My grandmother requires nursing home care in Pennsylvania. She receives $6,500 / month in income, which is well above Medicaid’s income limit of $2,349 / month. However, she cannot afford the private cost of a nursing home at an average cost of $9,700 / month. Is it possible for my grandmother to still qualify via Medicaid’s medically needy pathway?
Yes, it is possible for your grandmother to still qualify for nursing home Medicaid via the medically needy pathway, which is called Medically Needy Only (MNO) Medicaid in Pennsylvania. For PA Medicaid, also called Medical Assistance, persons who have income over long-term care Medicaid’s income limit (300% of the Federal Benefit Rate), but are unable to afford their cost of care, may be able to qualify via this option.
Essentially, with the MNO pathway, one must “spend down” their excess income on medical expenses. In the case of your grandmother requiring nursing home care, her “excess” income would be paid towards the cost of her nursing home care. However, it is important to mention that Medicaid nursing home beneficiaries are only able to retain a $45 / month personal needs allowance from their monthly income. (For married beneficiaries with non-Medicaid spouses living at home or in the community, a monthly maintenance needs allowance may also be paid from their monthly income to a non-applicant spouse).
As an example, let’s say your grandmother is single. She has $6,500 / month in income and is only able to keep $45 / month as a personal needs allowance. This means that the rest of her monthly income, $6,455 / month ($6,500 – $45 = $6,455), must go towards the cost of nursing home care. Given the monthly nursing home costs are greater than $6,455 / month, she will be income eligible for Medicaid nursing home care in PA. As a side note, your grandmother must also meet Medicaid’s asset limit as well as have a functional need for nursing home care. To see Medicaid eligibility criteria in PA, click here.
Medicaid eligibility can be complicated, particularly if one has income and / or assets over Medicaid’s income limit. In this situation, it is highly suggested that one consult with a professional Medicaid planner to discuss the specifics of one’s situation and the options to lower income and / or assets.