How Long Will Medicaid Pay for Long-Term Care or Nursing Home Care?

Summary
Medicaid Long Term Care will pay for nursing home care and long-term care in the community as long as beneficiaries continue to meet their financial and functional eligibility requirements. State Medicaid agencies complete annual Medicaid Renewals to recheck eligibility, which can be jeopardized for many reasons, and beneficiaries need to complete renewal paperwork in a timely manner. Long-term care in the community also depends on the availability of programs, funds and caregivers.

 

How Long Medicaid Pays by Program Type

There are three types of Medicaid Long Term Care relevant to seniors – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers and Aged, Blind and Disabled (ABD) Medicaid. All three programs will provide long-term care benefits as long as seniors continue to meet their eligibility criteria.

  Just For You: The easiest way to check the specific financial and functional eligibility criteria for your situation is using our Medicaid Eligibility Requirements Finder.

 

Nursing Home Medicaid

As the name suggests, Nursing Home Medicaid will pay for all the costs associated with living in a nursing home for financially limited seniors who need a Nursing Facility Level of Care, which means they need the kind of 24/7 care and supervision usually associated with a nursing home. For most states in 2024, the individual income limit for Nursing Home Medicaid is $2,829/month and the individual asset limit is $2,000. As long as a senior meets the financial requirements for their state and meets the functional requirement of needing a Nursing Facility Level of Care, and continues to meet them on an annual basis for their Medicaid Renewal, Medicaid will pay for their nursing home care.

Nursing Home Medicaid coverage includes payment for room and board as well as all necessary medical and non-medical goods and services like physician’s visits, prescription medication and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Nursing Home Medicaid is an entitlement, which means all eligible applicants are guaranteed by law to receive benefits without wait. However, Nursing Home Medicaid beneficiaries are required to give almost all of their income to the state to help cover the cost of care.

Home and Community Based Services (HCBS) Waivers

HCBS Waivers will pay for long-term care services and supports for financially limited seniors who need a Nursing Facility Level of Care but live somewhere in the community, like their own home, the home of a loved one, assisted living facilities or adult foster homes. For most states in 2024, the individual income limit for HCBS Waivers is $2,829/month and the individual asset limit is $2,000. As long as a senior meets the financial requirements for their state and meets the functional requirement of needing a Nursing Facility Level of Care, and continues to meet them on an annual basis for their Medicaid Renewal, Medicaid will pay for their long-term care benefits in the community.

While HCBS Waivers can pay for long-term care benefits in a variety settings (the beneficiary’s home, the home of a loved one, assisted living residence, adult foster home, memory care unity for people with Alzheimer’s, adult day care, etc.), they will not cover room and board costs such as mortgage payments, rent, facility fees, utility bills and food expenses. The types of available HCBS Waivers long-term care benefits (and where they can be provided) depends on the state, program and individual, but they can include home modifications, nursing visits, medication management and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Most HCBS Waivers are not an entitlement. Instead, they have a limited number of enrollment spots and once those spots are full additional applicants are placed on a waitlist.

Aged, Blind, and Disabled (ABD) Medicaid

ABD Medicaid provides basic healthcare coverage for financially limited seniors who live in the community. It will also pay for long-term care services and supports for beneficiaries who show a functional need for those long-term care services and supports. The ABD Medicaid individual income limit varies by state, but for 2024 it’s between $943/month and $1,751/month. The 2024 individual asset limit for ABD Medicaid in most states is $2,000. As long as a senior meets the financial requirements for their state and meets the functional requirement of showing a need for long-term care benefits, and continues to meet those financial and functional requirements on an annual basis for their Medicaid Renewal, Medicaid will pay for their long-term care benefits in the community.

Available ABD Medicaid long-term care services and supports depend on the state, program and individual, but they can include include case management, meal delivery, transportation and personal care assistance. While ABD Medicaid is an entitlement, long-term care benefits are not always available. That can be because the beneficiary does not show a need for those benefits, but those benefits may not be available in their state or their part of the state due to lack of funds, caregivers or programs.

 

Medicaid Eligibility Renewals

To make sure Medicaid Long Term Care beneficiaries continue to meet the financial and functional eligibility criteria for their program, state agencies conduct annual Medicaid Renewals, also known as Redetermination.

In the past, Medicaid Renewals were usually done every year on the date the beneficiary’s application was approved. However, Medicaid Renewals were suspended during the COVID-19 Public Heath Emergency before being resumed on April 1, 2023. At that time, states were given up to 12 months to initiate all Renewals and up to 14 months to complete them, so the timing of Renewals changed. Plus, many states are conducting their post-COVID Renewals based on things like vulnerability, potential ineligibility and time since last renewals. So, Medicaid Renewals dates will now be all over the map instead of on the anniversary of application acceptance.

During a Medicaid Renewal, the state will evaluate a beneficiary’s financial situation (including the value of their home, if they own one) to make sure they still meet their income and asset limits. The beneficiary’s medical status will also be checked to make sure they still meet the functional requirements, but in most cases medical condition does not improve enough to merit any changes here.

What Are a Beneficiary's Responsibilities During Medicaid Renewals?

In some cases, the state can conduct Medicaid Renewal electronically and the beneficiary doesn’t need to do anything. This is known as automatic renewal or ex parte renewal.

However, if a beneficiary’s financial situation cannot be checked automatically, they will receive an email and/or a letter with a Medicaid Renewal Form they must complete. So, the first responsibility for a beneficiary, or their representative, is making sure their state Medicaid agency has their correct email address and mailing address.

The second responsibility is completing, dating, signing and returning that Renewal Form within 30 days to ensure Medicaid Long Term Care coverage continues without interruption. The Renewal Form may be “pre-populated” with information the state has been able to gather about the beneficiary’s financial status. But the beneficiary may also need to provide documentation that details their financial situation. In some states, beneficiaries also have the option to complete the Renewal Form over the phone, online, or in person.

If beneficiaries do not complete and return the Renewal Form within 30 days, or if they no longer meet their Medicaid eligibility requirements, they will be disenrolled. From the day they are disenrolled, they have 90 days to submit or resubmit their Renewal Form for a chance to be re-enrolled without having to fully re-apply. After 90 days, they have to go through the full application process, which is more time-consuming.

 

Reasons for Losing Medicaid Long Term Care Eligibility

There are many reasons a Medicaid Long Term Care beneficiary might lose their coverage, including:

  • The state Medicaid agency does not have the proper contact information and cannot contact the beneficiary for their Medicaid Renewal
  • The Medicaid Renewal form is not completed by the due date or required documentation is not provided.
  • The value of the Medicaid beneficiary’s home increased and they are now over the asset limit.
  • The Medicaid beneficiary inherited money and they are now over the asset limit.
  • The Medicaid beneficiary’s income increased and they are now over the income limit.
  • Assets were gifted or sold for less than fair market value in violation of the Look-Back Period, resulting in period of Medicaid ineligibility.
  • The Medicaid beneficiary no longer meets the functional criteria.

 

How to Avoid Losing Medicaid Long Term Care Eligibility

To avoid losing Medicaid Long Term Care eligibility, you or your loved one should:

Make sure your contact information is up to date with the state Medicaid agency. This includes your address, phone number and email address.

  • Watch for information regarding Medicaid Renewal. This could be via mail, email or phone.
  • Complete your Medicaid Renewal Form and provide all requested information by the due date.
  • Be aware of your specific income and asset limits for your state and Medicaid Long Term Care program. Income that is not spent in the month of receipt is treated as an asset the following month. Therefore, if you or your loved one is saving income each month, it might push you over the asset limit.
  • If a large sum of money is received, such as an inheritance, contact a professional, like a Certified Medicaid Planner or an Elder Law Attorney, to inquire about the best course of action. The state will also need to be contacted.
  • Do not sell your home. The proceeds from the sale will count as assets, most likely pushing you over the asset limit.