Nursing homes in Pennsylvania are expensive. Based on the Genworth cost of care survey, for 2021 [1]the median cost in the greater Philadelphia area for nursing home care was $11,437 per month for a semi-private room. Many are simply unable to afford the monthly cost of nursing homes without applying for Medicaid. To qualify for Medicaid there are limits on the resources that an applicant may have. Resources include both income and assets.
The Medicaid rules regarding eligibility are complex, with an interplay of both federal and state laws. Generally, when a family member is entering nursing home, the family will allow the facility to apply for Medicaid and will not consult with an experienced elder law attorney. In some situations, having the facility submit the Medicaid application is fine. If the individual entering the facility has a spouse, or significant assets, it is highly advisable to meet with an attorney to advise you on the options for qualification and asset protection.
Generally, to be eligible for Medicaid for long-term care the applicant may have no more than $2,400 in countable assets in their name if their gross monthly income is $2,523 (2022 income limit) or more. An applicant may have no more than $8,000 in countable assets if their gross monthly income is less than $2,523 (2022 income limit).
In addition to the asset limit that the applicant must meet, there are set guidelines for the assets that a spouse of a Medicaid applicant (referred to as the “community spouse”) is allowed to keep, as well as the income that the spouse in the nursing home “institutionalized spouse” must pay to a skilled nursing facility. Federal and state law recognize that the community spouse should not become impoverished when his or her spouse qualifies for Medicaid benefits to pay for long-term care, and the income and resources of both spouses can be examined to determine whether the community spouse is entitled to additional income or resources. The community spouse is allowed to keep half of the countable assets up to a maximum of $137,400 for 2022, and a minimum of $27,480 for 2022. It is important to note that these guidelines can be modified in certain situations.
Although the above referenced rules set guidelines for the resources that a community spouse is allowed to retain, as well as the income that an institutionalized spouse must pay to a skilled nursing facility, these guidelines can be modified in certain situations. Federal and state law recognize that the community spouse should not become impoverished when his or her spouse qualifies for Medicaid benefits to pay for long-term care, and the income and resources of both spouses can be examined to determine whether the community spouse is entitled to additional income or resources. Having an experienced Elder Law Attorney represent you for a Medicaid Application has several advantages, including expert advice on how best to qualify for benefits as early as possible and experience in dealing with difficult eligibility issues. Additionally, if a Medicaid denial occurs or there is an adverse Medicaid decision, the attorney will know how to navigate the appeal.
The legal advice in this column is general in nature, consult your attorney for advice to fit your particular situation.
Rebecca A. Hobbs, Esquire is licensed to practice in the Commonwealth of Pennsylvania and is certified as an Elder Law Attorney by the National Elder Law Foundation as authorized by the Pennsylvania Supreme Court. She is a principal of the law firm of O’Donnell, Weiss & Mattei, P.C., 41 High Street, Pottstown, and 347 Bridge Street, Phoenixville,610-323-2800, www. owmlaw.com. You can reach Ms. Hobbs at rhobbs@owmlaw.com