Long-term nursing care is surprisingly expensive. Medicaid for long-term care is a state and federal program that will pay for long-term in-home care or nursing home care for those who qualify.
In addition to the requirement of being a U.S. citizen and resident of Pennsylvania with a social security number, eligibility for Medicaid depends on three main factors. Medicaid considers the medical necessity for the care along with your financial situation. Medicaid requires that patients use their own funds first.
Medical necessity
To be eligible for Medicaid in Pennsylvania, a patient must have a medical need for long-term care. A doctor must complete a form explaining the need for care and submit it to the Department of Human Services.
Income
Medicaid considers social security, pensions, interests and dividends from investments, IRA withdrawals and rental income when determining your total income. The level of income allowed varies depending on if you are applying as a single person, as a married couple who are both applying or as a married couple where only one of you are applying for assistance. A chart provided by the American Council on Aging breaks down the specific amounts of income and assets allowed in each instance.
Assets
When looking at your assets or resources, Medicaid will review bank accounts, stocks, bonds, mutual funds, retirement accounts, the cash value of life insurance, vehicles and non-resident property. Revocable and irrevocable burial costs, a burial space and one vehicle are exempt from this calculation along with your home if someone is still living in it. Any transfer of assets in the five years prior to applying for Medicaid could hurt your eligibility.
It is not necessary to relinquish all of your income and assets to pay for care in order for one spouse to qualify for nursing home care when the other will remain at home. Medicaid considers a couple’s assets together, but their incomes are separate. The spouse who remains at home may keep their income.
If you want to start planning to receive Medicaid benefits, please do not hesitate to reach out to learn how an attorney can help you prepare.
