Eligibility guidelines for the assistance program place strong restrictions on personal income. You can't have much.
Today, primarily because of the advances in medical science and personal health awareness, people are living longer than at any other time in our history.
This increased longevity may, unfortunately, bring with it increased chances for people to contract both mentally and physically debilitating diseases. Such diseases may require treatment and care that is beyond what their families are capable of providing at home. As such, many times, long-term nursing-home care is the only option.
Among the many concerns of a family facing the prospect of admitting a loved one to a nursing home is how they will afford the costs, which, in Pennsylvania, average $4,500 per month.
In Pennsylvania, most health insurance plans and Medicare provide very limited coverage for patients in nursing homes. Unless people have long-term care insurance to cover their stay in nursing homes, their only option is to pay for the care themselves until their assets are exhausted, and they become eligible for Medicaid.
Medicaid is a joint federal-state program begun in the 1960's to provide medical care, including nursing care, to those who cannot afford it. In Pennsylvania, Medicaid is termed Medical Assistance (MA), and is administered by the local county assistance offices of the Department of Public Welfare. The local county assistance office will review the patient's resources and income to determine if he or she is eligible to receive benefits under the Medicaid Program.
Your financial resources can be no more than $2,400 to be eligible for Medicaid. This includes cash, stocks and bonds, bank accounts, your IRA, and real estate you own outside of Pennsylvania. Also, if you have transferred any financial assets to family or friends within three years of the date you applied for Medicaid, these will be counted as available resources, and may affect your eligibility.
There are a number of resources that are not counted in determining your eligibility for Medicaid. These include your automobile, household goods, clothing, jewelry, a grave marker, a pre-paid funeral, and your home if you state an intention to return to it after your nursing-home stay, or it is used as the principal place of residence by your spouse or any dependent relative.
After qualifying by showing your resources are down to $2,400, you will have to prove that your income is insufficient to pay for your nursing-home care. Generally, all of your income, but not your spouse's income, is counted. This includes pensions, Social Security, and interest and dividends from bank accounts and other investments. You are, however, permitted to keep $30 per month for personal expenses.
The above discussion of the Medicaid rules applies to a single person being admitted to a nursing home. If you are married and living at home with your spouse, different rules apply in determining your eligibility. Generally, your spouse is permitted to keep his or her income and any qualified retirement funds. Also, your spouse is permitted to keep a portion of the resources owned by either of you, in addition to the resources mentioned above that are not counted in determining your eligibility for Medicaid. This amount is approximately one-half of the couple's non-exempt assets, with a low limit of $16,162 and a high limit of $80,760 for 1998. These amounts can change from year to year.
In summary, this article attempts to give the reader an understanding of some of the rules that apply for Medicaid eligibility. It is not a comprehensive examination of Medicaid regulations pertaining to nursing home care. If admission to a nursing home is a potential future reality for a family member, you should consult your legal adviser now to properly plan for that possibility.
