Nursing home proposal may run afoul of federal regulation

CARSON CITY - Gov. Kenny Guinn's ''nest egg'' protection plan to help middle- and upper-income senior citizens get into nursing homes at government expense is off to a slow start.

Guinn wants to prevent a drain on incomes of families with members who may be forced into nursing homes - where yearly costs can average $31,000 or more.

But a legislative committee on the study of long-term care was told Tuesday that the federal government may not approve a waiver needed to use Medicaid money to pay the cost of the nursing home.

Janice Wright, administrator of the state Health Care Financing and Policy Division, said the federal Health Care Financing Administration ''would probably not be receptive to a waiver looking at the income aspect. There is no sense in sending them something they won't approve.''

She said a task force has been formed to come up with alternatives that would get federal approval.

Guinn suggested and the Legislature earlier this year approved a bill providing that senior citizens would buy private insurance to pay the first three years of their time in a nursing home. After that, they'd be eligible for Medicaid and the family would be able to keep up to $200,000 a year in income.

But there's a problem with the word ''income'' in the law. Most other states that passed similar laws allow people to keep assets up to a certain amount - not to realize a family income of $200,000 a year.

Steve Abba, a legislative fiscal analyst, said four other states have enacted plans to protect the assets of the elderly but still allow them access to Medicaid to pay nursing home costs. The states include California, Connecticut, Indiana and New York.

Under those programs, for each dollar that is paid by a private insurance company to a nursing home an individual can retain that much in assets when qualifying for Medicaid.

The asset protection program in the four other states got off to slow starts but increased steadily. However, Abba said Congress then required states to recover money spent on nursing homes from the estates of patients who died, and ''that stifled a growing interest.''