Eligibility for Long Term Care Medicaid

In 2016 the average monthly cost of nursing home care in Michigan is anticipated to be $8,282/month – nearly $100,000 year. Consequently, more and more people will apply for Medicaid benefits to pay for their nursing home expenses.

Medicaid is a joint federal-state social welfare program designed to pay for the long term care costs of impoverished seniors. The program is administered by the Michigan Department of Community Health (MDCH) and more locally through the Department of Health & Human Services (DHHS). There are asset and income eligibility limits. Generally, if the applicant owns more than $2,000 in “countable assets,” he will not be eligible for Medicaid. However, some assets are not “countable.” These may include a home, a prepaid funeral, a car, and household goods and furnishings, among others.

There are additional financial eligibility rules that apply to cases involving married couples. The spouse in the nursing home is the “Medicaid applicant”. His or her spouse living at home is considered the “community spouse”. When applying for Medicaid, the couple is required to disclose the total amount of their combined assets. Under the eligibility guidelines, the community spouse is permitted to keep one-half of the couple’s total countable assets up to a maximum of $119,220 (for 2015). This amount is considered the “protected spousal amount”. The remaining assets are subject to a “spend down” or other planning techniques in order to qualify for Medicaid benefits.

Additionally, for both singles and married couples, the applicant’s monthly income (Social Security benefits, pension, etc.) is considered. A portion of the applicant’s monthly income is applied to the cost of care in the nursing home and is referred to as the “patient pay amount”. This is similar in concept to a “co-pay”. It is the portion that the nursing home resident is required to contribute to his or her cost of care each month.

Becoming eligible for and applying for Medicaid can be a complex process. It is appropriate to consult with an experienced elder law attorney to understand the eligibility requirements as well as to assemble and submit the application for Medicaid benefits. There is no “one size fits all” approach for purposes of Medicaid eligibility. Accordingly, if you or a loved one is experiencing health problems or considering moving into an assisted living facility or a nursing home, you should consider meeting with an experienced elder law attorney to determine what options are available.