Medicaid for the Nursing Home Long-Term Care Resident

Glenna Darst
Business Office Coordinator
Abbyshire Place Skilled Nursing & Rehab

Understanding Medicaid

Medicaid is a joint funded health care program of State and Federal government for individuals who have limited income and assets that will pay for Nursing Home long-term care cost.  Medicaid is administered by the State which shares the cost with the federal government.  The rules governing Medicaid in Ohio are extremely complex and this article is intended to provide general information only.

Most people fail to realize that neither their health insurance nor Medicare will cover Nursing Home long-term care.  As a result, many middle-class seniors spend their entire life savings on long-term care.  After exhausting all resources, these seniors turn to Medicaid.  If you qualify for Medicaid benefits, you should pay little or nothing for medical care because Medicaid pays your out of pocket expenses in Medicare.  Medicaid also pays for items that Medicare doesn’t cover, such as hearing aids and eye glasses and long-term care.  Medicaid automatically covers you for free or low cost drug coverage through the Medicare Part D Prescription plan.

The Process

The application process may take a while and you are required to submit personal information regarding your income and assets.  Because Medicaid is a State Government program, you may only have Medicaid coverage in the State you reside in and provide a State Driver’s license or State Identification Card.  You must prove you are a U.S. citizen by providing your birth certificate and social security card.  In 2022 your income for a single person must not exceed $2,523.00.  (There are provisions in place if your income is higher by opening a Qualified Income Trust (QIT) Account and any income over the limit must be deposited monthly into QIT Account and will be disregarded for the Medicaid application purposes.)  A person’s assets must not be greater than $2,000.00.  Most household goods and personal items are not counted.  Medicaid will also require copies of all bank account statements.  Medicaid will also do a 5 year look-back to ensure there were no improper transfers of any assets including cash, real estate or stocks and bonds.

A person’s home is generally not counted as an asset for Medicaid purposes if the individual’s intent is to return home.  However, due to the asset limit for an unmarried individual being $2,000.00 and their income has to pay for their care, this leaves no funds to pay for property taxes, home insurance, utilities or repairs.  Also when the Medicaid recipient dies, the State of Ohio will seek to recover the money it spent on the individual’s care from the proceeds from the sale of the house.  If the intent is not to return home, the real estate must be sold and the cash spent to pay for the individual’s long-term care before Medicaid will provide coverage.

Note that if you are married and living with your spouse the eligibility limits and guidelines for income and assets are different.  The community spouse is permitted to keep ½ of the couple’s total assets up to a maximum of $137,400.00.  Also, if the spouses’ monthly income is below $2,177.50 a portion of the individual’s income applying for Medicaid assistance may be paid to the community spouse.

Once an individual is approved for Medicaid, all of the individual’s income, including any income that was placed into the Qualified Income Trust (QIT) Account, must be used to pay for their long-term care cost before Medicaid covers the balance.  Medicaid allows a person to retain $50.00 of their monthly income for personal use.

Abbyshire Place Can Help

If your loved one needs long term care placement, Abbyshire can assist you in the application process as we have helped hundreds of local families with this process.   More information is available from the Department of Medicaid or the American Council on Aging