With the average monthly cost of a private room in a nursing home in Maryland surpassing $10,000 in 2020, seniors who are likely to need long-term care should pay serious attention to ensure they have a way to pay for that care. Long-term care is usually paid for by private funds, nursing home insurance, or Medicaid. For patients who cannot afford to pay privately and do not have long-term care (LTC) insurance, Maryland's Medicaid program (Maryland Medicaid, or Medical Assistance (MA)), administered by the Maryland Department of Health (MDH), might cover their care.
Medicaid is a medical assistance program funded by the federal and state governments to pay for, among other things, 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 LTC.
In Maryland, Medical Assistance provides LTC coverage under certain circumstances. 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 specified income and resource qualifications. Maryland also operates certain Medicaid waiver plans, known as Home and Community-Based Services (HCBS) waivers, including programs that allow elderly individuals in need of assistance to remain living independently, in their homes and communities, instead of in a nursing home.
If you are age 65 or older, blind, or disabled and meet income and resource requirements, Maryland Medicaid provides coverage for nursing home residents under certain circumstances. To obtain coverage for nursing home care, not only do you have to be financially eligible, but you must also need the kind of care nursing homes provide. Nursing homes provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, and other services. To determine the level of care (LOC) that you need, Maryland Medicaid requires a physician's certification that such services are needed.)
For more information about Medical Assistance, visit Maryland’s Department of Human Services (DHS) or contact your local Maryland DHS office. You can access the DHS benefits portal, applications, and information site for more services and assistance. Additionally, the MDH maintains web sites that answer Medicaid eligibility questions and provide additional Medicaid application resources.
Before you apply for Medicaid coverage, make sure that to the best of your knowledge you meet the eligibility criteria. Typically, your nursing care facility can assist you with the Medicaid application process. For other questions about LTC Medical Assistance, you can call the Maryland DHS main office at (800) 332-6347.
In Maryland, whether you are single or a married person with one or both spouses applying, to qualify for Medicaid-paid nursing home care, your income cannot exceed the cost of institutional care. This income limit for nursing homes may be different than the income limit for those applying for other health care benefits from Medicaid, such as for in-home Medicaid or Medicaid waiver services (discussed below). For example, though the monthly income limit is $350 for regular Medicaid, the limit is $2,349 per month for Medicaid waiver programs.
For purposes of determining Medicaid LTC eligibility, any income an applicant receives, from any source, is considered. However, when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse is not counted, so that he or she has enough funds on which to live. Additionally, the non-applicant spouse is entitled to keep a minimum monthly needs allowance, which may range from $2,155 to $3,216.
If you qualify for Medicaid and live in a nursing home, you will be expected to spend almost all income on your care. Maryland Medicaid allows nursing home residents receiving Medicaid to keep only $82 per month as a personal needs allowance.
Maryland also provides a Medically Needy pathway, or “spend-down” program, that allows applicants otherwise over the income limit to qualify for Medicaid services. Individuals with high, recurring medical expenses can spend down their income that exceeds the medically needy income limit, effectively reducing their income level to the point that they become eligible for Medicaid to assume coverage.
Medicaid for long-term care has asset resource rules, which you must satisfy to be eligible for coverage, that may be different from those for other Maryland Medicaid programs. Resources are assets like real property, personal property, life insurance with a cash value, vehicles, motorhomes, boats, bank accounts, and cash. You will have to total up all of your non-exempt, countable assets to determine how much you have in resources.
If you are a single person, you can have only up to $2,000 or $2,500 in assets, depending on the Medicaid program to which you are applying, with a few allowable exclusions such as a car and your home (up to a value of $595,000 in 2020). If you are married, your non-applicant spouse at home can keep up to $128,640 worth of joint assets.
Maryland residents may be eligible for Medicaid long-term care services that are delivered outside of the nursing home facility setting. The state has programs with different eligibility requirements that offer certain other benefits so that seniors at home or in the community can obtain needed services. These programs can provide services to promote home- and residence-based independent living.
Maryland Medicaid offers certain Home and Community-Based Services (HCBS) waiver programs that afford individuals LTC services assistance so that they can remain living independently—in their homes and communities—instead of in nursing homes. For example, the Community Options Waiver provides services like assisted living, medical day care, case management, transitional services, supports planning, and nurse monitoring for eligible individuals who need help with activities of daily living and meet a nursing facility level of care. Maryland’s Increased Community Services Program is a related program that offers similar services but has different financial eligibility requirements.
Another program, Community First Choice, allows eligible participants in need to receive at-home services featuring personal assistance with activities of daily living like bathing, grooming, dressing, meal preparation, and transportation. Individuals must meet an institutional level of care and qualify financially. Under this program, participants can actively self-direct care and can even hire family members to deliver care and receive compensation through Maryland Medicaid. Community Personal Assistance Services, a related program, is designed to serve eligible individuals who live at home and need assistance in areas like personal hygiene, bathing, and meal preparation. These services are delivered by an approved provider and subject to nurse case monitoring.
For general information about these programs, contact the MDH at (410) 767-1739. To learn more about the Community Options Waiver, Community First Choice, Community Personal Assistance Services, and related programs, contact your local Maryland Access Point (MAP) office or call MAP at (844) 627-5465.