Nevada Medicaid Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. This article focuses on Nevada Medicaid Long Term Care for seniors, which is run by the Nevada Department of Health and Human Services and will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or Medical Assistance to Aged, Blind and Disabled. This is different from regular Medicaid, which is for financially limited people of all ages.

Nevada Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Nevada Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited Nevada seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

• Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
• Skilled nursing care
• Physician’s visits
• Prescription medication
• Medication management
• Mental health counseling
• Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Nevada Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover the nursing home expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $154/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Nevada Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

Home and Community Based Services (HCBS) Waivers

Nevada’s Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help Nevada Medicaid recipients who require a Nursing Facility Level of Care, or are at risk of nursing home placement in the next 30 days, remain living in the community instead of residing in a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Nevada residents who live in their own home, the home of a loved one, group residential facilities or an assisted living residence. While Nevada’s HCBS Waivers will cover some long-term care services and supports in those settings, it will not cover room and board costs.

Nevada’s HCBS Waiver programs that provide long-term care benefits to seniors are the Waiver for the Frail Elderly and the Waiver for Persons with Physical Disabilities.

1. Waiver for the Frail Elderly
Nevada’s Waiver for the Frail Elderly, which is also known as the Frail Elderly Waiver or the FE Waiver, is intended to delay or prevent nursing home placement for Nevada Medicaid beneficiaries who live in their own home, the home of a loved one, a residential group facility or an assisted living residence. FE Waiver applicants must require a Nursing Facility Level of Care or be at risk of being placed in a nursing home in the next 30 days without some of the benefits provided by the FE Waiver. The state will assess FE Waiver applicants to determine their level of care needs.

Benefits of the FE Waiver include adult day care, companion services, housekeeping help, Personal Emergency Response Systems and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Benefits are made available depending on each individual’s needs and circumstances.

Unlike Nursing Home Medicaid, Nevada’s FE Waiver is not an entitlement. Remember, entitlement means guaranteed by law. Instead, there are a limited number of enrollment spots (about 3,000 per year as of 2022), and once those spots are full, additional applicants are placed on a waitlist.

2. Waiver for Persons with Physical Disabilities
Nevada’s Waiver for Persons with Physical Disabilities, which is also called the Physical Disabilities Waiver or PD Waiver, is intended to delay or prevent nursing home placement for any Nevada Medicaid beneficiary with a physical disability who lives in their own home, the home of a loved one or an assisted living residence. PD Waiver applicants must also be at risk of nursing home placement if they don’t receive some of the benefits provided by the PD Waiver. The Nevada Division of Health Care Financing and Policy and the state’s Aging Disability Services Division will make the determination if an applicant has the type of physical disability that could require placement in a nursing home.

Benefits of the PD Waiver include case management, home modifications, chore services, meal delivery, housekeeping services and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). PD Waiver benefits are made available depending on each individual’s needs and circumstances.

Medical Assistance to Aged, Blind, and Disabled

Nevada’s Medical Assistance to Aged, Blind and Disabled (MAABD), which is similar to Aged, Blind, and Disabled (ABD) Medicaid in other states, provides healthcare and long-term care services and supports to financially limited Nevada residents who are aged (65 and over), blind or disabled and live in the community. MAABD can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially needy people of all ages. MAABD is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via MAABD depends on the availability of funds, programs and caregivers in the area where the beneficiary lives.

MAABD beneficiaries who show a need for long-term care benefits can receive some of them through the state’s Personal Care Services Program.

Personal Care Services (PCS) Program
Nevada’s Personal Care Services (PCS) Program provides long-term care services to MAABD recipients who are at risk of being placed in a nursing home without the benefits of the PCS Program. The intention of the PCS Program is to delay nursing home placement by providing program participants with personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and other housework).

The state can assign a licensed caregiver to provide those benefits, but PCS Program participants also have the option of self-directing their benefits and selecting a caregiver of their choice. This can include a family member, as long as that family member is not legally responsible for the PCS Program participant, so spouses and legal guardians can not be hired. An Intermediary Services Organization helps the program participant with many of the responsibilities of being an “employer,” such as background checks, tax withholding and payments.

Like Nevada’s MAABD Medicaid itself, the PCS Program is an entitlement. This means that all eligible applicants are guaranteed by law to receive program benefits.

Program of All-Inclusive Care for the Elderly (PACE)
PACE coordinates medical, social service and long-term care coverages into one comprehensive plan and delivery system for ABD Medicaid recipients, including Medicare coverage for those who are “dual eligible.” PACE also administers vision and dental care, and PACE day centers provide adult day care, meals, social activities and regular health checkups. PACE program participants are required to need a Nursing Facility Level of Care, but they must live in their home or somewhere else in the community. Although Nevada does not have a PACE program of its own as of Jan. 1, 2024, there are programs in California and Oregon. While seniors can not use PACE programs (or receive any kind of Medicaid benefits) in other states, or transfer their Medicaid coverage from state to state, they can re-apply for Medicaid in a new state without any waiting period if they relocate. To learn more about PACE, click here.

Eligibility Criteria For Nevada Medicaid Long Term Care Programs

To be eligible for the Nevada Medicaid, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Medical Assistance to Aged, Blind, and Disabled (MAABD).

Nevada Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Nevada residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Nevada Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Nevada Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Nevada Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $154/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for Nevada Nursing Home Medicaid is a combined $3,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Functional Requirements
The functional, or medical, criteria for nursing home coverage through Nevada Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home. The Nevada Medicaid Level of Care assessment tool is used to determine the level of care required. This tool takes into consideration an applicant’s ability to manage their own medication, their need for supervision and their ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and other housework).

Nevada Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
Nevada residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Services (HCBS) Waivers. For a single applicant in 2024, the asset limit for HCBS Waivers in Nevada is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for HCBS Waivers in Nevada for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Nevada is a combined $3,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers through Nevada Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home, or being at risk of nursing home placement in the next 30 days without the long term care services and supports provided by the HCBS Waiver. The Nevada Medicaid Level of Care assessment tool is used to determine the level of care required. This tool takes into consideration an applicant’s ability to manage their own medication, their need for supervision and their ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and other housework).

Nevada Medical Assistance for the Aged, Blind, and Disabled Eligibility Criteria

Financial Requirements
Nevada residents have to meet an asset limit and an income limit in order to be financially eligible for Medical Assistance for the Aged, Blind, and Disabled (MAABD). For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for a single applicant is $943/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants, the 2024 asset limit for Nevada’s MAABD is a combined $3,000 combined, and the income limit is a combined $1,415/month. This applies to married couples with both spouses applying or with just one spouse applying.

Functional Requirements
The only functional requirements for Nevada’s Medical Assistance for the Aged, Blind, and Disabled (MAABD) are being aged (65 or over), blind or disabled. For MAABD Medicaid applicants who require long-term care services and supports, Nevada Medicaid will conduct an assessment of their ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications) to determine what kind of services the applicant needs and the state will cover.

How Nevada Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

• If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
• If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
• If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – MAABD applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Nevada Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Nevada and how you can protect your home from it, click here.

Applying For Nevada Medicaid Long Term Care Programs

The first step in applying for Nevada Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Service (HCBS) Waivers or Medical Assistance for the Aged Blind and Disabled (MAABD).

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that program. Applying for Nevada Medicaid coverage when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Nevada Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Nevada residents can apply online at Access Nevada. They can also download an application here or call their local Division of Welfare and Supportive Services office for an application.

For step-by-step guides to applying for each of the 3 types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

Choosing a Nevada Medicaid Nursing Home

After being approved for nursing home coverage through Nevada Medicaid, seniors need to choose which Medicaid-accepting nursing home best suits their needs. Even though Nevada Medicaid nursing home coverage is an entitlement, not all nursing homes take Medicaid, and those that do may not have available spaces. Finding the right nursing home can be a challenge, especially if you’re looking in a specific location.

Nevada has roughly 60 nursing homes that accept Medicaid. More than half of them, 35 total, are within 25 miles of Las Vegas. There are another dozen or so nursing homes that accept Medicaid in the Reno area, including Carson City and around Lake Tahoe. Outside of those two areas, nursing home choices are thin in the rest of the state.

Residents in some Nevada communities, like around Lake Tahoe, regularly cross state lines for personal or business reasons, including healthcare. Medicaid coverage does not cross state lines, however. So, a person with Nevada Medicaid would not be covered in South Lake Tahoe, California, even if a facility in that city is well-suited and convenient for the Nevada resident.

When you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The same is true for the list on the Nevada Department of Health and Human Services webpage that’s linked in the blue box above. The healthcare professionals who work with you can also be a great source of information. And you can contact your local Area Agency on Aging for more information about nursing homes in Nevada.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? Does it provide transportation? How does it help residents with vision and dental care? What is the food like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

Data collected by CMS reveals that nursing homes in Nevada are significantly below average when it comes to health standards and fire safety. Nevada nursing homes averaged 43.7 health deficiencies during a three-year period from 2019-2022, which is much more than the national average of 25.7. Things were even worse when it came to fire safety: Nevada nursing homes averaged 36.8 fire safety deficiencies during the three-year time frame while the national average was 13.5. This doesn’t mean all Nevada nursing homes have health or fire safety issues, but some of them most certainly do, so you should do your research in these areas before making any final decisions.