What does Medicaid Pay For Anyway?
Medicaid states that they will pay for nursing home care if you pass all of the requirements that are listed, but only if you agree to chip in your monthly income.
First, here are the requirements:
1. Sickness: A doctor has to certify you are really sick enough to need nursing home care. Generally, they determine whether you are able to feed yourself, dress yourself, walk unassisted, get to the bathroom and get your business done without assistance, etc. They also consider your cognitive abilities.
2. Age: You have to be 65 years of age or older, or legally blind, or disabled according to Social Security standards.
3. Citizenship: You must be a US citizen.
4. Residence: You must be a resident in the state that you are applying.
5. Income: Your monthly income must be less than the cost of the care that you are receiving.
6. Assets: Your "countable" assets must be less than $3,000, not counting exempt assets or unavailable assets. Exempt assets include your house, one automobile, and your personal and tangible possessions, such as furniture and clothing. Everything else is generally countable, your CD's, savings, checking, investments, other real estate, IRA's, etc.
7. Compliance: The look-back period for gifts is five years, meaning that if you have given an asset away inside the last five years, the value of that gift may cause a period of ineligibility. The penalty imposed by that gift will begin on the date that you apply for Medical Assistance.
So if you are in a nursing home and getting Medicaid benefits, you have to give your income to the nursing home every month. The nursing home then bills Medicaid for the difference between the rate Medicaid will pay them and the amount you contributed from your monthly income. Now, Medicaid does not pay for everything, but they pay for a lot.
What Medicaid Pays For
First, they pay for room and board for a semi-private room. Sometimes you can get a private room, but that's only if it's convenient for the nursing home and they are willing to accept the semi-private rate from Medicaid.
The nursing home is not allowed to charge you more than the semi-private rate regardless of your accommodations.
Medicaid also pays for all medicine while you are in the nursing home; and for health insurance premiums, including your Medicare and Medi-gap premiums.
Medicaid pays for physical or occupational therapy if ordered by a doctor.
And finally, Medicaid pays for medically necessary odds and ends like diapers, walkers, oxygen etc. They don't pay for private nurses or a TV in the room or most things you would pay extra for if you were in a hospital.
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