If you or your loved one surpass the 100-day Medicare coverage for a nursing home but an extended stay is necessary, you may be eligible to receive nursing home coverage through Medicaid. Eligibility requirements include income and asset limits as well as health stipulations, such as requiring assistance with at least three activities of daily living. Unlike Medicare, Medicaid coverage for nursing home care is unlimited as long as you remain financially eligible. As such, Medicaid is the single largest payer of nursing home stays in the U.S. Here’s a breakdown of what Medicaid covers in a nursing home as well as some of the additional amenities you may be charged for.
First and foremost, Medicaid covers custodial care in a Medicaid-approved facility. This would typically be a skilled nursing home, but some states offer waiver programs for assisted living facilities or home health care programs. Custodial care encompasses room and board, pharmacy, and incidentals. Essentially, Medicaid pays for any services that attain the highest level of practical well-being for each patient, including their physical, mental, and psychological well-being. More specifically, residents may not be charged for the following:
On the flip side, nursing home residents may be charged extra for the following:
Each Medicaid recipient receives a monthly stipend, known as their Personal Needs Allowance, which they may use on these extra items. The allowance varies by state.
If your loved one is facing a nursing home and you would like to know options for becoming Medicaid eligible, we have some good news for you. It’s not too late! But first, here are a few tips for you to utilize in the process:
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