How do I pay for nursing home care?

Paying for Nursing Home Care
Your stay at CCNH may be paid in one of two ways. You may pay out of pocket for your stay at our daily Private Pay Rate or you may qualify to have Medicaid pay for your stay. Although we are a New Hampshire nursing home, we are located on the border of Vermont and are able to accept both New Hampshire and Vermont Medicaid.

Medicaid
Under Medicaid, the cost of providing care to the elderly is shared by the Federal Government and the County of Coös.The Federal Government provides funds for nursing home care through Title XIX of the Social Security Act.Title XIX is known as the Medicaid program. In order to receive Medicaid coverage for nursing home care, a person must: 1) have medical needs that require nursing home care; and 2) meet the income and resource limits set by the NH Department of Health & Human Services.

Medical Need: The NH Department of Health & Human Services makes the decision on a person’s need for nursing home care based on medical information provided by a physician. An individual found eligible for nursing home care will be reviewed periodically to assure the continued need for this level of care. If an individual no longer needs the nursing home level of care, Medicaid will stop paying for care in a nursing home.

What are the income limits for Nursing Home Care? An individual’s monthly income must be less than the current monthly Medicaid rate charged by the nursing home.  Income includes money from a job, veterans’ benefits, Social Security, pensions or other payments received regularly. If income is more than the rate charged by Medicaid, the individual will not qualify financially for nursing home care but may be eligible for payment of other medical services.

An allowance of $70 per month is reserved for the personal needs of New Hampshire Medicaid recipients. Vermont Medicaid recipients receive $47.66 per month for their personal needs. If an individual does not have enough income to meet this personal needs allowance, the Department of Health & Human Services will issue supplemental checks each month to make up the difference. This money may be kept and spent by the resident or deposited by the nursing home to the resident’s personal account.

Resource Limits for Medicaid Covered Nursing Home Care
Resources include cash, life insurance, stocks and bonds, bank accounts and property. Land and buildings owned by the Medicaid applicant are considered real property. An unoccupied real property that does not produce income must be sold within six months after the applicant is found eligible for Medicaid and has been notified in writing. The money from the sale is then counted as a cash resource. The property does not have to be sold if the applicant’s spouse will continue living there.

If resources go over the limit and the resident no longer meets the necessary financial requirements, he/she cannot continue to receive Medicaid benefits. A Medicaid recipient cannot have more than $2,500.00 of accumulated money. When over the $2,500.00 limit, he/she will lose his/her Medicaid benefits. This can be prevented by keeping track of resources and using the amounts to: 1) reimburse the Division of Human Services for the nursing care costs; or 2) buy items the resident needs. You may inquire of the case technician in the local Division of Human Services office how to do this.

Spousal Allotment - Under the provisions of the Medicare Catastrophic Coverage Act of 1988, community spouses of Medicaid eligible nursing home residents are eligible for a spousal allotment to supplement their income. Please refer to your local Human Services District Office for more information.

            Berlin District Office                                    State of Vermont
            650 Main Street                                          DCF Economic Services
            Berlin, NH  03570-0684                              100 Main Street, Suite 240

            (603) 752-7800                                           Newport, VT  05855

            or (800) 972-6111                                       (802) 334-3924      

Private Pay Residents
It is the policy of our County Commissioners to keep our private care rate in line with those authorized by the Federal Medicaid program. The State of New Hampshire’s Medicaid policy is to reimburse us for our actual audited costs of providing nursing care, less a "budget adjustment factor" or the amount of our private rate, whichever is smaller.  Therefore, our private pay rate is slightly higher than our Medicaid rate in order to protect this rate set by the State of New Hampshire. Our current Private Pay Rate is $300 per day.

Private pay residents will be billed monthly at the beginning of each month. The monthly statement will include charges for regular room and board. For the month of admission, if the resident is admitted prior to the 15th of the month, the resident/responsible party will be billed for the remainder of the month with payment due on the day of admission. If the resident is admitted on the 16th or after, the resident/responsible party will be billed for the remainder of the month plus the entire following month with payment due on the day of admission.

Notification of any change affecting the resident’s billing will be provided to the resident, in writing, at least 15 days prior to the change becoming effective.

The resident or legal representative is responsible for his/her payment of monthly charges on a timely basis. Statements not paid by the 15th of each month will be considered delinquent and may be grounds for discharging the resident. A monthly late fee of $50.00 will be applied on balances that are 90 days past due.

Payments may be made by the resident or legal representative. Under no circumstances will the nursing home advance funds for payment.