If your elderly loved one needs help to pay for long-term care, he or she might be eligible for Medicaid if his or her income and assets meet the guidelines. Medicaid is a joint program between the state and federal governments. the states are able to set the benefits that they offer and the criteria that you must meet to obtain them. Elder Care Direction can help you to understand Medicaid eligibility when your loved one needs nursing home care.
Services that states must pay for
Under federal law, states must pay for nursing home care for people who receive Medicaid. They must also pay for home health care for people who would be qualified for nursing homes. States are also able to use Medicaid funds to offer additional services such as home health care aides for people who might not qualify for nursing homes. They can also provide other services such as adult foster care, assisted living, and in-home help with medication and housekeeping.
Nursing homes are not required to accept Medicaid. Homes can inform you about whether they accept Medicaid. Facilities that do accept Medicaid undergo regular inspections and are licensed by the state.
Medical eligibility
People can qualify for Medicaid to pay for long-term care regardless of their ages. To receive Medicaid, the applicants must prove that the care is medically necessary. All states require your doctor to certify that nursing home care is medically necessary for you to be covered by Medicaid.
Financial eligibility
If you are medically eligible for Medicaid, you must also meet the financial eligibility guidelines. Most states have income limits that are more flexible for long-term care than for regular Medicaid. In a majority of states, you are able to make up to 300 percent of the SSI income limit. There may be different income limits for different types of long-term care such as home health services, community-based services, and nursing home services.
In a majority of states, people who do not qualify under the resource and income guidelines may still qualify for Medicaid if they are medically needy. This means that your medical expenses are so high that your assets or income are reduced to a level that qualifies you.
Resource limits
Some states follow the SSI standards, which set a $2,000 limit for one person’s countable assets and a $3,000 limit if both spouses of a married couple are receiving nursing home care. Not all resources are counted, however. If your assets push you above the Medicaid resource limit, you will need to spend down your assets before you will be eligible for Medicaid. Once you have done so, you can then apply for Medicaid.
It is important to note that you cannot transfer assets simply to qualify for Medicaid. Medicaid looks back five years from the date of your application to see if you have transferred assets or sold them for less than their fair market value. If you have, you will be penalized.
The penalty will be that you are ineligible for Medicaid for the number of months that the asset that you gave away or sold could have been used to pay for your care. For example, if you gave away an asset that was worth $12,000, you will have to pay for your nursing home care for three months out of pocket if the monthly cost is $4,000.
Under Medicaid rules, you will have to contribute a majority of your income to your care. You can keep a small amount of money to pay for medical expenses that are not covered or extras such as subscriptions or snacks. The remainder has to go to your long-term care costs.
Spousal impoverishment
If your spouse needs long-term care but you do not, Medicaid will not require you to give up all of the income and assets so that your spouse can qualify for Medicaid. Each state has its own rules to protect spouses. Depending on your state, you might be able to keep somewhere from $24,180 to $120,900 in assets.
Medical claims against your estate
Once you pass away, Medicaid will be able to pursue a claim against your estate for the amount that it spent on your care. The state will not try to recover until after your spouse has passed away. If you have disabled or minor children, the state will not try to recover from your estate.
Contact Elder Care Direction
The Medicaid rules can be confusing. To learn about more about qualifying for Medicaid to pay for long-term care, contact Elder Care Direction to schedule an appointment.
