MEDICAID NET AVAILABLE MONTHLY INCOME (NAMI)- FREQUENTLY ASKED QUESTIONS
What is a NAMI?
NAMI stands for Net Available Monthly Income, which is the amount of a nursing home resident’s income that they are expected to contribute toward the cost of their care.
How much of my income am I expected to give to the nursing home when I am on long term care Medicaid?
In most cases all of your income, minus $50, which is the resident’s personal needs allowance, every month will go to the facility. This is considered your NAMI. The exception to this is if someone is receiving aid and attendance from the VA, their personal needs allowance will be raised to $90, but they will still need to pay their NAMI.
What is considered income?
Examples of income include but are not limited to:
• Social Security
• Pension
• Annuity with monthly distributions
• Rental income
• IRA distributions
• Unemployment compensation
• Workers’ compensation
Do I have to pay the NAMI to the facility?
Yes. The advantage of having Medicaid coverage is having the Medicaid rate for the bed you are occupying. When an individual does not have Medicaid, they will be required to pay the private pay rate. The average cost of one month’s nursing home care at a private pay rate is $12,241, or $402 per day.
What happens if I do not pay my NAMI?
There is a possibility for the facility to initiate a lawsuit to recuperate the money if the NAMI is not paid monthly. The facility can also, in certain circumstances, seek a discharge from the facility for non-payment. For information on your rights as a resident including discharge/transfer rights and protections, please visit https://www.elderjusticeny.org/elder-law-learn If a facility is not receiving your monthly NAMI, the facility may attempt to become representative payee to ensure they are getting paid. A rep payee is a person or organization who is appointed to manage benefit payments for someone that has been deemed unable to do so on their own.
There is also a possibility for Medicaid to place a lien on one’s home if the NAMI is not paid to the facility. This is a way to guarantee payment of the debt that is owed to the nursing home. There are exceptions to Medicaid placing a lien on your home. If you have further questions regarding this issue, please contact our office at (716) 853-3087 to speak with someone from our Health Care Team.
Can a Pooled Trust be used in a facility to replace paying my NAMI?
No. Once you are on long term care Medicaid, and there is no intent to return home, a pooled trust can no longer be used, as all your income, minus the $50 personal needs allowance will be going to the facility.
Are there any exceptions to not paying the NAMI to the facility?
If you are in a facility for sub-acute rehab, and you have the intent to return home, your Medicaid coverage will stay as community Medicaid and does not need to be shifted to long term care Medicaid. The facility will still need to be paid for the care they are providing you; however, it will be at a Medicaid rate.
If you are permanently in a long-term care facility, but you have a spouse in the community, there is a Medicaid budgeting scheme called Spousal Impoverishment. New York State recognizes that it would be unfair to force a couple to deplete their income and assets to pay for high health care costs for one spouse. The spouse who is not a Medicaid recipient is allowed to keep combined income of up to $3,853.50 per month in 2024. If the Medicaid recipient is permanently absent from the home (living in a nursing home), he or she retains a personal expenditure allowance of $50.00 per month in most cases. Medicaid allows the non-Medicaid spouse to hold on to at least $154,140.00 in nonexempt resources and the Medicaid-recipient spouse an additional $30,182.00. The resource limits for the non-Medicaid spouse may be increased in some cases. Spousal impoverishment budgeting is only available for married couples where one receives Medicaid long-term care services (either at home or in a nursing home), and the other does not receive Medicaid at all.
What happens if I have bills that need to be paid in the community?
If you are permanently in a long-term care facility, but have bills in the community, such as a mortgage, it would be in your best interest to discuss these difficulties with your family to determine how these may be paid. If you are paying for a mortgage on a home, but will not be returning home, you may wish to sell your home to ensure that your NAMI is being paid to the facility. The exception to this would be the budgeting scheme that is detailed above, spousal impoverishment, if you still have a spouse in the community.
What can I do if I have more questions?
Give us a call at 716-853-3087 – we would be happy to discuss your individual circumstances.
Eligibility guidelines in this post are subject to change at any time. This is intended as general information only and should not be considered legal advice. You should consult with an attorney about your specific circumstances to learn more about your eligibility and options.
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