Nursing Home Cost contd.

Medicare will cover nursing home care only if the patient receiving the care needs the highest level of care called skilled nursing. The patient must also have spent at least three consecutive days in a hospital, not more than 30 days prior to nursing home admission. A physician must certify that skilled nursing services are needed for the same or related illness for which the patient was hospitalized.

Medicare pays for an eligible individual’s care in a skilled nursing facility for up to 100 days. Under the program, the first 20 days are covered 100 percent. For the remaining days, the patient must make a daily coinsurance payment. The co-payment for 200 is $101.50 per day. If the patient remains in the nursing home longer than 100 days Medicare will make no further payments during that spell of illness.

Medicaid

Medicaid is often a last-resort for families, since you need to have low income and very few assets in order to be eligible. Hence families often turn to Medicaid after using the loved one’s savings to pay for care.

Medicaid is a joint Federal and State program, so you’ll need to check with your state to see how to qualify. Typically this means that the loved one has $1000 or less in assets in his or her name. The loved one’s spouse may have some assets – again, check with your state to see how much of the spouse’s assets are protected.

Medicaid nursing home patients must meet two requirements:

• Financial eligibility: You have to consult your states department for information on these as it differs from state to state.
• Medical eligibility: To determine medical eligibility for Medicaid, applicants must have a Medicaid-approved examination called a Pre-Admission Evaluation and a mental health screening (pre-admission screening and annual resident review, or PASARR). The PAE determines the level of care a patient needs and whether the patient meets Medicaid’s medical criteria. The PASARR determines if the patient has any mental illness or mental retardation that requires special treatment. If so, the applicant cannot be admitted to a nursing home.

Medicaid will pay for nursing facility care for those both financially and medically eligible. Medicaid beneficiaries, however, do contribute all of their income to the cost of their nursing home care, with a few exceptions: the cost of a health insurance premium, the cost of certain medical services not covered by Medicaid (such as limited podiatry services, for example) and $30 for personal needs.

Some people attempt to give away their assets to their children and others in order to qualify for Medicaid. However, any assets given away within three years of starting the program may still be counted as an asset, which then delays when the elderly resident would start receiving benefits.

When the loved one dies, Medicaid may try to recoup some of their expenses from the estate. However, they cannot try to collect if there is a spouse or dependent children still living.

In addition, Medicaid cannot put a lien on your home if there is a reasonable chance you might return home, or if there is a spouse or dependents living in the home.

Admissions Process

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