Medicaid Coverage and Nursing Homes

Medicaid is a joint federal and state program that provides medical care and coverage to under privileged people. The application process is nothing less than torturous and the aide workers will look closely at assets and require the spending down of personal assets before a patient will qualify for Medicaid. This is called the means test. Some applicants will be required to use their assets to pay for care before Medicaid will pay for nursing home care. Once admitted to the program Medicaid will pay for most nursing home care including room and board, custodial care and nursing staff, therapists and doctors, durable medical equipment and prescription drugs.

What is not Covered by Medicaid?

Medicaid coverage doesn't cover everything in every nursing home. First, the nursing home must be a Medicaid approved provider. In addition, there is a standard list of things that Medicaid will not cover. When choosing a nursing home ask for a list of services and items that are covered and are not covered by Medicaid. Every nursing home has this list and they are required by law to give you a copy so that you will know in advance the costs that will not be paid for by Medicaid. Things that are generally not paid for include a private room, telephones and televisions. In addition, Medicaid will not pay for podiatrists, alternative medicine practitioners and independent specialists. Again, ask the nursing home for a list of their Medicaid approved providers.

What Happens if Only One Spouse Needs Nursing Home Care?

Medicaid requires that beneficiaries spend down their assets before qualifying for Medicaid. However, this spend down is limited if there is another spouse living at home. The spend down should not leave the spouse impoverished. However, the spend down may be too much for some individuals. For example, only a small saving account is allowed and the spouse in the nursing home may be limited to a personal budget of $60.00-$90.00 a month to meet personal needs.

In summary, if you are too poor to pay for nursing home care, Medicaid will provide substantial coverage in a Medicaid approved facility. Qualifying for Medicaid includes a means test and the application process can be very lengthy and difficult. Once admitted into the program patients are usually covered for life. A spouse is not required to become destitute to meet the means test. However, the remaining amount that is left to the spouse and to the nursing home recipient makes Medicaid the choice of last resort for most families.