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Medicaid Part 2: the Six Tests to Qualify for Medicaid Nursing Home Benefits

Posted by Andrew Byers | Jun 01, 2011 | 0 Comments

There are six tests or criteria that have to be met in order to qualify for Medicaid in a Michigan nursing home.

1.  Medical Need:    To be eligible for long-term care Medicaid benefits, the person must meet certain medical and functional eligibility criteria, i.e., they must need custodial care in a nursing home.

2.  Age or Disability:  the nursing home resident must be age 65 of, if not yet age 65, blind or disabled.

3.  Citizenship and Residence:  the nursing home resident must be a U.S. citizen or a permanent resident alien.  You have to be a resident of the State of Michigan; this criteria is met by having the intention to stay in Michigan.

4.  Income:  the Medicaid applicant's income from Social Security, pension and certain investment income must be $20.00 less than the nursing home's private pay rate.  For instance, if the nursing charges $220 per day or $6,600 per month, so long as your monthly income is $20 less than the $6,600 private pay rate, you meet the income criteria for Medicaid.  Note, if you are married, the income of the spouse who is not living in the nursing home, called the community spouse, is not counted.

5.  Assets:  the nursing home resident's countable assets must be less than $2,000.00 for at least one day of each month in which Medicaid benefits are sought.  If married, the nursing home spouse can have $2,000.00 in countable assets and the community spouse can keep a portion of assets called the protected spousal amount.  The protected spousal amount is one-half of the couple's countable assets, but at least $21,912 but no more than $109,560.00  For instance if a married couple has $80,000 in countable assets, without further asset protection steps being taken, the community spouse would only be able to keep $40,000.  Alternatively, the protected spousal amount can be set by a judge by filing a petition to increase the protected spousal amount.  In addition, certain trusts can be used to protected additional assets for the community spouse without causing any Medicaid problems.

6.  Application:  you have to apply for Medicaid, provide certain financial documentation and the Department of Human Services has to verify that you passed each of the first five tests.

We will review each of these criteria in more detail in future posts.

Andrew Byers is an Elder Law attorney in Auburn Hills, Michigan who assists seniors and their family with Medicaid nursing home benefits.

About the Author

Andrew Byers

Andrew Byers' elder law practice focuses on the legal needs of older clients and their families, and works with a variety of legal tools and techniques to meet the goals and objectives of the older client. Under this holistic approach, I handle estate and longevity planning issues and counsel cli...

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