Who Qualifies for Medicaid Coverage of Nursing Home Care?

While some individuals have the ability to privately pay for long-term care or have purchased separate long-term care insurance policies, Medicaid coverage can be essential to funding long-term care for many Americans. Medicaid is a federal government benefits program administered by the states that pays for the costs of long-term nursing home care for eligible individuals. The program also pays for some of the costs of assisted living care in some states.

In order to be eligible for Medicaid nursing home coverage, an individual must be unable to care for himself or herself at home. The individual also must meet certain income and asset limits, which vary from state to state. These limits also depend on whether an individual is single or married. Furthermore, an individual does not have to be hospitalized prior to moving to a nursing home, restricted to a certain level of nursing home care, need skilled nursing care, or still be recovering from an illness or injury in order to become eligible for Medicaid nursing home coverage. Medicaid also will provide coverage for an individual who simply needs assistance with activities of daily living, which may be non-medical in nature.

Some state Medicaid programs measure Medicaid eligibility according to certain monthly income limits, less any regular medical expenses. In other state programs, there is no income limit, but the individual must pay almost all of his or her income towards the costs of the nursing home care, with Medicaid paying the balance of those costs.

If the individual qualifies for Medicaid nursing home coverage, Medicaid will pay for the full costs of room and board in a nursing facility, as well for personal care items and services, such as bathing and laundry. Medicaid coverage does not expire after a certain amount of time, nor does it require that the individual make any co-payments.

Whether your loved one’s care is funded by Medicaid or another source, Boller & Vaughan knows the devastation that can occur when nursing homes and other long-term care facilities breach their duties to keep residents safe from harm and properly cared for. Fortunately, we have the knowledge and the experience to help you through any type of elder abuse or neglect claim. No matter what type of nursing home facility abuse or neglect is at issue in your case, we can help. All too often, residents and their families are reluctant to demand justice for situations that occurred in the resident’s care. In this situation, you can count on your Madison elder abuse attorneys to guide you through every step of the personal injury claims process.


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