After the Medicare benefit period ends, then the nursing home patient must pay for care from income, savings, or long-term care insurance. If the Medicaid patient does not have enough income, savings or long-term care insurance, then she should apply for Medicaid through the local Medicaid agency. In Tennessee, the Medicaid agency is called the Department of Human Services (DHS). Often, a nursing home business office staff member will submit an application for the patient without speaking with the family. Why? Because the nursing home needs payment as soon as Medicare ends. While submitting a Medicaid application may ultimately create eligibility problems for the patient, nursing home staff is merely trying to make sure the patient’s medical bills will be paid.
How does a nursing home patient qualify for Medicaid? When an unmarried patient-homeowner applies for Medicaid, she must show that she meets three simple eligibility criteria:
For an unmarried patient, the elder law attorney may recommend setting aside funds in a special “exception” trust that will be used to improve the patient’s quality of life in the nursing home. There are simple spend down ideas that benefit the patient such as purchasing an irrevocable prepaid funeral/burial plan or purchasing any good or service that benefits the patient. The elder law attorney may also suggest ways to set aside funds for the family without jeopardizing the patient’s medical care.
For a married patient, the elder law attorney may use those techniques and others. The Medicaid rules for a married couple are different because the law provides protection from impoverishment for the community spouse. The elder law attorney uses techniques to maximize the income and assets that the community spouse retains so that he/she will not be impoverished by the high cost of the disabled spouse’s nursing home care.