Ask the Expert – Finances and Nursing Home Care

​by Ronald E. Roel with expert Ken Kern, Esq.

THE PROBLEM:  Does my mother’s financial means influence the quality of the nursing home she is able to go into?  How does financial disclosure work in this situation?  Is there now a five-year look back period or is it still three for determining Medicaid eligibility?

THE EXPERT:  Ken Kern, elder law attorney, Melville

THE RULES:  Federal law prohibits nursing homes from discriminating against potential residents based upon their source of payment.  However, most facilities require full financial disclosure before or upon admission.

HOW IT WORKS:  Since few people can afford to pay for nursing home care out of their own pocket for very long (costs range from $8,000 to $15,000 per month), about 90 percent of nursing home residents in New York State are recipients of institutional Medicaid benefits.  While a private-pay resident is certainly attractive to most nursing homes, these facilities have no guarantee that the resident or the resident’s financial agent will make timely payments.  Consequently, nursing homes are often equally attracted to those residents who are already receiving institutional Medicaid benefits or who can show during the admission process (via full disclosure of their finances) that they are eligible to receive institutional Medicaid benefits upon admission or shortly thereafter.  Remember, Medicaid recipients are required to turn over their monthly income, less $50, to the nursing home each month from the date of their Medicaid eligibility and onward.  And as of July 2009, the look-back period – when Medicaid scrutinizes asset transfers of an applicant – is 42 months for transfers to another individual.  Under the Deficit Reduction Act of 2005, the look-back period will grow by one month for every passing month, eventually reaching the full five-year look back beginning Feb. 1, 2011.

THE RESULTS:  Even if your mother didn’t do any Medicaid planning before the look-back period and now requires a nursing home, she may still be able to protect a portion of her assets with proper planning.