Maine Nursing Home Medicaid

The financial rules use MaineCare cost of care

The Eligibility Manual says that a nursing-facility or skilled-hospital applicant’s gross income must be below the facility’s private rate for a semi-private room. If income is over the categorically needy income limit but below that private rate, Maine evaluates eligibility using medically needy rules and a deductible; if income is over the private rate, Maine may determine medically needy eligibility but does not cover nursing-care costs under that provision (MaineCare Eligibility Manual).

Countable assets for the institutionalized person must be under $2,000 on a day in the eligibility month, subject to the special community-spouse rules. The manual says the cost-of-care calculation begins in the first full calendar month at nursing-facility or skilled level of care (MaineCare Eligibility Manual).

Personal-needs deductions depend on the category

For the institutionalized individual below the categorically needy income limit described in the manual, Maine deducts $40 per month for personal needs when calculating cost of care. The manual specifies $130 instead for an individual receiving the reduced $90 VA pension who is not in a VA facility, or for certain single or surviving-spouse residents of VA nursing facilities receiving a VA pension (MaineCare Eligibility Manual).

SSI recipients in a medical institution have a different stated deduction: $50 for one person or $100 for a couple in the situations described by the manual. A personal-needs figure should therefore never be quoted without identifying the person’s eligibility category and income source (MaineCare Eligibility Manual).

Apply with complete evidence

The assessment, facility information, income, resources, insurance premiums, unpaid medical expenses, marital facts, and transfer history all affect the financial outcome. Request the written MaineCare determination and review it promptly if a deductible or cost-of-care amount appears wrong.