By: Staci Hornberger
When a loved one enters a skilled nursing facility, whether it be for rehab or long-term care, lots of questions start to arise. Fear settles in and families start to ask anyone who will listen about the concerns they have moving forward. Will I lose my home? How will I pay for this care? What options are available to help? While you are not alone in any of this, every situation is different as everyone’s assets and income are different. Therefore, what works for one family and one situation, may not work for another. This causes a lot of confusion and misconceptions when it comes to the options for paying for Long Term Care with programs such as Medicaid.
To get a better understanding of this, lets first start with “What is Medicaid?”. Medicaid is a joint federal-state program that provides health coverage and financial assistance to disabled individuals, senior citizens, and other qualifying individuals. An applicant must meet the financial and medical requirements to be eligible.
What are those financial and medical requirements to be eligible? To put it simply, an applicant must have a medical need for long-term care services, be a US Citizen or a qualified non-citizen, and meet the requirements for financial eligibility by meeting the income and resource guidelines. A Certified Elder Law Attorney can work with you to protect your assets in a way that will still allow you to be financially eligible for Medicaid.
In Pennsylvania, Medicaid covers care in a skilled nursing facility as well as a variety of home care services through different programs and waivers. Medicaid benefits can help cover the cost of in-home nursing services for disabled or older adults with Medicaid waiver programs such as Home and Community Based Services (HCBS) and Living Independence for Elderly (LIFE). These programs provide financial assistance to obtain skilled nursing care while remaining at home.
If receiving benefits through HCBS or LIFE, an applicant may not owe any funds to pay for their care as their income is used to maintain their living expenses within their own home. If residing in a skilled nursing facility, an applicant’s income is used to pay the monthly room and board to the facility. The amount is based on the applicant’s total gross income. The state will calculate the applicant’s gross income and make any available deductions such as a personal needs allowance, home maintenance deduction, spousal allowance, and Medicare and supplemental health insurance premium deductions. The amount after the available deductions are made is what would be paid to the nursing home each month for the applicant’s care. The applicant’s spouse (also known as community spouse) is NOT required to pay for the applicant’s long-term care services with their own income. The community spouse is allowed to keep all of his/her income, regardless of the amount.
One of the biggest misconceptions I hear when talk of Medicaid comes up, is “the nursing home is going to take my home!” In the state of Pennsylvania, the primary residence of an applicant can be exempt so long as the home is less than or equal to $730,000 (based on 2025 values), the applicant has the intent to return home, or if the applicant, spouse or dependent child resides in the home. If an applicant is looking to sell their home while receiving Medicaid benefits, it is important to discuss the options with a Certified Elder Law Attorney. There are many ways to protect your home and the proceeds from selling your home if the proper steps are taken.
You may be asking yourself, when should I start planning for future care for myself or a loved one? There are different options and avenues available to protect your assets from the cost of care at any stage. By working with a Certified Elder Law attorney, you can make sure you have all the tools you need so that if and when long-term care needs arise, you are prepared. It’s never too soon (or too late) to start planning for your future!