1. Unlike Medicare, you must apply for benefits. There are requirements for a successful application that we cover on another page. In short the applicant must complete the application process. You must not only submit an application but you must be able to prove all statements on the application to a Medicaid worker’s satisfaction. A general rule of thumb is for every statement on the application you must have a piece of paper proving the fact.
2. The applicant must be “aged” (65 and over), disabled or blind. For a person under 65 the level of disability must such as would allow him or her to collect social security disability and need nursing home level of care.
3. The applicant must be in Long Term Care, e.g. nursing home.
4. The applicant must be in a “Medicaid certified” bed. Some nursing homes have a limited number of “Medicaid beds” and there may be a waiting list before one will be available. Note, that the nursing home must give a Medicaid bed to a person who is Medicaid eligible. That often means that the bed goes to the resident who first applies for Medicaid and not to the resident who has been in the home the longest.
5. As stated above the applicant needs nursing home level of care. That means either skilled nursing or assistance with activities of daily living on a daily basis. Activities of daily living is often shortened to ADL and refers to such items as transferring from bed to chair, toileting, bathing and eating.
6. The applicant must be financially eligible having no more than $2,000 in countable assets. There are two main categories of assets in Medicaid:
“Excluded assets” include a home, one vehicle, funeral plan and life insurance with total face value not exceeding $1,500.
“Countable assets” are just about everything else. These can produce cash must be spent down to $2,000. Note there are special asset rules for at-home or “community” spouses that we cover on another page.
Those are the eligibility guidelines. A person may be eligible, but Medicaid may still not pay if the applicant gave away assets during the five year look back and is under a “divestment penalty period.” That is a subject we cover elsewhere on the web site.
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