Understanding Medicaid-Sponsored SNF Coverage

When an elderly individual experiences the need for services at a skilled nursing facility, it can be very stressful for the family to consider the options available. Another big question — usually causing much anxiety — is how you’re going to pay the exorbitant cost. Does your loved one qualify for Medicaid? What, exactly, does Medicaid cover? In many states, understanding Medicaid coverage is half the challenge.

However, by determining the services that are available to your loved one, you help ensure that they will receive the quality of care they need. Senior Planning Services, a leading Medicaid planning company that assists seniors and their families with Medicaid eligibility would like to share some information related to Medicaid-sponsored SNF care.

What Services are Included at Skilled Nursing Facilities (SNF)

Skilled nursing facilities provide skilled nursing, rehabilitation and long-term care. In some cases, when an individual’s ability to take care of themselves has severely deteriorated, SNF may be necessary through the end of an elderly individual’s life. Often, however, the need for SNF is brought about due to illness or injury, and once the problem has passed, it’s possible for the individual to return to their previous residence.

Who Qualifies for SNF Services?

In order to qualify for SNF coverage and services, an individual must medically need those services. Typically, in order to qualify for Medicaid assistance, an individual must need skilled nursing assistance in at least four activities associated with day-to-day living. These include bathing, transferring out of a bed or wheelchair, using the restroom, and dressing. Typically, the determination of this need must be made prior to Medicaid approval for the service.

Medicaid Isn’t Always Accepted

Many facilities do not accept Medicaid. These facilities are not required to accept Medicaid. In some cases, when an individual has run out of money and no longer has the means to pay for their existing treatment facility, it may be necessary to transfer to a facility that accepts Medicaid.

Determining Medicaid Eligibility

There are a number of factors that determine whether or not an individual is eligible for Medicaid. First and foremost, individuals must meet financial eligibility requirements. These will vary by state, but typically require that an individual hold less than a specific amount of assets — $2,000 in many states — and earn below the state income threshold.

The income bracket in several states is $2199 monthly. Most states have a policy in place that will allow an elderly individual to contribute the portion of their income over the limit to the cost of their medical care, and then receive Medicaid to cover the rest. New Jersey, as well as some other states, offers the option of placing income in excess of the state maximum in a QIT (Qualified Income Trust) account, which may be used for specific expenses and will not hinder an individual’s Medicaid eligibility.

Elderly individuals who know that they will need to qualify for Medicaid are able to spend down their assets on qualified purchases to reach the minimum threshold. Several types of assets, including an individual’s primary residence, do not count as assets and will not be counted against an individual who is applying for Medicaid.

Protection is also provided for spouses of those who need to meet Medicaid eligibility requirements, called Spousal Impoverishment laws. Spouses are not required to give up all of their income and assets in order to get the needy spouse the services they need, though a limit may be placed on the assets and income that they are able to keep each year.

For individuals who are in need of SNF services, it can be a real relief to learn that it’s possible to receive help to pay for these services. Long-term care can be expensive, and the need for skilled nursing services can quickly eat up an individual or family’s income and life savings. Through Medicaid, however, it’s possible to pay for these services without putting a family into debt — a true gift for everyone involved.

About the Author

Benny Lamm is a communication specialist and blogger at Senior Planning Services, an industry leader in helping seniors and their families achieve Medicaid-sponsored long-term care. He enjoys playing the guitar, spending time with family and social networking.

What questions do you have about Medicaid-sponsored SNF coverage? Share your questions with us in the comments below.

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