If your loved one needs constant care, or has experienced a recent downturn in health, you may be faced with the difficult decision to place them in a nursing home or assisted living facility. In some cases, it isn’t the emotional reaction that families fear the most—it’s finding a way to pay for the significant costs of long-term nursing care.
Paying for Long-Term Care is Expensive!
If you are reading this, chances are you do not want to ever live in a nursing home. Most of us want to live a long, healthy life, live at home as we get older, and pass away peacefully in our sleep. But many of us do not get that chance. As we age, even though we want to stay at home, the transition to long-term care often occurs quickly, such as after a fall, stroke, or other quick downturn in health. From home, we often go to the hospital and from the hospital we often go to get stronger in the skilled nursing facility/rehabilitation center. Part of this process means thinking about paying for long-term care.
Will Medicaid Pay for Long-Term Care in the Nursing Home?
Medicaid was created to ensure that people who have very few resources can still get the late-in-life care they need. In Florida, Medicaid can be used to pay for an elderly relative’s nursing home, assisted living facility, or in-home nursing care. For those who qualify and are accepted, Medicaid pays a fixed daily rate to cover costs such as a patient’s room, meals, staff care, and medical supplies, possibly for the remainder of their life.
However, Medicaid will only pay for nursing home care if your loved one meets the program’s eligibility requirements, including:
- Needing a nursing home level of care. In general, nursing home care is required if a loved one’s medical condition, mental state, physical restrictions, or other vulnerability makes require the skills of technical or professional personnel such as nurses, physical therapists, and occupational therapists. In order to be deemed skilled, the service must be so inherently complex that it can be safely and effectively performed only by, or under the supervision of, professional or technical personnel.
- In Florida, the doctor will confirm nursing home care is needed through the AHCA Form 3008, which the nursing home will help complete for you.
- Income must be below threshold: Medicaid only accepts you if your income is below a certain level. Residents are allowed to keep a small allowance of their income for personal needs (such as entertainment, snacks, and personal products), but must stay under the income limit. For example, the 2023 Florida income limit is $2,742 per month with a personal needs allowance of $130 per month.
- If income is over the limit, a qualified income trust must be used in order to gain Medicaid eligibility.
- The income limit does not apply to the spouse at home (known as the community spouse).
- Assets must be below threshold:
- For a single person, the Medicaid applicant is only able to have $2,000 in countable assets
- For a married couple, the couple is allowed to have a total of around $150,000 in countable assets to allow one spouse onto Medicaid.
- A good elder law attorney can help protect assets as a part of the Medicaid application.
- Countable assets generally include bank accounts, stocks, bonds, etc., but do not include the applicant's homestead*
- There is an exception to this rule if the applicant is unmarried and the home is worth over $688,000 (2023).
- We have more on financial eligibility on this webpage.
- Contributions to long-term care. Keep in mind that the income threshold is just to qualify for long-term care Medicaid. When receiving care in a nursing home, the Medicaid recipient needs to give up nearly all of their income as partial payment for their care. For example, an applicant who makes $2,000 per month under the Medicaid income cap, but they will have to pay $1,870 of their income to the nursing home (known as the Patient's Responsibility).
- We have a lot more on income and married couples on this webpage.
- Owning minimal assets. Medicaid is available to people who have few resources that could be used to cover the costs of care. However, applicants do not have to give away all of their assets to qualify—in fact, this can work against them. Medicaid has a 5-year look-back period to determine whether any assets have been transferred (i.e, gifted) for less than fair market value. A good elder law attorney (like us!) can advise on how to protect assets and can provide proper spend down planning, even when the elder is already in the nursing home.
- Many people think about how Medicaid effects their homestead property. One key thing to know is that Medicaid does not take your home away, even upon death.
- Nothing is Easy. When your loved one needs long-term care, nothing is easy. Friends, family and even people working in healthcare think they know good advice. Here are some common Florida Medicaid myths you should read about if you are helping yourself or your loved one.
Even if you meet these requirements, you may still have trouble securing a nursing home residency. For one thing, not all nursing homes and assisted living facilities accept Medicaid payments (The American Council on Aging offers a search tool to find facilities near you that accept Medicaid). Medicaid also counts any gifts and property transfers made up to five years before the date of application, which could delay your eligibility and force you to pay for immediate costs of care out of your own pocket.
It’s possible to secure the care you or a loved one needs without sacrificing everything you have built over your lifetime. By starting the Medicaid planning process early, an experienced elder law attorney can redirect income and assets over the Medicaid limit, keeping your heirs’ inheritances safe while you receive long-term care.
Questions to Ask if Your Loved One is in a Nursing Home
If your loved one just went to a nursing home, you may have a lot of questions swirling around, such as:
- How long will insurance pay for rehab?
- What about the Medicare co-pay?
- Is my loved one responding to therapy?
- Is the power of attorney in place?
- Should my loved one go home after rehab is over?
- How do we pay for care if my loved one cannot go home?
- What does long-term care mean?
We have a lot more about common questions if your loved one just went into the nursing home.
Can Assets be Protected?
If your loved one's assets are over the asset limit, it may be possible to protect assets are part of Medicaid spend down planning. The key to spend down planning is knowing that this can happen, even if your loved one is already in a nursing home.
How Good is Care on Medicaid?
There are few of us that will ever want to be in a nursing home, but sometimes, that is the only place we are able to get necessary care. So if we have to be in the nursing home, one question people often have is do nursing homes that accept Medicaid provide good care? The basic answer is that medical providers, such as nursing homes, cannot discriminate against patients based upon payer source. This means that those who private pay for the nursing home at over $12,000/m get the same quality of care as those on Medicaid. I answer this question here if you want to learn more.
What About Medicaid at home or in the Assisted Living Facility?
Medicaid pays for both the nursing home and assisted living/in-home care but the rules differ in subtle but important ways. If your elder wants Medicaid for the assisted living facility or for in-home care we have more on Assisted Living Medicaid in Florida to assist you.
Moving Your Loved One to Florida?
If you are thinking about moving your loved one to Florida to get long-term care, we have a great article on how Medicaid works when relocating to Florida.
Need Help with Your Elder?
We charge $200 to consult with our elder law attorney where we will:
- Evaluate your elder's situation
- Translate the issues you are having - there is a great deal of bad information you will receive in helping your elder - we cut through the BS!
- Review the estate plan/durable power of attorney (very, very important!)
- Discuss how Medicaid may help your elder's situation
- In the event you need further help, we will quote a fee for any services
We can help your elder no matter where you live! We have done thousands of Medicaid applications helping families in difficult situations and we are glad to help you.