Medicaid Planning — Nursing Home
As the population ages, we see more and more people who, because of debilitating illness or injury or deteriorating mental facility, must go into nursing home care. In fact, current statistics indicate that approximately 70% of Americans over the age of 65 will need long term care services in their lifetime, and 40% will require nursing home care. Such long term care may be the best choice for the safety and medical care for a loved one. However, with costs of long term care as high as $70,000 per year or more, a family’s assets would soon be depleted. When that happens, Medicaid is frequently the source for funding ongoing care.
Medicaid is a joint federal and state program, with the states setting the benefits they will offer and the eligibility criteria for those benefits. Medicaid requires that people seeking Medicaid coverage to meet specific medical and financial eligibility standards. Therefore, for a nursing home resident’s care to be covered by Medicaid, a certain number of assets may have to be depleted. This process is referred to as “spending down” the assets. Some assets are protected for the nursing home resident and his or her spouse (exempt assets) and some would disqualify the resident for Medicaid (countable assets). Our office has worked with hundreds of southern Indiana families over the years to protect assets in such cases. In situations where a nursing home resident is married, nearly all of the assets can be protected. In single/widowed cases, 50% or more of the assets can often be protected. It’s never too late to begin the process for asset protection. Even if you, or a loved one, have been “private paying” at a nursing home for months or years, we may still be able to protect assets.
Because the Medicaid rules vary somewhat from state to state and are fairly strict and complicated, working with an elder law attorney will help people gain maximum value from their assets while still qualifying for Medicaid assistance. Our office also goes the extra mile in making sure that the protected assets are properly titled and have the appropriate beneficiary designations. If appropriate, we also update the estate planning of the at‐home spouse (in married cases) to ensure that the protected assets do not pass to the Medicaid recipient spouse in the event that the at‐home spouse passes away before the Medicaid recipient spouse (as these assets may cause Medicaid to be discontinued for the surviving spouse).
Medicaid Planning — At Home (Aged & Disabled Waiver)
Over the years, we’ve seen a trend for clients to want to care for their loved ones in a home setting. In many cases, this is an ideal situation. The Medicaid Aged & Disabled Waiver program allows for those who are eligible to remain home while receiving Medicaid benefits to help pay for the care received at home. In order to be eligible for the program, an evaluation must be performed by a care manager with your county’s agency on aging. There is no charge for this evaluation. For those who live in Gibson, Perry, Posey, Spencer, Vanderburgh, or Warrick Counties, a care manager from SWIRCA & More will perform the evaluation. Call (812) 464‑8717 and request an evaluation for the Aged & Disabled Waiver. For those who live in Daviess, Dubois, Knox, Greene, Martin, and Pike Counties, a care manager from Generations Vincennes University Statewide Services will perform the evaluation. Call (812) 888‑5880 and request an evaluation for the Aged & Disabled Waiver.
The Medicaid eligibility process is slightly more complex in a waiver case, in that one must be medically eligible for the Medicaid Aged & Disabled Waiver (as determined by your area agency on aging) AND financially eligible prior to the second step of the process, the Medicaid application. Our office can walk with you if you are deemed eligible for an Aged & Disabled Waiver, prior to the application for Medicaid, to protect as much of the assets that the law allows.
The Aged & Disabled Waiver program also allows for recipients to transition to a Medicaid‐certified assisted living facility. Also, Medicaid follows from home or the assisted living facility to a Medicaid‐certified skilled care nursing home, if and when the Aged & Disabled Waiver recipient must transition to a nursing home in the future.
Qualifying for Medicaid Assistance
If your health requires that you should be in a nursing home to receive appropriate care, or if you’ve been approved for an Aged & Disabled Waiver, you should evaluate your financial eligibility to receive Medicaid benefits. A single or widowed person should have countable assets of no more than $2,000.00 by the last moment of the last day of the month to qualify for Medicaid benefits beginning on the first day of the next month. Certain assets are exempt, meaning they do not count towards the $2,000.00 asset limit. For instance, one vehicle of any value is exempt. The home is exempt as long as it’s listed for sale or for rent (it doesn’t need to be actually sold or rented within a particular time frame, merely listed for sale or for rent). Personal items within the home are generally exempt, including jewelry and wedding rings. Our office has years of experience in helping clients to protect the maximum amount of assets while spending down to $2,000.00 to qualify for Medicaid benefits. Generally, we can protect 50% or more of the countable assets in single or widowed cases.
A married person who requires nursing home care, or care at home under the Aged & Disabled Waiver program, may protect nearly all of his or her assets using existing Medicaid laws. Our office has years of experience in protecting assets for married individuals, so that they are passed to heirs rather than to the nursing home. Not only do we work to achieve Medicaid eligibility for our clients, but we also ensure that the assets are appropriately titled and that the beneficiary designations are correct. If possible, we also update the estate planning of the non‐Medicaid recipient spouse to protect the assets from falling to Medicaid or a nursing home in the event that he or she passes away before the Medicaid recipient spouse. Our seasoned professional team of Medicaid planners will walk with you through the entire process, answering any questions and concerns you may have along the way.
If both spouses require nursing home care or Aged & Disabled Waivers (or, if one is in a nursing home while the other is home on a Aged & Disabled Waiver), the asset limit is $3,000.00 for the couple. Planning is similar to single or widowed Medicaid planning in that 50% or more of the assets may be protected. The home is exempt, along with one vehicle of any value. Again, we will walk with you to ensure that the maximum amount of assets are protected if both spouses require nursing home or at‐home level of care.
Each case is unique in its own ways. Our Medicaid planners have years of experience in working closely with SWIRCA & MORE, Indiana Family & Social Services Administration, and local nursing homes as we seek to attain Medicaid eligibility for our clients. Call us today for a free consultation to discuss Medicaid planning options for you, or a loved one.
Expenses Usually Covered by Medicaid
Federal law requires the states to provide certain services to Medicaid recipients. States must pay for nursing facilities for Medicaid recipients, and they must pay for home health care services for recipients who would qualify for nursing home care (through the Medicaid Aged & Disabled Waiver program). Not all nursing homes accept Medicaid payment, so it is up to you, working with social services if necessary, to determine which home would provide the care appropriate to your needs and determine whether they would accept Medicaid funding.
Also, Medicaid funding may sometimes be used to provide additional long‐term care services for those who might not qualify for a nursing home. Those services might include assisted living facilities, adult foster homes, senior day care, and in‐home services like help with housekeeping and medication management.
Income Medicaid Allows You to Keep
Although Medicaid requires that most of your income be contributed toward the cost of your nursing home care, you would receive a small allowance for non‐medical purchases such as snacks, subscriptions, and other personal items; this is referred to as a Personal Needs Allowance, and is currently $52.00. You are also allowed to keep the amount of income required each month to keep your health insurance premiums (Medicare supplement, dental, vision) current.
The non‐Medicaid recipient spouse may have unlimited income each month. This income will not be required to pay the nursing home. Additionally, the non‐Medicaid recipient spouse may qualify for an allocation, based on his or her current income, and costs related to the home, such as mortgage, taxes, insurance, and related expenses.
If the Medicaid applicant’s income is above the required Medicaid maximum, then he or she may qualify for coverage if he or she has a Qualified Income Trust, also known as a “Miller trust.” Part or all of that person’s income can be directed into a Miller trust which would designate payment to his or her personal care, the spouse’s care, and to the medical care in such a way that he or she would not be disqualified for Medicaid. Upon death of the Medicaid recipient, any assets remaining in the Miller trust would go first to reimbursing Medicaid for any amounts spent for his or her care. If further value remains in the trust, it would be paid out to the designated beneficiary.
Our office will walk with you on these income‐related issues as a part of the Medicaid planning process.
The rules governing Medicaid eligibility are complicated, and consulting with your Medicaid planning attorney, Glenn A. Deig, will assure you meet the income and asset eligibility standards to receive Medicaid benefits, and still retain as much of your assets as possible.