When Will Medicaid in Virginia Pay for a Nursing Home?

For most American seniors, nursing home care becomes necessary at some point in time and for some length of time as they age. Unfortunately, most seniors are unable to pay the high cost of nursing home care for any extended amount of time. In Virginia, the cost of a private room in a nursing home was $270 per day in 2019. During the same year, the average stay in a nursing home was about 25 months.

How Does One Pay For Nursing Home Care?

There are generally three ways to pay for nursing home care:

1. Your money;
2. Insurance;
3. Medicare; or
4. Medicaid

Your Money

Your money is self-explanatory—you enter a nursing home, they bill you every month, and you pay it until you run out of money.

Insurance

Long term care insurance essentially comes in two varieties 1) traditional use-it-or-lose-it insurance and 2) asset-based or hybrid insurance. Unless you buy long term care insurance by your 50s, the insurance premiums are likely to be prohibitive. On the other hand, if you buy it at the right time and have the right coverage this can be a good option.

Medicare vs. Medicaid

Medicare and Medicaid are not the same things. Both or government programs enacted during the Johnson administration. However, Medicare is health insurance that all US citizens get when they turn 65, whether they are rich, poor, or in between. Medicaid, on the other hand, is a means-tested program that was designed to pay medical expenses for people at the poverty level.

Medicare is not designed to pay for nursing home care. Nevertheless, if you have Medicare and you have entered a nursing home or rehabilitation facility after a certain amount of time in a hospital, Medicare will pay for the first 20 days. After that first 20 days, Medicare may pay 80% of the cost for the next 80 days, but only if you meet certain conditions. Then after day 100, Medicare will cease to pay and you will be on your own.

Medicaid, on the other hand, was specifically designed to pay for health care for low-income children and some low-income adults, as well as, for long term care for low income and low asset adults. Medicaid will pay for long term care in the form of in-home care or care in a nursing home.

Initially, Medicaid was only intended as a safety net for the poor. Now, however, since the need for long term care threatens to bankrupt even middle-class families, the state and the federal governments have created some loopholes so that families don’t have to lose everything paying for long term care.

When Medicaid Will Pay For Nursing Home Care?

There is a prevailing myth that you have to deplete all of your assets before Medicaid will pay for nursing home care. But, this is only true if you didn’t consult with an experienced elder law attorney before needing care, or at least before spending all of your money on nursing home care. Medicaid will pay for nursing home care if and when you meet certain requirements pertaining to 1) your need for nursing home level care (medical necessity), 2) your income, and 3) your assets.

Medical Necessity

Medical necessity means that you must show that you are unable to care for yourself for a sustained period of time and that a lack of nursing home level care would result in you being a danger to yourself. For example, this can be achieved by proving that you suffer from memory loss or mobility issues, or a combination of the two.

As a result, a Medicaid applicant must undergo “pre-admission screening”. This screening evaluates what activities of daily living you need assistance with (such as eating, bathing, dressing, toileting, and using the bathroom), as well as, how much help you need with these activities. Pre-admission screening is typically performed by a nurse or a Medicaid social worker after you have applied for Medicaid and using a form called the Virginia Uniform Assessment Instrument. Whether or not it is determined that you need a nursing home level of care will depend on the number of activities you need assistance with and the combination thereof, as well as, the level of assistance you need.

Income

Income is the amount of money that a person receives every month. It can include earned and unearned income. Earned income is money received from work i.e. wages and salary. Unearned income is money from sources such as Social Security benefits, alimony, interest on saving accounts, Veterans Administration benefits, and pensions.

For a single individual to qualify for Medicaid to pay for nursing home care, your monthly income cannot be more than 300% of the SSI amount for an individual, or $2,349 per month in 2020. for a married couple with both spouses applying, the limit is $4,698. For a married couple with one spouse applying, only the income of the applicant is counted.

If your income is above these amounts, you may still qualify if you have many medical bills. Virginia’s Medically Needy Program will allow you to use your medical bills as a means of “spending down” your income to qualify for Medicaid. To learn more about the Medically Needy Program you should consult with a knowledgeable Virginia elder care attorney.

Assets

For Medicaid purposes, assets are defined as real or personal property that is owned solely or jointly by a Medicaid applicant. This includes cash, checking accounts, saving accounts, stocks, bonds, and the cash surrender value of life insurance policies owned by the applicant.

In 2020, the asset limit for a single person to qualify for Medicaid to pay for nursing home care in Virginia is $2000. For a married couple with both spouses applying, the limit is $4000. For a married couple with only one spouse applying, the asset limit is $2,000 for the applicant and $128,640 for the non-applicant spouse. This is the total of all non-exempt assets in the applicant’s name.

Nonexempt assets include things like checking and savings accounts, cash on hand, IRAs, stocks, bonds, and the cash surrender value of life insurance policies. Other assets owned by the Medicaid applicant may be exempt from being counted towards Medicaid’s asset limit. These are called exempt assets.

The most common exempt assets include:

• Your home;
• Personal effects and household goods;
• One motor vehicle; and
• Pre-paid funeral/burial plans

Virginia has a very complicated system to determine if your home will be considered an exempt asset or not. Firstly, if you reside in the home, it is exempt. But, if you own the land around your home and that land is worth more than $5000, it will be considered a countable asset if you qualified for Medicaid by satisfying the 300% Federal Poverty Level (FPL). On the other hand, if you qualified with an income less than 80% of the FPL, then both your home and all of the land around it will be considered exempt assets.

However, to qualify for Medicaid to pay for nursing home care, you cannot have more than $595,000 in equity in your home as of 2020. What’s more, your home is only exempt for the first six months that you are in the nursing home, unless 1) you intend to return to it, 2) a spouse, dependent child, disabled adult child, or disabled parent lives in the home, or 3) selling it would cause undue hardship to a co-owner. If either case is true, your home will be exempt indefinitely.

Contact an Experienced Virginia Elder Law Attorney

Medicaid rules are complicated. But, by consulting with a qualified elder law attorney regarding your eligibility for Medicaid to pay for nursing home care, you can save yourself and your family a considerable amount of money not have to deplete all of your life’s savings.

Even if you are a high net worth individual, you can still qualify for Medicaid to pay for nursing home care. You should preferably engage in Medicaid planning before you need care. It is rarely too late to preserve assets. Call us today to learn more.

To learn more about Medicaid and long-term care and how we can help you qualify, please feel free to contact Speedwell Law, PLLC at (703) 553-2577 or [email protected] to arrange a consultation.

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The information on this site is for general informational purposes only. The information presented in this site is not legal advice or a legal opinion. You should seek the advice of legal counsel of your choice before acting upon any of the information in this site.