Medicaid Nursing Home Requirements

Round-the-clock nursing home care is expensive. State Medicaid funds kick in to cover costs for many patients, but only after individuals have "spent down" their assets.

Cost

• For private pay patients, the average annual cost is about $79,935 for a private room, according to the 2009 MetLife Market Survey of Nursing Home. Medicaid funds cover facilities certified by the federal government, according to the Centers for Medicare &Medicaid Services.

Individual Spend Down

• The funds pay for care when a nursing home patient's overall monthly income falls below a certain level, for example $2,022 in Alabama, according to the state's Medicaid division. More information may be found from your state's Medicaid office.

Couple Spend Down

• When only one member of a married couple enters a nursing home, certain assets are protected. Most states consider a spouse's home and car exempt from the income requirements, according to CMS.

Protecting Assets

• Individuals with too much monthly income commonly set up a qualifying income trust, which comes with strict conditions. Many individuals consult an attorney or contact a local Area Agency on Aging for guidelines, according to CMS and state Medicaid divisions (see Resources).

Medicare Payments

• While state Medicaid programs cover the majority of nursing home care, the federal Medicare program pays in some cases. A State Health Insurance Assistance Program can provide information on specific cases.