Medicaid Payment for Nursing Home Care

In General.

Many people rely on Medicaid, also known as Title 19, to pay for their nursing home care. People may generally receive Medicaid payment for their nursing home care if their income is $2,094 or less per month and their nonexempt resources are $2,000 or less. In some instances, people with incomes above $2,094 per month may be eligible for Medicaid if they can establish a medical assistance income trust, also known as a Miller Trust. All non-exempt resources are considered countable toward the $2,000 limit. Resources that may be exempt, meaning they will not affect your eligibility, include a car, homestead, household goods, and prepaid burial accounts. 

People who do not have a spouse must meet the general income and resource Medicaid eligibility requirements. Medicaid eligibility is much more complicated for married people. The Medicaid program allowsthe spouse who lives outside of the nursing home, called the community spouse, to have more than $2,000 in resources withoutdisqualifying the spouse who lives in the nursing home from receiving Medicaid.

Apply for Medicaid Immediately.

Many people fail to apply for Medicaid when they enter a nursing home and wait until most of their assets are gone. This is a big mistake. To receive maximum Medicaid benefits, married individuals should generally go to the Department of Human Services (DHS) and apply for Medicaid when one spouse enters a nursing home. DHS will decide how many assets each spouse can keep. This will fix the amount of assets the community spouse can keep. All non-exempt resources of the couple are considered to be available to pay nursing home costs, regardless of which spouse owns them. DHS will assign one-half of the non-exempt assets to each spouse, provided the community spouse is assigned a minimum of $24,000 and a maximum of $113,640 (in 2012).  DHS will notify the couple that the spouse in the nursing home is not eligible for Medicaidto pay his or her expenses until the spouse in the nursing home has reduced the value of his or her assets to $2,000. 


Appeals May Allow More Assets to be Kept.

Couples who have more than $24,000 in assets should not assume that the initial DHS decision regarding the attribution of resources is the best decision for them. By appealing the initial DHS decision, an administrative law judge may set aside additional assets for the community spouse so that those assets, together with the couple’s income, could produce income of up to $2,841 per month. The amount of additional resources set aside depends on the couple’s income and life expectancy. 


Benefits of Appealing Initial DHS Decision

Ben and Vicki Hill are both 84. They each receive $750 in Social Security benefits. They also jointly own a $60,000 home, a $10,000 car, and $60,000 in savings. Ben enters a nursing home and applies for Medicaid to pay nursing home expenses:

Initial DHS
  • Home - exempt
  • Car - exempt
  • Vicki can keep $30,000.
  • Ben is assigned $30,000 and must spend $28,000 before Medicaid will pay for his nursing home expenses.

Final DHS
decision after appeal:

  • Home - exempt
  • Car - exempt
  • Vicki can keep the $60,000 because of her age and limited income.
  • Ben is eligible for Medicaid to pay for his nursing home care.


After the final attribution of resources, all of the resources assigned to the community spouse must be placed in the name of the community spouse in order for the resident spouse to maintain eligibility for Medicaid. All exempt resources, such as the home and car, should also be transferred to the community spouse.

In addition to financial eligibility for Medicaid, there are many rules regarding transferring assets and eligibility for Medicaid. The rules regarding eligibility for Medicaid are often complex and confusing.  Please contact the Legal Hotline for Older Iowans to receive advice about your particular situation. 

Iowa Legal Aid provides help to low-income Iowans. 

To apply for help from Iowa Legal Aid:

  • Call 800-532-1275. 
  • Iowans age 60 and over, call 800-992-8161.
  • Apply online at

If Iowa Legal Aid cannot help, look for an attorney on “Find A Lawyer”   A private attorney there can talk with you for a fee of $25 for 30 minutes of legal advice.

*As you read this information, remember this article is not a substitute for legal advice.



Last Review and Update: Aug 29, 2012

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