Will Medicaid pay for nursing home care?

A fellow caregiver asked...

If someone runs low on funds, will Medicaid pay for nursing home care?

Expert Answer

It depends on her income and other financial assets at the time she applies. In general, Medicaid, which is a federal program, provides medical and long-term care for people with low income and few assets (no more than a few thousand dollars). The exact level of income and assets varies somewhat from state to state; the value of a home the applicant lives in does not count in determining assets.

If someone meets the financial eligibility standards for the state where she lives, and her doctor determines that she needs nursing home-level care, Medicaid can pay the full cost of her residence in a long-term care nursing facility. Medicaid can continue to pay for care in the nursing home for as long as she remains there. If she has slightly too much income to qualify for full Medicaid coverage of nursing home costs, Medicaid may find her eligible on the condition that most of her income go to pay the nursing home costs, with Medicaid paying the rest of those costs.

Medicaid pays less for nursing home care than many nursing homes charge their privately paying residents. Because of this lower payment rate, nursing homes often will only offer a limited number of spots for Medicaid-paid residents. This means that if someone is already enrolled in Medicaid when she first looks for a nursing home, her choice of nursing homes would be restricted to those that have a spot open for a Medicaid-paid resident. However, if she already lives in a nursing home when she first becomes eligible for Medicaid, that nursing home must allow her to stay even if it otherwise has no spots open for new Medicaid-paid residents.

To find out the specific Medicaid eligibility rules and procedures for nursing home coverage in the patient's state, use any Internet search engine and enter the word Medicaid and the name of the state, which will take you to the official website of the state's Medicaid program. Or go to the Benefits.gov website and click on the name of the state. You can also call the Eldercare Locator toll-free at (800) 677-1116 and ask for the number of the Medicaid program in the patient's state.