Exactly how Medicaid works in nursing homes can vary based on state laws, but the coverage generally focuses on individuals who are unable to provide care for themselves while living at home. Medicaid is based on specific income limits and asset limits, and may not cover all expenses.
In order to qualify for a nursing home based on Medicaid coverage, patients must meet certain medical criteria. This can include not being able to walk on their own or needing skilled nursing care for short-term rehabilitation. Other examples of medical criteria include a chronic medical condition and impaired cognitive function. Consumers must also have a qualifying medical event in some states, which requires a three-day hospitalization.
Medicaid can cover a number of different services in a nursing home, including room and board, necessary medical services, prescription medication, therapy services and meals. However, patients may also be required to pay some out-of-pocket costs in addition to the Medicaid coverage.
Individuals must meet specific requirements regarding income and assets in order to qualify for Medicaid coverage in a nursing home. If there are assets such as a home, states can participate in a practice known as asset recovery, where the assets are seized or a lien is placed in order to recoup some of the funds spent on nursing home care. Asset recovery is often done after the patient's death.