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What does it take to qualify for Medicaid status in nursing homes?

From , former About.com Guide

Updated: September 14, 2004

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Question: What does it take to qualify for Medicaid status in nursing homes?
Answer: (Q) - Can a nursing home that participates in medicaid require you to be self pay for 1 year before they will accept you as a medicaid resident?

(A) - Medicaid is a federal program administered at the state level that provides health care for low income individuals. It also pays for nursing home care for low income elderly and disabled Medicare recipients who require that type of care. To qualify for Medicaid the potential recipient must meet a means test - their income and assets must be under a certain level as determined by the individual state. Most states use a percentage of the Federal Poverty guidelines as the measuring stick to determine eligibility for Medicaid.

When someone applies for Medicaid to cover the costs of nursing home care a case worker will investigate the financial status to help make the determination if that person meets the qualifications for coverage. Income includes wages and pension payments and assets can include items such as savings, cars, homes and valuables that may be owned by the applicant.

If during the application process the persons assets are determined to make that person have income over the set amount in the guidelines they may have to enter the nursing home as a private pay resident and "spend-down" those assets. This may involve selling those assets for cash to pay the nursing home bill. Most nursing homes that accept Medicaid payment will be able to help the patient or family with the application process.

If there is a spouse who will not be living in the nursing home, they will not be required to become destitute in order to pay for the care (for example selling a home to pay for care), but Medicaid can require some "payback" for care after that spouse has died by billing the estate.

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