If you or your spouse are entering a nursing home, you need to answer these three questions:
It is important to answer these questions when one of you first enters a nursing home. That way, you will know whether Medicaid can help right away, or after you have paid some nursing home bills yourself.
Before you apply for Medicaid, you also need to know about related issues, such as cost-sharing, transfer of assets, and estate recovery. Please contact your local Health and Welfare office
before you act on this general information.
To determine if you qualify for Medicaid in a nursing home, view the income guidelines
. The income limit changes each January.
If your income is higher, ask your local Health and Welfare office to explain your options. Income includes:
Supplemental Security Income (SSI);
Interest from bank accounts and investments;
Retirement and other pensions; and
Payments from trusts, annuities, wages, etc.
You need to figure out how much income belongs to each spouse to find out if the spouse in the nursing home meets the income limit.
In most cases, you must use the "name on the check" method. This is based on who receives each check or payment. Income paid in the name of the spouse in the nursing home is counted for that person. Likewise, income paid in the name of the spouse at home is counted for the spouse at home. If money is received in both names, half is counted for each spouse.
There is another method for dividing your income called "community property." It divides a couple’s total income in half and counts one-half for each spouse. If you have this option, Health and Welfare will help you decide the best method to use.
WHAT YOU OWN
In addition to the income limit, there is a limit on how much you can own in cash, savings, certificates of deposit, stocks, bonds, mutual fund shares, promissory notes, contracts, cars, real estate, and other "resources."
Some items do not count, including:
Your home, as long as one spouse still lives there or you intend to return home
Household goods and personal effects, including one wedding ring and one engagement ring
Cash value of life insurance, if the face value of all policies is not worth more than $1,500 for each spouse
Up to $1,500 set aside for burial of each spouse
SPOUSE AT HOME
You can set aside some financial resources for a spouse at home. This is explained in the "Resources" section, which follows.
In some cases, you also can use some of your income to support your spouse at home, in addition to any resources that have been set aside. This is explained in the "Income" section.
You will need a "resources assessment" as soon as possible after you or your spouse enters a nursing home. Ask your local Health and Welfare office
for this assessment.
You will need to figure out how to divide your resources with your spouse because the spouse at home may keep a certain amount to meet his or her needs. You may want advice from an attorney before dividing your resources. After you have divided your resources, Health and Welfare will count how much belongs to the spouse who is moving to the nursing home. If this amount is more than $2,000, that person may not qualify for Medicaid right away.
Medicaid may help after the spouse in the nursing home has paid enough bills to have only $2,000 left. This is why it is important to know where you stand when one of you first enters a nursing home. Your situation at that time will determine how much the spouse at home can keep and when Medicaid may start to help the other spouse.
The process may become much more difficult if you wait very long to assess your resources. The amount the spouse at home can keep changes each January.
TRANSFER OF RESOURCES
You may need to transfer resources between spouses to make sure one of you has enough money to continue living at home. The need for this will depend on your personal circumstances, including what each spouse owns when one of you moves into a nursing home.
If you transfer resources, you must do it in a way that meets the limits mentioned above. Also, you must follow other Medicaid rules, because you could delay or lose your benefits.
This warning applies to transfers that occur up to 60 months before you apply for Medicaid, if the transfer is to a trust.
If you transfer resources between spouses, the transfer can affect how much is counted toward the $2,000 limit for the spouse in the nursing home. The outcome will depend on how much you transfer and how much your spouse can keep.
You also could lose benefits if you transfer resources for less than the fair market value. The penalty depends on the value of the resources and what you received in exchange for them.
To complete this process, you may need a marriage settlement agreement. You may want to talk with an attorney or Idaho Legal Aid Services before accepting a marriage settlement agreement.
INCOME TO SUPPORT SPOUSE
After you qualify for Medicaid, you may be able to use some of your income to support the spouse at home. This is separate from the resource transfer discussed above.
TRANSFER OF INCOME
If you decide to transfer income between spouses or to anyone else, you must follow certain rules or you could delay or lose Medicaid benefits.
If you transfer income to your spouse, some of that income may still be counted as your income. This will depend on how much you transfer and how much can be used to support your spouse at home, under the process mentioned above.
Nursing home residents who qualify for Medicaid will be allowed to keep $40 each.
ESTATE RECOVERY AND PROPERTY LIENS
If you receive Medicaid after age 55, a lien may be placed on your estate up to the value of benefits paid. If you have no estate, the claim may be made against the estate of your spouse. No estate recovery will be made until after your death and that of a surviving spouse.
If you have no surviving spouse living at home and you need continued nursing home care, the state may place a lien on your real property to preserve it for estate recovery. The real property lien may be placed regardless of your age. A real property lien will be removed if your need for nursing home care stops. No lien will be placed on your property, and if a lien is placed, no recovery will be made, as long as any of these people live there:
Your child under 21 years of age
Your child who is blind or permanently disabled
Your brother or sister who owns an interest in the property and lived there at least one year before you went into the nursing home
The state may waive its claim against your estate, partly or entirely, if:
Nursing home care was needed because of a crime
Recovery would cause hardship to a survivor, as defined by Health and Welfare rules.
For information, the personal representative of the estate should contact:
Idaho Department of Health and Welfare
Third Party Liability Unit
Attn: Estate Recovery Officer
P.O. Box 83720
Boise, ID 83720-0036
If you have other questions about qualifying for Medicaid, contact the nursing home administrator, the Office on Aging, or the Idaho Department of Health and Welfare. If you have questions about medical and financial assistance, contact your local Health and Welfare office. If you have questions about government standards for nursing homes, contact:
Idaho Department of Health and Welfare
Division of Medicaid, Bureau of Facility Standards
P.O. Box 83720
Boise, ID 83720-0036