How Much Does Medicaid Pay for Long-Term Care?

Medicaid is one of the most common payers of long-term care in the U.S. But how much of your care costs will Medicaid actually cover? Since Medicaid is designed to help individuals with limited income and assets, there is no standard co-pay. Instead, the amount paid by Medicaid varies depending on the recipient. First, it’s important to be aware of what Medicaid covers in the context of long-term care.

Read More: What is Medicaid?

What Does Medicaid Cover?

In short, Medicaid pays for an individual’s room and board, pharmacy, and incidentals in a Medicaid-approved facility. This includes necessities like lodging, meals, laundry, and utilities as well as support from the nursing staff, which may include the administration of medication, assistance moving around, and help with other activities of daily living.

In most states, Medicaid-approved facilities include nursing homes. However, not all nursing homes are certified to accept Medicaid patients, and not all beds in a nursing home can be used for Medicaid patients. Some states also offer Medicaid waivers for Home and Community-Based Services (HCBS), such as assisted living facilities and at-home care.

Read More: What Assets Can You Keep on Medicaid?

Determining Your Medicaid Co-Pay

As mentioned before, instead of having a standard co-pay, the amount covered by Medicaid is based on your income. In order to determine your individual Medicaid co-pay, start by taking your total monthly income from all sources. Next, subtract your Personal Needs Allowance. This allowance varies by state but is typically around $50. Then, deduct any qualified medical expenses, such as health insurance premiums. And finally, if you have a community spouse at home who is eligible for an income shift based on the Monthly Maintenance Needs Allowance (MMNA) rules, deduct that amount as well. The resulting amount is then paid to the facility as your Medicaid co-pay, and Medicaid covers the rest.