For those paying for Skilled Nursing out-of-pocket, costs in this area run from $190/day (or $5,700/month) up to $400/day (or $12,000/month). Several readers have recently written in to ask questions about getting assistance with the cost of skilled nursing for their loved one. Last year, I interviewed Elder Law Attorney Janna Wallace, of Omega Elder Law, here about qualifying for assistance to help pay the cost of Assisted Living and Memory Care. Qualifying for Long Term Care Medicaid, to help pay for Skilled Nursing, is a different application altogether. I reached back out to Wallace. What distinguishes her expertise is that prior to Law School, she worked for four years for Wake County Human Services as a Medicaid Eligibility Specialist, reviewing over 500 Medicaid applications while there. Here are her answers to the most common questions:

  1. Do all stand-alone Skilled Nursing Facilities (also referred to as “SNF”) have beds that can be paid for with long-term care Medicaid?
    There is a federal law that states that a SNF must accept Medicaid if it accepts Medicare (for rehab, as an example). It is possible that a SNF would only accept private pay. (For example, some SNFs in Continuing Care Retirement Communities may only accept private pay.)
  2. If our loved one is in a rehab/skilled nursing facility now, and we think we want to stay and that we may over time (or sooner) qualify for long-term care Medicaid, do we need to ask them if they can be moved from rehab into a Medicaid bed? (We’re worried they won’t let him stay if they know this is our plan.)
    I would only ask for the bed transfer to a MEDICAID bed when the Medicaid application is begun
  3. What is the income limit to be approved for long term care Medicaid? What about the asset limit?
    There is not an income limit for SNF Medicaid per se….as long as the individual’s income is less than the Medicaid re-imbursement rate for the facility, the individual will receive Medicaid. (NOTE: Each facility negotiates their own Medicaid reimbursement amount. In general, the rate in this region is $4,000-$6,000/month.)
  4. Can I keep our house while my husband is in skilled nursing?
    If it’s a married couple the countable assets the spouse at home can keep is up to $126,420 of COUNTABLE assets. A skilled elder law attorney can advise a family how to turn COUNTABLE assets into non-countable assets and save the couple nearly all of their assets. The couple’s house is non-countable under Medicaid, though they will want to take steps to save the house from estate recovery. (Estate recovery is a federal policy that says each state must try to recoup the amount Medicaid paid for a recipient who received assistance for long term care costs after the recipient’s death.   In North Carolina, a claim is placed against the deceased recipient’s probate estate.)
  5. How much in savings can I save for my daily needs and care?
    The institutionalized spouse can deem monthly income to the spouse at home such that the spouse at home has minimum of $2,100/month. More may be kept if the couple has extraordinary housing expenses.
  6. Where can I find the application for special assistance for skilled nursing?
    The application must be placed through the county department of social services. To see more information on eligibility, what documents are required and other details, visit here.
  7. How long will it take to process?
    The processing timeframe is 45 days for the application.
  8. Do I need to hire a lawyer?
    Hiring an elder law attorney can better facilitate a successful application in what is a daunting endeavor. This work is highly specialized and a general attorney will not understand the ins and outs of Medicaid, possibly costing the couple eligibility or more money for care.
  9. Will Medicaid pay retroactively for the out-of-pocket costs we’ve already paid?
    Coverage does not begin until the individual is financially eligible and in a Medicaid bed in a facility. The coverage continues for life, as long as the patient continues to meet financial eligibility rules.
  10. How is the Individual’s cost calculated?
    An individual’s co-pay to the facility is figured by taking the individual’s GROSS income, subtracting the spouse at home’s deeming portion, subtracting $30 for pocket money and then subtracting any “unmet medical needs,” which are such items as Medicare supplement premiums, current Medical expenses that Medicaid does not cover, etc.

“The process is complicated and requires bank accounts and mortgage notes, 401k documents and car titles,” Wallace said. “It is a really overwhelming process to lay people. When I do an application for a family, I charge a flat fee. I incorporate all of the planning steps in that flat fee. The amount that I and other practitioners charge is usually around the cost of one month’s stay at a private pay nursing home… so if they are there for another year or two, the savings can really add up.”

To view more information on Wallace, visit:

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Qualifying for Long Term Care Medicaid –