When Medicaid in Nevada Will Pay for Long-Term Care in a Nursing Home, Assisted Living, and Home Care

With the average monthly cost of a private room in a nursing home in Nevada exceeding $9,000 in 2018, those who are likely to need long-term care should pay serious attention to making sure they have a way of paying for that care. Nursing home care is usually paid for by private funds, nursing home insurance, or Medicaid. If a patient cannot afford to pay privately and does not have long-term care insurance, Nevada's Medicaid program might pay for his or her care.

Medicaid is a medical assistance program funded by the federal and state governments to pay for long-term care for persons who meet certain requirements, such as being over 65, disabled, or blind. Other types of Medicaid services have different eligibility guidelines than the rules for long-term care.

Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care may qualify for Medicaid benefits, if they meet the income and resource qualifications of Nevada's Medicaid program.

There are also some limited services for people who still live at home but would otherwise require a nursing home. These are called home-based waiver programs. Similar income and asset rules apply for these programs.

Necessity of a Nursing Home

Nevada's Medicaid program uses a Pre-Admission Screening Resident Review (PASRR) test to determine whether a person needs a nursing home and a Level of Care (LOC) Assessment Form to determine the level of care a person needs. The nursing home staff usually does this screening, which includes a review of the person's medical diagnoses and abilities. The LOC form asks about the level of assistance you need with various activities of daily living (ADLs), such as moving about, dressing, eating, hygiene, and using the bathroom, and whether you have any special needs such as durable medical equipment.

In general, you must require a level of care that cannot be met anywhere but in a nursing home. Nevada Division of Welfare and Supportive Services (DWSS) makes the final decision on eligibility for institutional Medicaid.

Typically, your care facility can assist you with the Medicaid application process or you can apply directly with the DWSS. Before you apply, make sure that to the best of your knowledge you meet the eligibility criteria.

Medicaid Income Rules in Nevada

In Nevada, a single person can have a monthly income of only up to $2,313 in 2019 and qualify for Medicaid-paid long-term care. (This is 300% of the SSI payment level.) The Medicaid income limit for a married couple, with both spouses applying, is $4,626 per month in 2019. These long-term care income limits are higher than the income limit for those applying for other health care benefits from Medicaid.

If you have income over the monthly amount and are in need of a nursing home, Nevada allows you to establish a Qualified Income Trust to meet the Medicaid income limits. A Qualified Income Trust is a special account used only for Medicaid purposes. You set up your income to go into a Qualified Income Trust and it is then used to pay a portion of the cost of the nursing home. The trust can also pay for Medicare premiums and premiums for supplemental health plans. If you are a single person in a nursing facility, you can keep only $35 a month from the trust, and the rest goes to your nursing home costs or allowable medical expenses.

Medicaid Asset Rules in Nevada

Medicaid for long-term care has different resource rules than for other Medicaid programs. Resources are assets like real property, personal property, life insurance with a cash value, vehicles, motorhomes, boats, IRAs, bank accounts and cash on hand. You will have to total up all of these to determine how much you have in resources.

If you are a single person, you can only have up to $2,000 in resources with a few allowable exclusions such as a car and your home (up to a value of $585,000 in 2019). If you are married, your spouse at home can keep up to $25,284 worth of resources. In Nevada, the at-home spouse can also request a court order to keep a higher amount of up to $126,420.

Medicaid-Paid Assisted Living or Home Health Care in Nevada

Medicaid "waivers" will pay for some services to individuals who can appropriately be cared for at home or in an adult group care facility. These waivers can help individuals maintain their independence, sometimes in their own homes, as an alternative to nursing home placement.

The same financial eligibility rules that apply to Medicaid coverage for nursing homes apply to waiver programs. Thus, in 2019 an individual applicant cannot have monthly income greater than $2,313. Assets are limited to $2,000 for an individual and $4,000 for a couple with both spouses applying (each spouse is allowed up to $2,000).

Nevada's Home and Community Based Waiver for the Frail Elderly (HCBW-FE)

The Home and Community Based Waiver for the Frail Elderly (HCBW-FE, formerly the CHIP program) of Nevada's Aging and Disability Services Division (ADSD) provides non-medical services to older persons to help them maintain independence in their own homes instead of going into a nursing home.

Applicants for the HCBW-FE waiver must:

• be at least 65 years old
• require a nursing home level of care (or would require a nursing home within 30 days if the HCBW services were not available)
• have a continued need for services, and
• meet Medicaid's income and assets limits.

Note that the HCBW-FE program provides only non-medical services, so care from a nurse is not included in this program.

A licensed social worker will be assigned to each individual to determine what services he or she needs. The social worker will then coordinate and oversee the needed services. Some of the services provided under this waiver program include assistance with personal care such as bathing, grooming, transferring, eating and homemaker help with meal preparation, laundry, and shopping. This program also will provide some services for adult day care (not medical day care), an adult companion, and a personal emergency response system (for reporting falls). ADSD will hire all of the service providers in this program, and participant direction of services is permitted in just a limited capacity. You should contact ADSD for more details.

There are limited slots available for this waiver program. The ADSD uses a waitlist to prioritize applicants. When funding becomes available, the applicant will be processed based upon the level of care needed, the risk factors for that individuals, and the date of the waiver application.

Nevada's Home and Community Based Waiver for Persons with Disabilities (HCBW-PD)

The Nevada Home and Community-Based Waiver for Persons with Physical Disabilities (HCBW-PD), or the Physical Disabilities Waiver (WIN), is a waiver serving Nevadans of all ages who have a documented physical disability and who maintain the required level of care. This program offers services similar to those the HCBW-FE program offers, and recipients must meet applicable functional and financial requirements.

Personal Care Services for the Elderly or Disabled

Medicaid's Personal Care Services (PCS) program provides services to Nevadans who, due to a chronic health issue or disability, need assistance to continue living at home. The PCS program provides assistance with activities of daily living and instrumental activities of daily living to support and maintain individuals who live at home but need help with things like bathing, dressing, grooming, toileting, eating, mobility and ambulation, light housekeeping, laundry, and other similar activities as authorized by the program.

For more information about the PCS program and eligibility requirements, visit the Nevada Division of Health Care Financing and Policy web page. For more general information about all of these programs and to apply, you should contact your local Nevada Aging and Disability Services Division office.