Medicaid & Nursing Home Care

Medicaid is a joint federal and state program that pays health care costs to certain low income individuals and families. You must meet certain asset and income guidelines to qualify for Medicaid.

There are different rules that apply only when people when are applying for Medicaid to pay for nursing home care. This flyer discusses some of those special rules.

All nursing home residents must be approved for a nursing home level of care or Medicaid will not pay for that care. The nursing home should complete a Pre-admission and Continued Stay review.

Application forms for Medicaid programs are available at the Bureau of Eligibility Services office.  Mail-in applications are accepted.  They can be reached at: (801) 538-6155.  Toll-free, call 1-800-662-9651.  Many hospital and nursing home have applications forms on site.

Spouse living at home:

If a resident of a nursing home is married with a spouse living at home, there are special rules that deal with how much income and how many assets the spouse at home (the community spouse) can keep.  They protect a person whose spouse goes into an institution from having to deplete the couple’s assets for the institutionalized spouse to qualify for Medicaid. 

There is both a minimum amount and a maximum amount of resources allowed that are mandated by law. The amount is increased each year.  If you are married and you or your spouse needs to go to a nursing home you should call Eligibility Services office. Ask for an assessment of resources.  The worker will tell you how much of the community spouses resources are protected.

Your home:

Owning a home can make Medicaid eligibility more complicated. Understanding the rules is important.  The general rule is: the home you live and all the property immediately surrounding it are exempt from Medicaid’s consideration.

A problem arises when the home owner needs nursing home care.  The home remains exempt as long as:

• You intend to return to live in the home
• if the property is co-owned by you and another person and its sale would cause undue hardship, due to loss of housing, to the co-owner.
• if a doctor says that you are likely to return home within 6 month of admission to the nursing home
• A spouse or a “reliant relative” lives in the home.  Reliant relatives are relatives who claim to rely upon you for financial help, medical help or any other reason. These relatives can include:  child, stepchild, grand child, parents, stepparent, in-laws, siblings, half-sibling, stepsiblings, grandparent, aunt, uncle, nephew, niece, cousin.

If you have applied for Medicaid after January 1, 2006, and the equity you have in your home is more than $500,000, you will not quality for Medicaid unless your spouse lawfully resides in the home, or your minor child, or blind or disabled child, lawfully resides in the home.

Transfer of assets:

When you or your spouse transfers assets or income for less than fair market value, Medicaid can “look-back” for a certain period of time at those transfers to determine if you are eligible. Fair market value means the price at which you could have sold something to a willing buyer. If they determine that any such transfer has made you ineligible, Medicaid will not pay for long-term care services during what they determine as the applicable penalty period.

On February 8, 2006, Congress passed a new law that changes the treatment of transfers of assets for less than fair market value.   Asset transfers made on and after February 8, 2006 will be treated differently than those made before February 8, 2006.

For transfers of assets for less than fair market value made on or  after February 8, 2006, Medicaid can ”look-back” 60 months before the first date of which you are both in a nursing home and you apply  for nursing home services.

For transfers of assets for less than fair market value made before February 8, 2006, Medicaid can “look-back” either 36 months for transfers that do not involve a trust, and 60 months for assets that involve transfers into a trust, before the first date on which you are both in a nursing home and you apply for nursing home services.

Your ability to have access to health care is extremely important. It is difficult, if not impossible to determine what kind of health care you will need five years from now.  Think twice and seek legal help, before transferring any asset – including your home, for less than fair market value.

Medicaid is a complex program.   Some of the rules change every month.  You need to work directly with the Medicaid office obtain complete information.