understanding your medical insurance policy

4 Things To Understand About Medicaid For Nursing Homes

by Peppi Halko

If you have a loved one that needs around-the-clock medical care, it may be time to investigate a nursing home for them. If your loved one doesn't have the money to pay out of pocket for nursing home care, Medicaid may be able to help. It is essential to understand how Medicaid and nursing homes work.

1. Not All Nursing Homes Accept Medicaid

First, it is crucial to understand that nursing homes are not required to accept Medicaid patients. A nursing home can refuse to accept Medicaid patients, so you need to find a Medicaid-certified facility if you want to pay with Medicaid. A Medicaid-certified facility has to meet specific care requirements as set out by Medicaid. They have to submit to yearly state and federal inspections to ensure they meet these guidelines.

2. Have to be Sick Enough

Second, in most states, you have to meet the standard of needing medically necessary care to qualify for Medicaid that will pay for long-term care. You can't just decide that you need assistance or that you cannot take care of yourself. You need to have a state agency review your case and determine if you met the medically necessary care standard. If you don't meet the standards, you will have to pay for long-term care out of pocket or wait until you reach the point where your health condition reaches the standard for medically necessary care for your state.

3. Spend Down to Care

In many cases, you can start nursing care as a private patient using your funds. As you pay down and reduce your assets, you can spend down to qualify for Medicaid, as Medicaid only comes into effect when you reach specific financial requirements. Once you are determined to be both financially and medically in need, then Medicaid will step in to pay for the remainder of your long-term care. If you want to spend down to qualify for Medicaid, you will want to work with a professional to ensure that you spend down correctly.

4. Understand Countable Assets

Fourth, Medicare for long-term care is designed for those who don't have the ability to pay for it. You have to have less than a certain amount of countable assets. Non-countable assets include things such as your home, vehicle, personal items, and pre-paid funeral or burial arrangements. Everything else is generally considered countable assets, and your countable assets have to be low enough to qualify for Medicaid for long-term care.

Not everyone is going to qualify for Medicaid for nursing home care. You have to demonstrate both financial and medical needs, as determined by an outside governing board or individual. For more information about submitting a nursing home Medicaid application, contact a local insurance provider.