Limits on income and assets to qualify for Medicaid to pay for nursing home?

A fellow caregiver asked...

What are the limits on income and assets to qualify for Medicaid to pay for spouse's nursing home?

Expert Answer

If a woman's spouse needs long-term nursing home care, he may be eligible for Medicaid coverage of that care even though she keeps the family home and a substantial amount of other assets, as well as some regular income.

The Family Home . She can keep the home she owns and lives in, regardless of its value. However, two other important Medicaid rules relate to home ownership:

  • If the couple's home equity is over a certain limit, they might not qualify for Medicaid nursing home coverage at all. That equity limit varies from state to state, ranging between $500,000 and $750,000 
  • Medicaid will not force one spouse to sell the house. But Medicaid has a right to be reimbursed out of the value of the house, once both have died, for the entire amount it winds up spending on one person's nursing home care. Medicaid seeks reimbursement by making a claim against their estate. And to help collect this reimbursement, Medicaid may place a lien on the house while the surviving spouse still lives in it. As long as either partner in the marriage is alive, however, Medicaid will not enforce the lien. To learn more about this rule, go online to the Centers for Medicare & Medicaid website page called Estate Recovery .

Other Assets. She will be allowed to keep other assets -- such as bank accounts, stocks, bonds -- in an amount between $21,912 and $109, 560. The exact amount of this Protected Resource Amount (PRA), as Medicaid calls it, varies from state to state. Assets in excess of the state's PRA would be considered available to her spouse to pay for his nursing home care. She is also allowed to keep a car of any value, household and personal items, a wedding and engagement ring of any value, as well as life insurance with a cash value of $1,500 (for each partner in the marriage) and a separate savings account (of up to $1,500 for each person) to pay for burial expenses.

Income. Medicaid allows her to keep monthly income of between $1,750 and $2,739, depending on the state where they live. Income beyond the state's limit must go to help pay for her spouse's nursing home care.

To learn more about the rules concerning assets and income that may be retained by the spouse (called the Community Spouse) who remains at home, go online to the Centers for Medicare & Medicaid website page called Spousal Impoverishment .To find out the specific limits on house value, other assets, and income for her in the state where they live, go online to any search engine and enter Medicaid and the name of their state. Or you can call the Eldercare Locator toll-free at (800) 677-1116 and ask for the number of the state's Medicaid office.