With the average cost of nursing home care in Nevada nearing $8,000 per month, 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. For more information, see Nolo's article on when Nevada Medicaid pays for assisted living and home care services.
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.
In Nevada, a single person can have an income of only up to $2,163 in 2014 and qualify for Medicaid-paid long-term care. (This is 300% of the SSI payment level.) This limit is higher than the income limit for those applying for other health care benefits from Medicaid.
If you have over the monthly income 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, the rest goes to your nursing home costs or allowable medical expenses.
If you are a married couple and one of you lives in the community (at home), there are different income rules for obtaining Medicaid eligibility. If the spouse who lives in a nursing home has more income than the $2,163 limit, Medicaid will combine the income of both spouses and use the average income of the spouses. If the average is less than $2,163, the spouse will qualify. If the nursing home spouse has income under $2,163, the amount of income the community spouse receives is not taken into consideration.
In a married couple’s situation, the amount paid to the nursing home varies because, in some cases, the spouse living in the community can keep some of the nursing home spouses income. It depends upon how much the spouse at home makes in income.
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 case value, vehicles, motorhomes, boats, IRA’s, 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. If you are a married person, the spouse at home can keep up to $23,448 worth of resources. In Nevada, the at-home spouse can also request a court order that the spouse can keep a higher amount of up to $117,240.
Medicaid has a very strict no gifting rule to prevent Medicaid applicants from giving away their money and property to family members. The rule if this: You cannot give away assets or sell them for less than fair market value to meet the Medicaid resource limit. Medicaid is allowed to look back for 60 months (5 years) to see if you have given away any gifts during that time. Gifts include paying the expenses of anyone but yourself and your spouse. If you have done so, you may be ineligible for Medicaid for an amount of time dependent on how much money or property you gave away.
Read on to learn when Nevada Medicaid pays for assisted living and home care services.
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