Yes. Medicaid is the primary source of financial help in paying the tremendous costs of nursing home care. In West Virginia, Medicaid pays for half to two-thirds of all people in nursing homes. But the rules for eligibility for Medicaid coverage of long-term care costs are complicated and often difficult to navigate.

No way, not at all. We will try to cover some of the broad and frequent questions people have about coverage through Medicaid for long-term care. But the rules are far more complicated than we can explain in this kind of web page article.

Suppose you are not ready for nursing home care now, but it’s highly likely that you will need nursing care in the future. Get expert help and START PLANNING NOW! Talk with a lawyer who specializes in planning for Medicaid coverage for long-term care, especially if you have substantial savings and assets.

No! This is one of the biggest fears people have. This is also one of the best features of Medicaid coverage. Congress recognized the problem of “Spousal Impoverishment,” and wrote rules in Medicaid to minimize that problem. The good news is that Medicaid law provides financial protections when there is a spouse or dependent child remaining at home.

In effect, there is one set of financial eligibility rules for people with spouses or dependent children at home, and another set of rules for people who have no family remaining in the home.

Yes. The details are complicated, but here’s the simplified answer. Your income cannot be more than $200 above the nursing home monthly cost. There’s a complicated formula, with complicated exceptions for some situations. But for most people it comes down to this: Is your monthly income enough to pay the monthly nursing home bill AND have at $200 left over? If so, as a single person with no spouse or dependent at home you won’t be eligible for Medicaid.

Yes, and it is really low. For single individuals the asset limit is $2,000. The total amount of all “countable” bank accounts, savings accounts, investments, boats, ATVs, etc cannot be more than $2,000. But not all assets are “countable.”

Some items of property are not counted. The legal term is that they are “exempt” from being counted. The most common examples of exempt assets are the home (in some circumstances); one car; ordinary household furnishings, clothing and equipment; burial plots and pre-need funeral contracts; and some other personal effects. None of these will be counted against the asset limit.

Almost everything else will be counted against the asset limit: cash on hand, money in checking and savings accounts, Individual Retirement Accounts (IRAs) and other retirement savings accounts such as 401k or 403b plans, boats, 4-wheelers, vehicles other than the first one, etc.

In short, Congress intends that Medicaid be the last resort. Congress requires the single individual living in a nursing home to spend pretty much all of his own money and assets for his own care costs BEFORE Medicaid will step in to help.

The good news? Medicaid will assure that the single individual with no spouse or dependent at home gets nursing home care even after the money runs out.

The bad news? Medicaid will require almost all the money to run out before helping with the nursing home costs of an individual with no spouse or dependent child at home.

No. Stop. There’s a very serious penalty for doing this. In most circumstances, you will not be eligible for Medicaid for as long as the transferred money could have paid for the nursing home.

• For example, suppose the nursing home costs $5,000 per month. You give $60,000 to your children. Medicaid will say that $60,000 could have paid for one year of nursing home care. You will not be eligible for Medicaid coverage for nursing home costs for one full year.

Medicaid will “look back” five years to see whether an applicant has transferred money “without adequate compensation.” If there have been any “uncompensated transfers” during those five years, then the penalty of disqualification will probably be imposed.

There are some narrow exceptions to this penalty. Also, making transfers more than five years before you need nursing home care may also escape penalty. BUT DON’T TRY THIS AT HOME! Don’t do this without expert help from a lawyer who specializes in planning for nursing home costs. This is a very risky step. It should not be done unless you have gotten expert advice. It’s even possible you could be charged with the crime of fraud if you do this and try to hide it. Don’t take chances!

Normally, no. Medicaid generally follows a “name on the check” rule. Medicaid will count YOUR income and apply the same income limit to your income. Medicaid will not count against you any separate income that is paid to the name of your spouse or dependent child.

However, if the separate income of the spouse or child is very high, some of that income may be counted against the nursing home spouse’s eligibility.

No. The Medicaid law is specifically designed to minimize what’s called “spousal impoverishment.” For many older people, the husband worked outside the home while the wife worked inside the home, raising children and taking care of the family. As a result, the husband’s name is on the pension and retirement income. In that situation the wife usually has much lower retirement income. To make it worse, “most” of the time it’s the husband who needs a nursing home first.

Congress recognized this possible problem. There are parts of the Medicaid statute designed to assure the spouse at home has at least a minimum level of income. If her own income is too low, then some of the nursing home spouse’s income can be protected for the spouse at home.

In 2019, Medicaid’s minimum income protection for the spouse at home is roughly $2,000 per month. If the at-home spouse’s separate income is lower than that, then some of the nursing home spouse’s income can be given to the at-home spouse to bring her up to the minimum.

For example, suppose the at-home spouse’s income is $400 a month, while the nursing home spouse’s income is $3,000 per month.

• The Medicaid minimum income level for the spouse at home is $2,000 (roughly).
• The at-home spouse has only $400 a month. She is $1,600 below the Medicaid minimum of $2,000.
• Medicaid will allow the spouse at home to have 1,600 from the income of the nursing home spouse. That’s the amount that will bring her up to the $2,000 minimum.
• In total, the at-home spouse will have her separate income ($400) and also $1,600 of the nursing home spouse’s income, to bring her up to $2,000 per month.
• From the nursing home spouse’s total income of $3,000, only $1,400 will be counted against his income limit. The other $1,600 will be protected for the spouse at home.

No. Here again, the good news is that Congress has written Medicaid rules to assure that the spouse at home is NOT left with nothing. Like the income rule for spouses at home, there is a method of protecting marital assets for the spouse at home. There are several steps in the process we need to to explain.

• First, Medicaid will add up EVERYTHING that either spouse owns, either separately or jointly. This is different from the “name on the check” rule Medicaid uses for Income. It doesn’t matter whose name is on the property, it’s all counted. (But remember, some items are exempt and aren’t counted at all, especially the home, one car, and household furnishing, etc.) The total amount of everything that is counted is the total pie. (Lawyers call it the “total marital estate.”)
• Second, Medicaid will divide the pie (“the total marital estate”) in half. Half the pie will be protected for the spouse at home. Half the pie will be counted against the nursing home spouse’s eligibility.
• Third, there is a minimum protected amount for the spouse at home. In 2019 the minimum protected asset amount for the spouse at home is roughly $25,000. If the half-pie for the spouse at home is less than $25,000, then some of the nursing home spouse’s half-share will be given to the spouse at home to bring her up to $25,000. (This is similar to the minimum income protection.)
• Fourth, however, there is an upper limit on the at-home spouse’s protected half-share. In 2019 if the at-home spouse’s half-share is more than about $126,500, the amount above that limit will be counted against the nursing home spouse’s eligibility.

In short, the at-home spouse can protect at least one-half of the marital estate. If her half is less than $25,000, she can also have some of the nursing home spouse’s share. But if her half is more than $126,500 then the “excess” amount may be counted against the nursing home spouse’s eligibility.

Apply as soon as you enter the nursing home! Even if you know you aren’t eligible.

Medicaid makes all its calculations based on the financial picture on the “date of admission.” The most accurate way to show the financial picture on the date of admission is to apply on the date of admission. As part of the application you’ll have to collect all the financial information and give it to DHHR. Then Medicaid will assess how much will be protected for the spouse (or dependent child) at home, and how much will be counted against the nursing home spouse’s eligibility.

This way you know exactly what must be spent and what does not. Too many families don’t do this, and wind up spending a lot more of their own money than Medicaid requires. Apply on the date of admission. That’s the best way to make sure you don’t spend more than you need to.

Not necessarily. There are two major exceptions. Your house will not be counted against your Asset limit for Medicaid if:

• Your spouse or dependent child still lives in the house or on the property; or
• You (or your “legal representative”) sign a statement that you intend to return to the home or property whenever you are released from the nursing home. Even if there is no spouse or dependent child living there, the property will not be counted against your eligibility.

If you meet one of these two exceptions, your house will not be counted as an asset. If neither of these two exceptions apply your house probably will be counted against your eligibility.

There are some more detailed and complicated exceptions. For example, if other family members were living with you and taking care of you for a substantial time before you needed the nursing home. But those situations are beyond the scope of this article. Generally, if these two exceptions do not apply, you will have to sell the home and use the money for nursing home costs before Medicaid will provide coverage.

The short, over-simplified answer is that the home probably will have to be sold to reimburse Medicaid for the care you received UNLESS:

1. You have a spouse or dependent living in the home when you die, and they need to stay there; or
2. Someone else is on the deed with you, and they hold title “jointly” and with “right of survivorship.” In this situation the home will go to that other person without the Medicaid repayment obligation.

Again, there are some other, more complicated exceptions. For example, when family members have lived with you for a long time and provided care that helped you avoid going to the nursing home. But again, describing those rules is beyond the scope of this article. If you have a situation like that, you need to talk with an expert lawyer.

In general, the law gives Medicaid the authority to file a claim against your estate for reimbursement of amounts Medicaid paid for your nursing home costs. Given how expensive nursing homes are, these claims can be quite large. Unless you meet one of the two exceptions above, the home likely will have to be sold to pay the Medicaid claim. In some (many?) cases that might mean there is little or nothing left for the heirs.

Bottom line: When you’ve died and don’t need the house anymore, it probably will have to be sold to pay a Medicaid claim unless your spouse or dependent child are still living there.

There are a couple of answers here.

First, it depends on the nursing home’s policy. If the nursing home has a lot of vacancies, it might not charge to “hold the bed” during every absence. But most of the time the nursing home will want to be paid to keep the bed empty instead of giving it to another paying customer. Most nursing homes operate very close to “no vacancy” status. In that situation they feel they can always find another resident to fill an empty bed. You should ask your nursing home what “bed hold policy” it uses.

Second, assume that the nursing home does want payment to hold an empty bed while the resident is temporarily absent. Will Medicaid pay to hold your bed while you’re away? Yes, but only for a short time.

• Suppose there are Medical Reasons for the Absence, such as being sent to the hospital for an operation. West Virginia Medicaid will cover up to 12 days of bed hold per calendar year for medical reasons.
• Suppose there are Non-Medical reasons for the Absence, such as visiting relatives. West Virginia Medicaid will pay for only six days per year.

There are three protections.

1. The nursing home is required to tell the patient its “bed hold” policy before the patient leaves the nursing home. That is, the nursing home must tell you whether it will hold the bed for free; or whether it will charge to hold the bed.
2. Second, the nursing must tell you if the expected length of the resident’s absence will be longer than the number of days that Medicaid will pay to hold the bed.
3. Third, if the absence is longer than the days covered by Medicaid, the nursing home cannot charge the Medicaid resident to hold the empty bed UNLESS:
   • there are no vacancies in the nursing home AND
   • there is a waiting list of qualified applicants.

There are three main sources of help in paying for long term care:

• Private long term care insurance. Often expensive; often gives limited coverage; often will not cover pre-existing conditions.
• Medicare. Good for up to 100 days. After that it will run out.
• Medicaid. Significant financial eligibility limits. Not as harsh if there is a spouse or dependent child living at home. Will assure that everyone who needs nursing home care will get it if their money runs out.

Especially if you have some financial assets or property you want to protect, you should talk to a lawyer who is an expert in planning for the costs of nursing home care. This article is intended to help you realize the basic concepts. But this article is NO SUBSTITUTE for talking with an expert. The Medicaid rules are long, complicated, and difficult.

Medicaid Eligibility Information

Apply for Medicaid

Information on Nursing Facilies- Medicaid

WV Department of Health and Human Resources- Medicaid for Long Term Care Information

WV Recovery Unit

American Council on Aging