Florida Medicaid Basics – What is a Patient Responsibility?
A nursing home resident receiving assistance from Medicaid still has a
responsibility to pay a portion of their monthly nursing home bill. The
resident’s portion of the bill is called the patient responsibility.
The patient responsibility is calculated by subtracting Medicaid allowed
deductions from the patient’s gross monthly income. The amount of
income left after the allowed deductions are subtracted is paid to the
nursing home each month as the resident’s patient responsibility.
In calculating the amount of the patient responsibility it is very important
to make sure that you are starting with the resident’s gross monthly
income and not their net monthly income. In many cases, the amount of
income deposited into the resident’s bank account is the net income
and not the gross income because the deposit is the amount of money left
over after federal taxes and health insurance premiums have already been deducted.
Once the amount of the gross monthly income is established, the resident
can start determining the amount of the allowed deductions. One deduction
is a personal needs allowance in the amount of $105 per month. The personal
needs allowance is kept by the resident to spend on items such as clothing
and personal grooming supplies. The resident also may subtract from gross
income the amount of obligations such as the cost of health insurance premiums.
In addition, if the resident is married and the spouse still lives in the
community, the resident may also be able to give some of the income to
the spouse to help with living expenses rather than to the nursing home
which will further reduce the amount of the patient responsibility. Whether
any money can be diverted to the spouse depends upon the amount of the
spouse’s own income.
The patient responsibility calculation strives to have residents contribute
a portion of their own income towards the cost of their care in the nursing
home and then Medicaid provides the safety net needed to cover the gap
between the resident’s income and the $6,000 - $8.000 (or more)
monthly cost of living in the nursing home.