In 2018, the national daily average for a shared room in a long-term care facility was $245 or $7,441 per month, while a private room could cost you $275 a day or $8,365 a month. A report by SeniorLiving.org reported that the average cost of a semi-private room in Pennsylvania was $9,612 a month and a private room was $10,114. Pennsylvania ranked 11th nationally for its nursing home costs.  In 2020, the average cost of a semi-private room in Pennsylvania is $352.86 per day or $10,585.80 a month..

How can a Medicaid applicant make sure a spouse continues to live in his or her current lifestyle? If one must apply for Medicaid, will the spouse be able to keep property and assets?

Medicaid limits

Becoming eligible for Medicaid requires an applicant to meet specific limits for both income and assets. For instance, the income limit for a nursing home applicant is less than the monthly cost of nursing home care; but for individuals seeking help to pay for home care, the income limit in 2020 is less than $2,349 a month. The federal asset limit is $2,000 for an applicant, although Pennsylvania provides an additional exemption of $6,000.

Spousal impoverishment

In 1988, Congress enacted provisions to prevent a person from impoverishment if the spouse lived in a long-term care facility. The conditions protect the spouse who continues to live in the community.

Under Medicaid, a certain portion of the couples’ combined resources remains available for the community spouse’s use. Currently in Pennsylvania, the community spouse may have:

  • ½ of the couples’ countable assets with a minimum resource floor of $25,728 and maximum resource ceiling of $128,640
  • Home, with a home equity limit of $595,000
  • Household furnishings and personal effects
  • Cemetery plots
  • Pre-paid funerals for the couple (dollar limits by county in PA)
  • Limited amount of life insurance
  • One car
  • Community spouse’s retirement accounts