Dave Bevan
Business Office Coordinator
Abbyshire Place Skilled Nursing & Rehab Center

Understanding Medicaid

medicaidWhen an individual admits to a nursing facility under Medicaid coverage the patient’s monthly income is subject to review by the county.  This review is to determine what can be used as possible payment to the nursing facility.  There are a couple of instances whereby the monthly income may not become payable.

If the income is from an SSI benefit it is not payable.  The Social Security office will reduce the benefit from its existing amount down to $30.  This is used for the patient’s personal expenditures.

If the patient is under a community Medicaid Waiver program the benefit is not payable temporarily until the waiver is closed or 90 days, whichever comes first.

The most important exception involves patients with spouses still living at home.   Under this circumstance the county will request copies of monthly bills (utility, homeowner insurance, property taxes, car insurance etc.).  These are for calculation, by their formulary, to determine if the community spouse’s income is sufficient enough to live on.  If not, the county could stipulate all or a portion of the patient’s income is to be kept by the spouse to assist with their monthly living expenses.   The nursing facility would not be of much assistance in estimating how much income may be kept by the spouse at time of admission (as this is a Medicaid determination). The nursing facility could advise as to which type of monthly bills would be appropriate for submission.   Bear in mind none of the income of the spouse at home is ever subject to payment towards the care of the patient.

To discuss your particular Medicaid eligibility circumstances, please contact the Business Office at Abbyshire Place by calling 740-446-7150.  You can also reach out to the business office by using our contact form.