Most people entering a nursing home will eventually receive a Medicaid nursing home grant to pay for care. Many seniors rely on Medicaid to pay for in-home services necessary for aging at home.
According to the Pennsylvania Health Care Organization, the average cost of a private room in a nursing home in 2017 in Pennsylvania is $116,800. The cost varies across the state by region from $69,500 to $135,000. For a semi-private room, the median cost is $108,847, varying by region from $84,000 to 128,000. In-home aides cost about $25 per hour in the Philadelphia area. A care coordinator is often needed to supervise aides, which is an additional cost. Few people can afford those charges for very long.
Most nursing home residents eventually receive a Medicaid Nursing Home grant. Planning more than five years ahead is best. If a loved one is entering a nursing home now or in the near future, you should consult with an Elder Law attorney about the Medicaid spend down rules.
Qualifying for Medicaid
To qualify for Medical Assistance an applicant must meet both financial and medical criteria. An applicant’s assets must be below a set amount, which varies based on income. There is a five-year look back period which means that the Department of Human Services will review an applicant’s financial records for the last five years to make sure no property was transferred for less than fair market value. However, some assets are not counted and certain expenditures are allowed. In addition, there are special protective provisions for the spouse of a nursing home grant recipient. It’s complicated. Talking with an elder law attorney is recommended. Our office can help with a one-time consultation, an asset preservation plan, and/or with a Medicaid Nursing Home application.
Medicaid Estate Recovery
The estate of a deceased nursing home grant recipient must repay DHS for the amount spent on nursing home care. However, certain other expenses such as burial costs and estate administration fees are paid first. Under special circumstances, real property may be transferred to the decedent’s caregiver. The administrator of the decedent’s estate must notify the Department of Human Services that an estate has been opened and ask for the amount owed. DHS has a limited period to respond or forfeit the claim. Again, the rules are complicated. We can help you to understand the rules.