Earning while in a nursing home?

[Vintage]

In the US, has anyone here on this forum ever earned money, declared it, and paid taxes on it while living in a nursing home, with Medicare paying all or part of the nursing home bill? Please post here or contact me by PM if you have first-hand knowledge on this subject (not just conjecture, please.) Or, if a legal professional knows the answer, again, please post or contact me by PM.

The obstacles to working for an income while living in a nursing home are, to my knowledge, insurmountable. This question is not about whether one can "work online" or "sell online". It is about living in a nursing home, how that nursing home bill is paid, and how a resident's earned income would affect each month's bill at the nursing home. I have not found any website or any online discussion where this question is addressed.

[SCI-Nurse]

Medicare pays for only a tiny number of nursing home stays/days in the USA. Medicaid is the major payor, and there are limits on your earned income (and assets) you can have under Medicaid that usually preclude working even part time for pay.

(KLD)

[annev308]

I worked while in a SNF for two months covered by my former employer (which is who I was working for) and again for 3 weeks while covered by Medicare and Medigap. Taxes were deducted normally and I reached out to both Medicare and my Medigap insurer and was told that because it was a short, post surgical stay, they didn’t care.

As KLD says, it’s a completely different story if you’re resident in a SNF and covered by Medicaid. Best wishes.

[August West]

Medcaid guidelines are pretty strict. In most states, you can't have more than $2,000 in assets unless it's in a special needs trust. I suppose if you make less than that and spend it all, you may still qualify. It's worth investigating. Just don't get yourself disqualified.

[Vintage]

Do any of you know of an online site where the official information can be accessed?

August West, I am not in a nursing home. My question is about earning while in a nursing home, not assets. Again, please, I'm not asking for conjecture.

Your story, Anne, is the closest I've seen to the conundrum I am researching.

[annev308]

So here is a link to the red book, which is the legal guidance around working for folks on SSDI, SSI and disability related Medicare - https://choosework.ssa.gov/Assets/do...edBook2017.pdf - it doesn’t help with medicaid limits.

This is not something I was able to get any guidance or support on when I working and inpatient anywhere other than by calling SSA, Medicare and my insurer and asking a raft of questions, taking names and notes and so on. Is there one of the big rehabs in your general area? Or even a law school? Either or both may have a free legal clinic and if you can find a good volunteer they might be helpful.

I’m sorry my experience isn’t broader - I have worked pretty steadily since I got squished but have always been able to take leave around surgeries and also it’s possible to deduct certain disability related expenses from overall earned income and so my earned income has never threatened my SSDI or Medicare or even DWA Medicaid.

[Vintage]

I've saved the website, Anne. The website is important for anyone with a disability who lives in their own home and works. But it has nothing for nursing home dwellers within the US. It would take a person (or panel of people) having several areas of expertise to answer my question. My question isn't just about loosing eligibility for Medicare and Medicaide. It's about the larger issues of self-determination, the right to a "pursuit of happiness", and false imprisionment, as regards nursing home residents.

[SCI-Nurse]

Which is a reason to avoid living in a nursing home at all costs. Going into an institutional setting to live is defined by a loss of control over what you can do, when you can do it, and having choice and control over your body and care. Staying in your own home with a combination of home care and attendant care may cost about the same as a nursing home, but allows you to remain in control.

You don't loose your Medicare living in a nursing home, but Medicare rarely pays for nursing home care, more than perhaps a day or two at the beginning of the stay. They definitely do not pay if you are able to leave the nursing home on your own, as they would no longer consider you needing 24/7 skilled care if you were able to do so.

Medicaid pays for most nursing home care. Medicaid rules for leaving the nursing home on your own vary by state. Workers' Comp and the VA also pays for some nursing home long term stays. Few if any other insurances pay for more than a short "subacute" stay in a nursing home.

If you private pay for nursing home care ($$$) then you are generally not restricted to leaving the premises on your own, to work, go to school, attend concerts, etc. but unless you are independently wealthy, this is not going to be an option for most people. If you have long term care insurance that may cover some of this, but rarely all.

Here are some sites with information about Texas Medicaid and long term care:

https://hhs.texas.gov/services/aging/long-term-care

https://www.seniorplanning.org/long-...ibility/texas/

https://www.nolo.com/legal-encyclope...alth-care.html

https://www.elderoptionsoftexas.com/...quirements.htm

Note that in Texas, Medicaid has nearly the same standard for paying for nursing home care (the requirement that you have "skilled nursing" care needs that cannot be met in the home setting) as Medicare. This includes things like changing catheters, inserting/using feeding tubes, suctioning tracheotomies, wound care, etc. "Maintenance" care such as feeding, dressing, bathing, or even turning in bed is not considered skilled care.

In most states if you are on Medicaid and have other income (pension, SSDI, SSI, SS, etc.) even under the limits, you must give that money to the nursing home and can only keep a small amount for incidentals (usually around $50-60/month).

(KLD)

[Vintage]

In the US, has anyone here on this forum ever earned money, declared it, and paid taxes on it while living in a nursing home, with Medicare paying all or part of the nursing home bill? Please post here or contact me by PM if you have first-hand knowledge on this subject (not just conjecture, please.) Or, if a legal professional knows the answer, again, please post or contact me by PM.

The obstacles to working for an income while living in a nursing home are, to my knowledge, insurmountable. This question is not about whether one can "work online" or "sell online". It is about living in a nursing home, how that nursing home bill is paid, and how a resident's earned income would affect each month's bill at the nursing home. I have not found any website or any online discussion where this question is addressed.

I should have specified "with Medicare or Medicaide" paying all or part of the nursing home bill, rather than saying "with Medicare" paying all or part of the bill. In other words, my question only pertains to nursing home residents who are NOT "private pay". Other than this, my question has nothing to do with Medicare, Medicaide, nor anything else having to do with healthcare or leaving or not leaving the premises of the nursing home.

So, back to my original question, in the US, has anyone here on this forum earned money, declared it, and paid taxes on it while living in a nursing home?

[ChesBay]

I think Medicaid eligibility would prevent you from being able to work. If you need to go into a nursing home and aren't private pay you have to pass a preadmission screening. If you are capable of employment I don't know if you would pass the screening. IF you were able to earn income I am pretty sure all but the $50-$60 per month mentioned above by KLD would go to Medicaid / the cost of care.

This site has some info I don't have time to read through but it might help toward finding your answers:

https://www.medicaid.gov/medicaid/lt...ing/index.html

this applies to working and Medicaid services but I think the expectation is the individual lives in the community, uses Medicaid Waiver ( to keep someone out of nursing home) and Medicaid buy in determined by earnings and assetts:
https://www.medicaid.gov/medicaid/lt...ent/index.html

[Vintage]

In Texas, most nursing home residents receive $60 per month. Of course, this isn't what I'm asking about.

And, I'm not asking about preadmission screening, because that would have already taken place before the person became a resident in a nursing home.

ChesBay, you said, "IF you were able to earn income I am pretty sure all but the $50-$60 per month mentioned above by KLD would go to Medicaide / the cost of care."
---Are you able to substantiate this supposition?

[ChesBay]

In Texas, most nursing home residents receive $60 per month. Of course, this isn't what I'm asking about.

And, I'm not asking about preadmission screening, because that would have already taken place before the person became a resident in a nursing home.

ChesBay, you said, "IF you were able to earn income I am pretty sure all but the $50-$60 per month mentioned above by KLD would go to Medicaide / the cost of care."
---Are you able to substantiate this supposition?

I think Medicaid is the only one to give answer. Have you called them? rules can vary state to state depending on what the particular state opts in to.

this is second paragraph from second link in my previous post :

"The Medicaid Buy-In program is an optional State Medicaid benefit group for workers with disabilities who have earnings in excess of traditional Medicaid rules. Individuals with disabilities who would be ineligible for Medicaid because of earnings can work and access the services and supports they need. Ideally, it means workers with disabilities do not need to choose between healthcare and work."

[Vintage]

The paragraph you quote is not in regard to nursing home residents. Nothing in that entire link has anything to do with nursing home residents.

[Vintage]

I contacted a lawyer and got an answer to my question.

[2drwhofans]

I contacted a lawyer and got an answer to my question.

Would you mind posting what you learned? I'd been following the thread as an interested Texan, but had no facts to share.