WHAT IS INSTITUTIONAL MEDICAID? WHAT ARE THE REQUIREMENTS TO BE ELIGIBLE?

What is Institutional Medicaid? What are the requirements to be eligible?

Authored by: Kendra R. Rozboril

With rising health care costs and increasing life spans, more and more people are concerned with how they will be able to afford nursing home stays when the time comes. Currently, the average cost in Michigan for nursing home care is upwards of $8,000 per month, so it is easy to understand why this concern is not uncommon. In fact, most health insurance providers do not cover skilled nursing care, leaving even insured individuals with hopeless feelings about their “private pay” circumstances.

Medicaid provides an alternative to private pay where the government covers the cost of much of a person’s nursing home bill. However, Medicaid has strict financial requirements that must first be met in order to qualify for such coverage.

Any individual seeking Medicaid coverage must meet both the “income test” and “asset test.” Generally, a Medicaid applicant’s income cannot be more than the cost of their nursing home bill. Additionally, a Medicaid applicant’s assets cannot be valued at more than $2,000.00. This asset value restriction will be strictly applied, and Medicaid will not start paying for coverage until the applicant’s assets are at or below the $2,000.00 mark. There are generally very few exemptions or exceptions to both the income and asset test, so it is important to consult with an Elder Law attorney about the proper steps to take to qualify for Medicaid coverage.

There is no question that applying and getting a loved one qualified for Medicaid can be a daunting task. And there is a common misconception that an applicant must spend down all of his or her money in order to qualify for Medicaid. While each circumstance is unique, our Elder Law attorneys are experienced with the Medicaid qualification process and can help you navigate your way to coverage for your loved one. Please call our office today to set up a free consultation and free Medicaid audit.

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