Long-term nursing home care in Michigan doesn't come cheap. In 2018, the average daily cost of a private room in a nursing home in Michigan was $300. For people with few assets, including those who have already used up all of their own assets to pay for care, Medicaid is a common source of funding for long-term care. Those with too many assets often have to pay for their own care outright, because private health insurance policies generally do not cover long-term care, and few people purchase private long-term care insurance policies. (Medicare coverage for nursing home care is limited to a short period of time following a stay at a hospital.)
There are many different ways to become eligible for Medicaid, and there are specific eligibility rules for long-term care services like nursing homes. To apply for Medicaid in Michigan, contact your local office of the Michigan Department of Health & Human Services. You can also apply online.
Michiganders who are sixty-five or older, disabled, or blind can qualify for Medicaid if they also meet income and asset limits. People who receive SSI automatically qualify to receive Medicaid in Michigan, but if you are elderly, blind, or disabled and not receiving SSI, then your monthly income must be less than 138% of the federal poverty level (FPL) to qualify for Medicaid. In 2019, that is $1,436 per month for an individual.
If your income is above this limit, you still might be able to qualify for Medicaid if your medical expenses are higher than the amount of extra income you have. In Michigan, people who are sixty-five or older, blind, or disabled can use medical bills that they incur each month to "spend down" their income and qualify for Medicaid.
If you qualify for Medicaid and live in a nursing home, you will be expected to spend almost all income on your care. Michigan allows nursing home residents receiving Medicaid to keep only $60 per month as a personal needs allowance.
If you have unpaid bills for medical expenses that were incurred in the three months before you applied for Medicaid, you may be eligible for retroactive benefits that could pay those bills. You will need to submit a separate application for retroactive benefits and show proof of the bills.
To qualify for Medicaid in Michigan, you must have no more than $2,000 in resources. Resources are assets like money and property. Some property does not count toward the resource limit. In Michigan, one car is exempt, and household goods are exempt. Your primary residence and any attached acreage is an exempt resource. However, if you need Medicaid for long-term care, then you cannot have more than $585,000 in equity in your home in 2019. Retirement accounts are counted as assets to the extent you can withdraw money from them.
If you have a spouse who is going to continue to live independently, then Michigan will allow you to keep more income and assets to support that spouse. This is called spousal maintenance.
Your spouse will be allowed to keep some income each month. The amount will depend on how many dependents and expenses he or she has. In 2019, the minimum amount your spouse can keep is $2,057.50, and the maximum is $3,090. If your spouse needs more than the Department of Health & Human Services decides to allow, then you can go to court and ask a judge to order more.
You will also be allowed to keep more than $2,000 in resources if you have a spouse who will remain in the community. The Department of Human Services does a complicated calculation to determine how many assets your spouse can keep.
When you are admitted to a nursing home, you will complete a form called an "Assets Declaration," and the staff will do ask you about all of your assets in an "Initial Asset Assessment" (IAA). Michigan assumes that half of your IAA should belong to your spouse, subject to a limit that changes annually. In 2019, the minimum "Protected Spouse Amount" ("PSA") is $25,284, and the maximum is $126,420. When you apply for Medicaid, your PSA is subtracted from your countable assets at the time of your application.
Mr. Brown has $40,000 in countable assets when he moves into a nursing home on February 1st. His IAA is $40,000. Mrs. Brown continues to live in the couple's home. Mr. Brown's PSA is $25,284, because half of his IAA is only $20,000, and that is below the minimum allowed. Mr. Brown uses his own savings to pay for his nursing home care until April 1st, when he applies for Medicaid. On April 1st, Mr. Brown has $26,000 in countable assets (after spending $14,000 on the nursing home). To determine his Medicaid eligibility, the Department of Human Services subtracts his PSA of $25,284 from his countable assets of $26,000. His assets are $716, which is below the $2,000 resource limit. Mr. Brown meets resource eligibility criteria for Medicaid.
Medicaid will pay for a nursing home only when it is medically necessary. You must show that you require a "nursing home level of care," meaning that you have a physical or mental condition that requires nursing supervision and assistance with activities of daily living (ADLs).
Within the first two weeks after you are admitted to a nursing facility, Medicaid requires that you have a "Level of Care" ("LOC") determination. In Michigan, nursing facility staff do the LOC determination using an online state system.
To determine the level of care you need, nursing facility staff will ask you questions to determine how much assistance you need with your ADLs. The ADLs that Michigan uses to determine whether you meet the nursing home level of care are: bed mobility, transfers, eating, toileting, short-term memory, cognitive skills for decision-making, and making yourself understood. For each, the assessor will decide how much assistance you need and assign you a functional level. The levels are: Independent, Supervision, Limited Assistance, Extensive Assistance, Total Dependence or Activity Did Not Occur. For example, if you usually cannot get up from a chair without someone helping you, then the assessor may say that you need limited assistance with transfers.
When assigning a functional level, the assessor will look at your activities in the last seven days and will also look at whether you need skilled nursing services to treat a medical condition, or physical therapy or other therapy services.
Medicaid uses the information in your screening to decide whether you need a nursing home and, if so, what kind of nursing home is appropriate for you. In general, for a nursing home to be considered medically necessary, you must have a medical condition that is so serious that you need the level of nursing care that is only available in an institution.
Read on to find out whether Michigan's Medicaid program will cover assisted living facilities and home health care.
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