As of the New Year, a person who requires nursing home care in Pennsylvania can expect to pay $10,043.28 each month for that care on average. Medical Assistance is available to assist with the monthly cost, if the nursing home resident qualifies financially for such assistance. In order to qualify for help, a person with monthly income of under $2,250.00 may retain $8,000.00 in countable resources, such as bank accounts, investments, retirement accounts, life insurance, etc. If the person’s income is greater than $2,250.00 each month, then the resource limit is $2,400.00. This is also the threshold income to qualify for Medical Assistance for home health care expenses. For example, if the Medical Assistance applicant has income from Social Security and a pension of $3,000.00 per month and savings in the amount of $100,000.00, then the applicant will have to spend down $97,600.00 before Medical Assistance will help pay for his or her nursing home care.
If the Medical Assistance applicant has a spouse living in the community, that is the Community Spouse, then the Community Spouse is entitled to retain, generally, one-half of the couple’s total countable resources. The minimum amount of the couple’s resources that the Community Spouse is entitled to retain is $24,720.00. The maximum amount is $123,600.00. For example, if the couple’s resources total $100,000.00, then the Community Spouse may retain $50,000.00, and if the spouse in the nursing home has a resource allowance of $8,000.00, then the couple will have to spend down $42,000.00 before Medical Assistance will help pay for the care of the spouse in the nursing home. If, however, the couple has $500,000.00 is countable resources, then the Community Spouse may only retain $123,600.00 of the couple’s resources and the couple will be required to spend down around $370,000.00.
Once a person qualifies for Medical Assistance benefits to help pay for nursing home care, he or she will be required to contribute his or her monthly income to help pay for the cost of care. The individual is permitted to retain $45.00 a month for personal needs. The Community Spouse is entitled to retain a certain amount of income each month. The minimum amount of income that the Community Spouse is entitled to retain is $2,030.00. If the Community Spouse’s own income is below that threshold amount, then the Community Spouse will be allowed to keep so much of the income from the spouse in the nursing home to bring his or her income up to at least the minimum monthly allowance. If the Community Spouse has shelter expenses that exceed the minimum amount, the monthly allowance could be increased to up to $3,090.00 per month. Moreover, if the nursing home resident is expected to require the nursing home placement for six months or less, as determined by a physician, then the resident may retain an additional $772.10 each month to maintain his or her residence.
The primary principal residence of the individual applying for Medical Assistance benefits is not a countable resource. That means that the value of the home will not be counted when determining financial eligibility for Medical Assistance benefits. There is, however, a cap on the home equity value, which is currently $572,000.00. As such, if the applicant’s home has an equity value of greater than $572,000.00, then the excess will be countable in determining Medical Assistance eligibility. Also, the home is only protected during the person’s lifetime. Upon the death of the Medical Assistance recipient, the Commonwealth will have a claim against the value of the home up to the amount of Medical Assistance paid on behalf of the recipient.
The rules for Medical Assistance eligibility are complicated, but there are many techniques that can be used to qualify for Medical Assistance while protecting the home and life savings of the nursing home resident. Remember, that although early planning is best, it is never too late to protect what is yours.