Long term care (nursing home, home health, and maybe assisted living) is very expensive. The Ohio Medicaid reimbursement rate is between $5,500 and $6,000 per month for nursing home care. The rate for private pay patients is greater (and sometimes much greater) than the Medicaid rate–in Trumbull County $6,000/month ($200/day) is common. This generally does not include costs for physician care, medicine, and very often things like laundry service and personal hygiene.

There are three methods of paying for nursing home care, and one additional payment source if the nursing home care is directly the result of hospitalization and is required for rehabilitation or similar follow-up treatment. In this last case, Medicare will pay for up to 100 days of nursing home care, but only if the nursing home care immediately follows a minimum three day hospitalization, the nursing home care is directly necessary as a result of the hospitalization for rehabilitation, and if the patient continues to show improvement from the rehabilitation.  It is rare anyone receives the full 100 days of Medicare payment because Medicare stops paying as soon as the rehabilitation does not show any improvement in the patient’s condition.  Otherwise, Medicare is not a source of payment for nursing home care.

The three primary sources for nursing home care payment are:

  • Self-Pay
  • Long term care insurance
  • Medicaid

Self-Pay– means just that–the person in the nursing home is responsible to pay for his or her own care in the nursing home.

Long Term Care Insurance – There are at least five components which affect the cost of long term care insurance. The first is the age of the person to be insured. Generally, the older the insured, the greater the cost of the insurance. Second is the health of the insured. The worse the health of the insured, generally the lower the premium will be. Because underwriting standards are much different for long term care insurance than for either life insurance or health insurance, one should never assume that one will be disqualified for purchasing long term care insurance because of health issues.  Third, the so-called “waiting period” selected by the insured affects the premium. Waiting periods can be as short as zero days, which means coverage applies the first day of nursing home care. It is not uncommon to see waiting periods of 90 days or longer, which means that payment under the insurance policy will not begin until after the insured has been in a nursing home for the length of the waiting period. The fourth factor is the length, or total amount, of benefit under the policy. The longer the period, or monetary amount, of coverage, the greater the cost of the premium.  Finally, the actual benefit affects premium.  A person can purchase a $50 per day benefit, a $100 per day benefit, or $150 or $200–whatever amount one desires.  The higher the benefit amount, the greater the cost.

Medicaid is a federally mandated program which is administered by each state.  Medicaid payment for nursing home care is “needs based”.  The threshold “need” is medical.  The nursing home patient must be incapable of 2 of the several “activities of daily living”, which include: Bathing, Transferring (from bed or chair), Dressing, Walking, Eating, Grooming, and Toilet Use.  Suffering from dementia or Alzheimer disease may be enough for the Medicaid program to pay for nursing home care.
If you or a loved one has questions about Elder Law or Medicaid Planning contact The Law Office of John C. Grundy today at 330-637-9030 for a no cost consultation.