certain assets later.
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Can I Get Rid Of My Assets And Still Get Medicaid
Medicaid has a look back period of 5 years. If you or your spouse gets rid of an asset for less than a fair price within 5 years of applying for Medicaid, you might not get help. A fair price means the price at which you could have sold something to a willing buyer.
If you sell or transfer an asset for less than a fair price, Medicaid will set a penalty period. You will not be able to get Medicaid during the penalty period. The penalty period is based on the amount your asset was worth and how long it could have paid for your nursing home care. For example, if your home was worth $100,000 and the average nursing home care costs $4,000 per month, you would not be able to get Medicaid for 25 months. 100,000 divided by 4,000 equals 25.
Access to health care is very important. You cannot know what kind of health care you will need five years from now. Seek legal help before transferring any asset, including your home, for less than fair market value.
Medicaid is a complex program. Some of the rules change every month. You need to work directly with the Medicaid office to get full information.
We Can Assist You With Crisis Planning
Crisis planning is what we refer to when someone is about to enter a nursing home or is already in a nursing home and needs to apply for benefits. If that person has too much income or too many non-excluded assets to qualify, that is where we can assist you in qualifying for benefits by:
- reducing your income through a Qualified Income Trust, or
- applying other strategies, such as gifting, promissory notes, and qualified annuities to preserve a portion of your assets and help you qualify for benefits as soon as possible.
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What People Say About Us
“Jason and his team are responsive and communicate very well. Jason helped me to get the benefits that I qualified for much faster than expected. I would recommend him highly. My case seemed complicated to me, but Jason explained everything in detail and made everything go quite smoothly. I interviewed several elderlaw attorneys prior to choosing Jason Neufeld.”
“Quick turn around time for appointments, great response time, very thorough, never rushed through and soooo easy to do business with over the internet! Read the website info, very very helpful!”
âThe attorney Jason and his team are amazing at planning and execution. Me and my family would not trust anyone else with our estate planning needs.â
âI’ve been very impressed! A friend referred me and I’ve experienced nothing but perfect service and professionalism. I am extremely grateful!â
Will Medicaid Cover Nursing Home Care
There are different rules that apply when a person is applying for Medicaid just for nursing home care. Medicaid will only pay for nursing home care if you are approved for nursing home level of care. The nursing home should complete a Pre-admission and Continued Stay review to make sure you are approved for this care.
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Do I Have To Sell My House And Use The Money For Nursing Home Costs Before Medicaid Will Cover Anything
Not necessarily. There are two major exceptions. Your house will not be counted against your Asset limit for Medicaid if:
- Your spouse or dependent child still lives in the house or on the property or
- You sign a statement that you intend to return to the home or property whenever you are released from the nursing home. Even if there is no spouse or dependent child living there, the property will not be counted against your eligibility.
If you meet one of these two exceptions, your house will not be counted as an asset. If neither of these two exceptions apply your house probably will be counted against your eligibility.
There are some more detailed and complicated exceptions. For example, if other family members were living with you and taking care of you for a substantial time before you needed the nursing home. But those situations are beyond the scope of this article. Generally, if these two exceptions do not apply, you will have to sell the home and use the money for nursing home costs before Medicaid will provide coverage.
Medicaid Eligibility And Nursing Home Care
To qualify for Medicaid in Michigan, your income and assets need to be under about $2,000 in countable assets. This includes cash, savings, investments, or other financial resources that can be turned into cash. Assets that arent counted include your home, personal possessions, household goods, one vehicle, prepaid funeral plans, and some life insurance.
If you dont currently qualify based on these criteria, dont worry
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Dual Eligibility For Medicare And Medicaid
Finally, keep in mind that it is possible to qualify for and be covered by both Medicare and Medicaid simultaneously. Such individuals are known as dually eligible beneficiaries. With dual eligibility, Medicare pays for covered medical services first and Medicaid is considered the payer of last resort. For example, Medicare covers qualifying health care costs for doctors appointments, durable medical equipment and hospitalizations while Medicaid covers qualifying remaining expenses, such as Medicare premiums and cost-sharing requirements and long-term care services.
Keep in mind that coverage and benefits available for dually eligible beneficiaries vary by state. To learn more, read Dual-Eligible Beneficiaries: Some Seniors Qualify for Both Medicare and Medicaid.
Do All Nursing Homes Accept Medicaid
A majority of nursing homes accept Medicaid however, this is also largely dependent on the state you reside in. To avoid complications with payment and coverage, Id recommend checking with your nursing home facility to see if they are a Medicaid-certified nursing facility. If it is, then you should be eligible for coverage under the Medicaid skilled nursing facility.
In the event that you find out the nursing home is not Medicaid-certified, you would have to transfer to a nursing facility thats covered by Medicaid.
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Choosing A Nursing Home
Lifestyle. Think about aspects of your care that are important to you. Can you maintain a lifestyle similar to what you would at home? If you follow a religion, consider whether you can attend or watch worship services.â
Location. You may want to live near family so they can visit easily. If you live in a town with no relatives, consider moving to an area closer to someone in your family.â
Ask for recommendations. Talk to your friends and family about what they think. Chances are, they know other people in nursing homes who can share pros and cons.
Before visiting, call and ask questions over the phone. Make a list of answers for each facility to compare notes easily. Write down any remaining questions you have so you can address them in person or when you call again.â
Visit in person. Make sure you tour facilities when possible. You may not be able to go in person because of visitor restrictions. If this happens, ask for photos and videos of the rooms. Request detailed information about what living and care are like at the nursing home.â
If you can visit in person, make several trips. Visit at least once without announcing. Doing this gives you a better idea of what the facility is like on an average day.â
Show Sources
American Council on Aging: âMedicaid Coverage of Nursing Home Care | When, Where and How Much They Pay.â
Medicaid: âNursing Facilities.â
Service Options Using Resources In Acommunity Environment
Georgia Health Services Network embraces two Medicaid programs to assist residents with paying for Assisted Living Services SOURCE and CCSP . These programs are Medicaid based and help people pay for services they receive in a personal care home.
How much does it cost? Residents pay the personal care home $660 out of their monthly SSI check of $783. The remaining $123.00 is kept by the resident for personal needs. Keep in mind that the $660 pays for room and board which includes a bedroom, access to the rest of the home, 3 meals a day, snacks and bi monthly medical monitoring by a nurse.
How long does it take to become enrolled in the SOURCE Program? Provided that a prospective client is already enrolled on Georgia Medicaid it typically takes 2 months from start to finish for a client to be enrolled on ALS SOURCE Services. Clients can still move into the PCH while their application is in process. If you are moving in during the middle of the month, the amount due is pro-rated based on the number of days left in the month.
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When A State Can Recoup Benefits
After the Medicaid recipient dies, the state can try to recoup whatever benefits it has paid out. The home is usually the only major claimable asset. Currently, the state can only put a lien on it if it is part of the deceased’s probate estate. If the asset is jointly owned with a spouse or in a life estate or trust, then it can escape recovery.
In most states, the government can place a lien on the home after the death of both spouses, unless a dependent child resides on the property.
Can Medicaid Pay For A Nursing Home When Money Runs Out
Unlike Medicare, which only covers a part of a qualified individuals nursing home costs for up to 100 days, Medicaid is a joint federal and state benefit that can pay for a nursing home when money runs out. Medicaid is actually the largest payer for long-term care for seniors and, in most cases, will pay for the full cost of nursing home care, even if the applicant requires it for the rest of their life.
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Medicaid Coverage Of Nursing Home Care
Medicaid is a federal government program administered jointly with state governments, and it pays long-term nursing home costs for people with low income and few assets . Each state administers its own Medicaid program, with slightly different eligibility rules. In some states, Medicaid pays some of the cost of assisted living for eligible residents in participating facilities.
Alternatives To Assisted Living That May Be Covered By Medicaid
Finding the best care arrangement for a loved one can be a stressful process. While an assisted living community can offer care services and peace of mind, there may also be other options. Your state ultimately determines the type of services that are covered by Medicaid, but some of the following alternatives to assisted living may be available to you:
Recommended Reading: How Do You Get Medicare And Medicaid
Will This Article Tell Me Everything I Need To Know About Medicaid Coverage For Nursing Home Care
No way, not at all. We will try to cover some of the broad and frequent questions people have about coverage through Medicaid for long-term care. But the rules are far more complicated than we can explain in this kind of web page article.
Suppose you are not ready for nursing home care now, but its highly likely that you will need nursing care in the future. Get expert help and START PLANNING NOW! Talk with a lawyer who specializes in planning for Medicaid coverage for long-term care, especially if you have substantial savings and assets.
How Much Does Medicare Cover For Nursing Homes
Original Medicare nursing home coverage is intended for rehabilitation, not long-term care. It only covers a portion of nursing home expenses for a maximum of 100 days. Medicare calculates nursing home rates by time period, so your out-of-pocket cost changes over time. Below is a breakdown of what you’ll pay per benefit period during those 100 days:
- Days 21-100: $194.50 per day coinsurance
- Days 101 and beyond: All expenses
FYI: If you’re new to Medicare or just want to learn more about the program, head to our 2022 Medicare guide. It covers everything you need to know about coverage and enrolling, and it answers the most frequently asked Medicare questions.
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Va Benefits For Nursing Home Care
The Department of Veterans Affairs can also help provide long-term nursing home care and other support services. The VA has its own nursing homes that can be contracted out to other community and state organizations. In some places, the VA may manage their own nursing homes.
There is another VA sponsored program that includes medical foster homes that contract with the VA to care for veterans. A medical foster home is defined as a VA-approved residential home that houses one or more veterans. This same medical foster home will also be under the care and responsibility of a VA medical team, which will provide services on-site as needed.
With these types of programs, veterans have to meet the criteria of physical or mental ailments that require nursing home care. This is determined by the VA when you apply to a VA nursing home.
Here are some other requirements:
- Veterans with a service-connected disability of at least 60 percent or are considered disabled according to VA guidelines.
- Veterans can also qualify for nursing home care without a service-connected disability who meet VA criteria for income and asset levels, like with Medicaid.
The VA may pay all or a portion of care in a VA contracted nursing home. It is advisable to apply for VA nursing home care as soon as you think you may qualify, as beds may be limited with other patients on a waiting list.
What Do Va Long
For extended care services, veterans may be subject to a co-payment of up to $97 per day. The amount of the co-payment depends on the veterans VA health system priority group and individual financial circumstances, and also on the type of care or service provided. The amount of co-payment for extended care services is based on income, and for some services, co-pay amounts are based on the assets held by both the veteran and the veterans spouse.
For extended care services expected to last 180 days or less, the VA looks only at the income of the veteran and spouse, taking into account the veterans expenses. For extended care services expected to last 181 days or longer , the VA looks at the income and the assets of the veteran and spouse. Details of these financial calculations are available from the VAs publication VA Copays and Charges.
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