Medicaid stands as the primary funding source for long-term nursing home care in the United States. With the average cost of a private room surpassing $100,000 annually in most states, many families face a financial crisis when savings run dry. Medicare, in contrast, only covers short-term skilled care, leaving a significant gap.
This report breaks down the eligibility requirements for nursing home Medicaid, including income and asset limits, the option of a Miller Trust for those who exceed income caps, the patient pay amount, and protections for spouses.
Key Points:
- Medicare vs. Medicaid: Medicare covers limited days; Medicaid covers extended years of care.
- Income Limits & Miller Trust: Applicants must meet strict income thresholds, but a Miller Trust can help those with higher incomes qualify.
- Asset Limits: Distinction between countable and exempt assets is crucial.
- Application Tests: Two main tests must be passed for approval.
- Patient Pay Amount: Residents contribute most of their income toward care costs.
- Spousal Protections: The Community Spouse Resource Allowance (CSRA) and spousal income allowance help protect the at-home partner.
Understanding these rules can help families plan for long-term care needs without depleting their life savings.