Nursing Home Care – Can I Qualify for Medicaid?

By David Salvaggio, Esq.

Medicare’s coverage of nursing home care is very limited.

So, what is the primary method of paying for nursing home care in New Jersey when you do not have the resources to do so otherwise?

The answer is Medicaid.

However, navigating the Medicaid system is complicated and confusing. Here are the basics:

Medicaid is a joint federal-state program. In addition to providing health insurance coverage to low-income children, seniors, and people with disabilities, Medicaid also covers long-term care in a nursing home for those who qualify.

The cost of that care is exceptionally high. Based on the 2020 Genworth Cost of Care Survey, the average cost of nursing home care in New Jersey is $11,254 per month.

So how can you qualify? At first glance, it appears to be very difficult.

In New Jersey, you cannot qualify for Medicaid to pay your nursing home costs if you have more than $2,000 in assets. Therefore, if you do not have a long-term care insurance policy, you may need to “spend down” those assets until you become eligible for Medicaid. In addition, you cannot simply give away those assets to family members or friends for less than their value without being subject to a “penalty period” before becoming eligible for Medicaid.

In addition, you cannot qualify for Medicaid to pay your nursing home costs if your income is more than $2,523 per month.

New Jersey does allow what are called Miller Trusts or Qualified Income Trusts (QITs), into which you can deposit your income of more than the allowable maximum (now $2,523 per month) if you otherwise would qualify for Medicaid. However, you must know those Trusts’ numerous requirements and limitations.

In addition to the strict income and asset limits, you must meet the level of care requirements to qualify for Medicaid nursing home coverage.

You are usually determined to need long-term care if you need help with two or more “activities of daily living” (such as bathing, dressing, eating, moving, and going to the bathroom).

Once you qualify for Medicaid, the program pays for all your essential expenses. Still, nursing home residents may be charged extra for specific amenities, like a private room, comfort items, or specially prepared food.

Sound complicated? It is. An elder law attorney can help you navigate the Medicaid process.

New Jersey Elder Law Attorneys at Lyons & Associates, P.C. Provide Legal Assistance Navigating the Medicaid Process

Our New Jersey elder law attorneys at Lyons & Associates, P.C. are available to discuss any concerns you may have if you or someone you love is facing difficult financial and emotional decisions, including health care costs, financial security, and estate planning, associated with growing older. Please do not hesitate to contact David Salvaggio by phone at 908-575-9777 or by email at [email protected] to schedule a free consultation. We have offices located in Somerville, Morristown, and Freehold, New Jersey. We represent clients throughout New Jersey, including our offices in Somerset County, Morris County, and Monmouth County, as well as in Bergen County, Burlington, Essex County, Hudson County, Hunterdon County, Mercer County, Middlesex County, Passaic County, Sussex County, Union County, and Warren County.