Will Medicaid Cover Nursing Home Care?

Mount Hope administrator Gina Terry with 2 staff members holding award certificate for providing outstanding long term care in Kansas

Kansas Eligibility for Medicaid Coverage of Long-Term Care

Facing the decision to enter a nursing home or to help put a loved one into a nursing home can be very difficult. Not only can this be a very stressful and emotional time, the worry about money often also looms large. When you get to the stage of knowing a nursing home is needed, you don’t always know who is going to pay for it.

Who Pays for a Nursing Home?

You want your loved one to get the care they desperately need, but are you worried you don’t have the money to pay for it? The good news is, there is help. There are a variety of ways that people can afford nursing home care, even those who don’t have the means themselves to afford it. In fact, the #1 way people pay for health care isn’t from their own bank account.

65 percent 300x291 - Will Medicaid Cover Nursing Home Care?The solution for many Kansans is Medicaid, which is administered through the KanCare program. Medicaid provides opportunity for many elderly people across Kansas to get the long term care they need in a certified facility like Mount Hope Nursing Center. But beyond Medicaid, there are other government programs that can help you afford the care you need.

Since the care given in a long-term nursing home facility is a vital health and wellness service so many of our aging population needs, the government recognizes they have a role in ensuring elderly persons get the care they require. Here in Kansas, nearly 65% of all nursing home residents have their care paid for by Medicaid.

Who is Eligible for Medicaid Coverage of Nursing Home Care?

There are many factors that help determine who Medicaid will cover for nursing home care including:

  • You must be a Kansas resident AND a U.S. Citizen (or have proper immigration status)
  • You must be at least 65 years old. Or if not, then be blind, disabled or have been granted to receive care in your home or other facility. An assessment of medical requirements may be conducted.
  • You do not have available assets. (This is a complicated issue that is further explained below)
  • You must have a monthly income that is less than 244% of the Federal Poverty Level. For an individual in Kansas, that would be an annual income of $30,475 (monthly = $2,540). See the chart below from the S. Department of Health and Human Services for the 2019 Federal Poverty Guidelines that include Kansas.

2019 Poverty Fed chart - Will Medicaid Cover Nursing Home Care?

Exempt vs Available Assets: Is Your Home at Risk?

In order to be eligible for Medicaid, you cannot have available assets. If you did, they would likely need to be liquidated with that money being used to cover your care costs before Medicaid will step in and start paying. But not only that, you can’t have had available assets within the last 5 years. Kansas looks back over the last 5 years to see if you had any assets (such as investments, money and properties) that you sold, transferred or gave away. Click here to learn more about Medicaid’s Asset Transfer rules.

What is an Available Asset?

There are two types of assets: available and exempt. For consideration of Medicaid availability, only available assets are taken into account. If you have any asset that is considered exempt, you do not have to worry about those items affecting your ability to receive Medicaid coverage for nursing home care.  Medicaid will not deny you benefits for having any exempt asset.

Common Exempt Assets include:
    • $2,000 or less in cash
    • Personal effects
    • A home valued no greater than $585,000.
    • A vehicle (of any value) that is used for the owner’s transportation needs of receiving medical treatment, employment, accommodating a disability, or is the primary vehicle of the person’s spouse

Medicaid eligibility can be a complicated matter as there are many factors that get considered. If you have a spouse and he/she will be keeping some of your assets, that also helps determine your eligibility. But these are the main issues that can help you get an understanding of what you may expect as you apply for Medicaid to handle your nursing home costs.

Confused? We understand. The financial aspect of getting the care you or your loved one need is complicated and not immediately clear. We have been asked to help countless people understand Medicaid and other financial matters regarding nursing home or other elderly care. Please let us know your questions. We would be happy to have a conversation with you to help you understand what you need to know. Call us with your nursing home care questions at (316) 667-2431.

Medicaid: What is NOT Covered?

While Medicaid provides so much of the necessary expense allowing people to enter a nursing home, it doesn’t cover everything each person will need. There are certain types of care services that an elderly individual may need that cannot be paid for with Medicaid.

Assisted Living is not covered by Medicaid. Assisted Living is a type of care given to people who can live nearly independently, but still need assistance with some day-to-day activities. Some nursing home facilities offer Assisted Living for those who can live with minimal assistance. So before you decide upon Assisted Living, it’s important to know that this type of coverage will not be covered by Medicaid.

Other services that are likely not going to be covered by Medicaid:

  • Coverage for in-home care
  • Routine physical check-ups
  • Over-the-counter medicine
  • Medical care received outside of the United States

Other than Medicaid: Who Else Can Help Pay for Care?

Kansas Program for Home Health Care

Home Health Care is another service that may not be covered by Medicaid. However, the Kansas Senior Care Act may provide the financial help you need. The Senior Care Act is run by the Kansas Department for Aging and Disability Services. It created by the Kansas legislature in 2014 to provide assistance to aging Kansans facing limitations. With the Senior Care Act program, Kansas does offer waivers for seniors at least 60 years old who can remain in their home but need assistance with some daily activities. Whether or not you are eligible for the Senior Care Act program depends on the county you live in and your ability to pay for the care you need. In addition, a functional assessment will be done to determine who is admitted into this program. How much a person may have to pay out of their own pocket for this care depends upon their income and assets.

Kansas Long Term Insurance Partnership

Here in Kansas, there exists a program created specifically to help pay for nursing home care. The Kansas Long Term Care Insurance Partnership was created in 2007 and is a collaboration of the state and private insurance companies. The program was designed to help people who may need to apply for Medicaid protect their assets. The amount of money in your policy equals the amount of your assets that won’t need to be used to pay for nursing home care.

Program for All-Inclusive Care for the Elderly

Kansas offers the Program for All-Inclusive Care for the Elderly, known as PACE. This program is for people at least 55 years old. It provides long term care and is not part of KanCare. It only is available in select Kansas counties, including here in McPherson County where Mount Hope Nursing Center is located:

  • Dickinson
  • Douglas
  • Ellsworth
  • Harvey
  • Jackson
  • Jefferson
  • Leavenworth
  • Lincoln
  • Lyon
  • Marion
  • Marshall
  • McPherson
  • Nemaha
  • Osage
  • Ottawa
  • Reno
  • Rice
  • Saline
  • Sedgwick
  • Shawnee
  • Pottawatomie
  • Wabaunsee
  • Wyandotte

Need Help Navigating Financing for your Nursing Home Needs?

Mount Hope staff with award 300x225 - Will Medicaid Cover Nursing Home Care?While Medicaid and all these other Kansas programs provide great opportunities for Kansas aging population to get the care they need, it can be very confusing. At Mount Hope Nursing Center, we are work closely with all these organizations and so have the knowledge and experience to know what resources can help. Contact us! We are more than happy to talk with you through the options that may be available for you to get the care you or your loved one need. We know this is a difficult decision and a complicated one. Let us help you understand your options and help you along the process that is right for you and your loved ones. Call us at (316) 667-2431.

Having provided quality, friendly and professional care to senior citizens in central Kansas for nearly 50 years, we work diligently to provide the best services in our region, whether it is delivering short-term care or long-term nursing home services, you can always trust Mount Hope Nursing Center to put our residents first.

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