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When Will Medicaid Pay for Nursing Home Care?

Elderly woman being cared for in a nursing home.

Nursing home care is a substantial cost for many across the country. New Jersey residents feel this financial burden, too, which is why the majority of New Jersey nursing home residents use Medicaid benefits to pay for nursing home care. If you have a limited amount of income and assets, Medicaid may be able to assist you in covering the costs of your nursing home care. Be aware though that the rules and requirements for Medicaid eligibility for nursing home care vary according to the state where you live.

Medicaid and Long-Term Nursing Home Care

First and foremost, it is important to be aware of the fact that not all nursing homes accept Medicaid payment. Check with the facility to see if they accept Medicaid. If they do, they will not only be licensed by the state, but they will also be subject to periodic inspections that look to see if they meet federal standards.

In order to qualify for Medicaid benefits that will pay for care, you must have limited financial resources. For New Jersey residents, you can have assets totaling up to $2,000 ($3,000 per married couple when both spouses are applying) and still qualify for Medicaid. Not all assets will be included for these calculations. New Jersey allows you to claim your home as an exempt resource, but it needs to be your primary residence. New Jersey also allows one car to be exempt from the calculation if the car is used by you or a family member for transportation. 

The big caveat though is that Medicaid will not pay for it until it is “medically necessary’. You must have a physical or mental condition that requires that you have a “nursing home level of care.” Essentially, you must be able to show that you are unable to care for yourself. This can mean that you require assistance in daily activities such as bathing, eating, and moving around.

Medicaid requires you undergo a “pre-admission screening.” The screening is administered by Long-Term Care Field Office counselors from the Office of Community Choice Options. The counselors will make an assessment of your needs by asking how you are able to conduct your daily activities. Do you need help bathing? dressing? eating?  Medicaid then uses the information gathered at the screening to determine whether or not you need nursing home care and, if you do need the care, what type of nursing home would be best for you.

Medicaid Applications are Complex

The Medicaid application process is complex. The attendant rules and regulations are constantly changing. It is critical for Medicaid applicants to work with an experienced professional when filing the application from the outset to avoid unnecessary delays or penalties with eligibility or the issuance of Medicaid benefits.

Contact E.A. Goodman Law Today for a Consultation

Planning properly is critical when assessing your long-term care needs. At E.A. Goodman Law, we help you consider your options and make the appropriate plan for your individual circumstances. Contact us today.

Posted in: Medicaid Planning