Chronic Medicaid is a needs-based benefit that will cover room and board in a nursing home. When an individual is approved for Chronic Medicaid, the local Department of Social Services (DSS) determines the net available monthly income contribution (or “NAMI”). This is the monthly amount that the Medicaid recipient must pay to the nursing facility. Typically, the Medicaid recipient gets an allowance of $50.00 and a deduction for the cost of health insurance premiums. Medicaid, as the payor of last resort, is responsible for the rest.
For example, if a Medicaid recipient has monthly income of $5,000.00 and health insurance premiums of $300.00, the NAMI is $4,650.00 ($5,000 – $300 – $50). However, there is an exception for a Medicaid recipient to receive a higher monthly allowance for a certain period of time. If the application is filed with an “intent to return home”, the recipient may be entitled to $904.00 per month rather than $50.00. This is apart from a spouse’s right to keep a portion of the income under certain circumstances.
An intent to return home means the Medicaid applicant has exhausted all other forms of insurance (i.e. Medicare coverage) and requires more time at the facility. If the applicant is Medicaid eligible, benefits help bridge the gap between exhausted insurance and going home. Many individuals have monthly expenses they must continue to pay while in the nursing home (i.e. rent, taxes, insurance). Realizing this, DSS will give a higher monthly allowance of $904.00.
In the above example, if the Medicaid recipient files with an intent to return home, the NAMI would be $3,796.00 ($5,000 – $300 – $904). This gives the Medicaid recipient extra money to pay monthly expenses in the community before discharge. This type of budgeting is usually granted for a period of six (6) months. After that time, if the recipient remains in the facility, the allowance becomes $50.00.
The intent to return home is a subjective standard. This mean that DSS should grant the intent to return home for income purposes without medical records or other evidence. However, there is a form that needs to be completed by the nursing facility wherein they can support the intention to go home. On the LDSS-3559, the nursing home must indicate if the placement of the applicant is “permanent” or “non-permanent”. To make a successful application with an intent to return home, the facility must state that the placement is “non-permanent”.
This additional monthly allowance enables an individual to have Medicaid cover room and board while still being able to pay for expenses in the community – at least for a short while. Six months gives applicants and their families the needed time to put together a plan of care. The expenses of a nursing home can cost upwards of $15,000 per month. Planning ahead of time with a Medicaid experienced elder law attorney can preserve assets and alleviate anxiety.