she care for him now? My parents are far from wealthy. Mom lives in the same small house where I was raised. Their only income is Social Security – a total of $1,300 per month. She has only $10,000 left to her name. She is in constant pain due to fractures of her fragile bones. We thought that Medicaid was for the poor, but now we find out that's not the case. What can my mother do, and what does it take to qualify for Medicaid? And please don’t tell me that they should have purchased long-term care insurance.

Answer: While we advocate long-term care insurance in appropriate situations, long-term care insurance was never an option for your parents and many other seniors in similar situations. Unfortunately, your family -- like many others -- learned too late that in order to qualify for Medicaid, a person must meet both financial (income and assets) and medical requirements. In addition, by spending down as you describe, your mother did not take advantage of community spousal asset protection rules which would have been available to her. Although your question raises a number of troublesome problems, we will focus on the Medicaid qualification issue.

While each state establishes its own income and resource limits within federal guidelines, there are a number of basic federal requirements that a person must meet in order to be eligible for Medicaid in a nursing home. One of these requirements is that the individual meet the medical level of care criteria of that state. If an individual qualifies financially and medically, Medicaid will cover both “Skilled Care” and “Intermediate Care” in a nursing facility.

"Skilled Level of Care". To qualify, a person must have an unstable medical condition which requires regular medical evaluation and intervention, frequent regulation and monitoring of medication, and education or therapy services provided by a professional to help the individual with self-maintenance. Because your father does not require some type of on-going therapy or invasive procedure, he would not qualify for skilled care.

"Intermediate Level of Care". To qualify, a person must have a combination of functional deficits and need at least one intermediate service. By “functional deficits,” we mean that an individual needs hands-on assistance with a number of the activities of daily life that include dressing, toileting, eating, bathing, locomotion (walking), transferring (getting in and out of bed or a chair), and frequent bladder and bowel incontinence care. “Intermediate services” include (1) daily monitoring of a significant medical condition that requires overall care planning, (2) supervision of a moderate to severe memory problem which is manifested by disorientation, bewilderment and forgetfulness and requires significant intervention in overall care planning, and (3) supervision of moderately impaired cognitive skills which affect an individual’s safety.


Taking the NextStep: Whether or not your father meets the medical level of care will be based upon an assessment of his condition by the appropriate agency in your state. You can seek this evaluation by filing a Medicaid application or by contacting this state agency. If he meets the level of care, Medicaid will pay. If he does not, he will be discharged back home if your family cannot pay. To avoid what happened to your mother, we suggest that prior to admission to a nursing home, a proposed resident be evaluated by a private geriatric care manager, and that the family consult with a qualified elder law attorney. In all probability, with proper planning, your father could have been cared for in an assisted living facility at a much lower cost, and your mother could have avoided impoverishment.