How much is the Medicaid copayment to the nursing home?

The Medicaid program requires nursing home benefit recipients to share in the monthly cost of their care. This is called the Medicaid copayment or their applied income. In Texas, every nursing home Medicaid recipient is entitled to a personal needs allowance of $60 per month. But as explained in more detail below, Medicaid recipients can actually keep more of their income than the $60 allowance suggests. It is also important to understand that the Medicaid recipient still receives their income. Therefore, even if an individual is on Medicaid, the recipient will still be responsible for satisfying a monthly copayment to the nursing facility. If this copayment is not paid, the nursing facility can begin the process to discharge the resident for nonpayment.

As the payor of last resort, Medicaid encourages benefit recipients to keep their Medicare or other health coverage by reducing the monthly Medicaid copayment dollar for dollar by the premium paid to maintain (or obtain) health insurance. To be more specific, the Medicaid copayment will be reduced for incurred medical expenses not covered by a third party. These expenses are limited to Medicare and other general health insurance premiums, deductibles and coinsurance, and to medically necessary medical care and services that are recognized by state law but not covered under the Medicaid state plan.

If the Medicaid recipient has a spouse who is not receiving Medicaid nursing home assistance, the ineligible spouse is entitled to a spousal minimum monthly needs allowance of $2,931 per month (in 2014). If the ineligible spouse’s monthly gross income is less than this amount, the Medicaid copayment is reduced dollar for dollar to make sure that the ineligible spouse has sufficient income to avoid impoverishment. If their combined spousal gross income is less than $2,931 per month (in 2014), then there is no Medicaid copayment. However, if both spouses are receiving Medicaid nursing home assistance, then they will only be able to keep $120 per month of their income after the Medicaid copayment is paid.

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