for Nursing Home Care, Utah Medicaid Program
Nursing Home Medicaid Program covers the cost of care in a long-term care
facility, such as a nursing home, in addition to the ordinary medical services.
limit is generally the amount the nursing home charges for a private-pay patient.
A client whose income is below the private-pay rate may be considered for
Medicaid coverage of nursing home costs. All of the client's income
is considered in determining Medicaid eligibility, except for certain types
of income excluded by federal law. A person with income above the private
pay rate may qualify if medical expenses exceed income. If married,
his or her spouse's income is not considered.
insurance premiums and some medical bills paid for the
person in a nursing home are allowable deductions.
Other deductions depend on whether the person is placed
short-term for a stay of less than 6 months or long term.
A spouse at home is allowed to keep a portion of total
income for living expenses. There is both a minimum
and a maximum amount of income the spouse in allowed to
keep. The minimum-maximum is adjusted annually.
The nursing home patient is allowed to keep only $45 for
personal needs. The remainder is paid to the long-term
care facility as the contribution to cost of care. Medicaid
will cover the remainder of the expense.
(see definition of "assets")
home client - $2,000.00
married persons with a spouse remaining in the home, assets
are divided between husband and wife. All assets
are considered to be jointly owned even if only one member
of the couple is shown as the owner. Special allowances
for burial spaces and funeral plans. The amount
of the assets the spouse at home may keep is adjusted
upwards each January. As of January 2010,
the spouse at home is allowed to keep at least $21,912
of the assets the couple owned when the client entered
the nursing home, and no more than $109,560. Current limits
can be found at the web site for the Centers for Medicare
& Medicaid Services: http://cms.hhs.gov/medicaid/eligibility/
apply if either (1) individual or spouse transfers assets
within 60 months of application date for Medicaid, or
(2) the individual transfers assets at any time after
eligibility is determined. Nursing home costs are not
paid during a sanction period.
of a nursing home client age 55 and older may be subject
to Estate Recovery.
covers nursing home charges only 90 days prior
to the date the nursing home submits the Form 10 to the
Department of Health. (Form 10 is used to determine
whether a client needs care in a nursing home.)
For all other medical services, considered ancillary charges,
the applicant may request coverage for medical services
for up to three months prior to the month in which the
the Medicaid application was filed. A person who
received medical, dental or mental health services and
subsequently qualifies for Medicaid may return to each
provider with a Medicaid Identification Card for the month
in which service was provided. A provider who has already
rendered services may subsequently choose to accept Medicaid
as payment in full or refuse to seek Medicaid payment
because the patient had not been determined eligible for
Medicaid at the time of service. If the provider
accepts Medicaid, Medicaid may pay for the service.
If the provider refuses Medicaid, the patient is responsible
for the charges.
and Where to Apply for Medicaid