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Medicaid is a very generous benefit once the person in need of long-term care services qualifies. However, like most government programs, it has certain rules that limit eligibility. We have written on Medicaid before, but it is worth exploring again since anyone who is living with Alzheimer’s is bound to have questions about these benefits and if they qualify.

The following is an abbreviated version of what you can find in my book, You’re not Alone: Living with Alzheimer’s Disease. Just remember that each person’s circumstances are unique. Please call Leigh Hilton PLLC about your specific situation.

What is Medicaid?

Medicaid helps cover medical costs for people with limited income and resources, many times offering benefits such as long-term nursing home care and personal care services that are not covered by Medicare. This is likely music to your ears, as these services can cost more than $120,000 a year out-of-pocket. The problem is that the Medicaid program has specific eligibility requirements, and understanding that process feels like it requires a degree in rocket science.

Federal law imposes restrictions on when and if you will qualify for benefits to cover long-term care expenses.

Income rules:
An unmarried qualified applicant for Medicaid may have only a very limited amount of countable resources in his or her name. If the applicant’s monthly income exceeds the Medicaid monthly rate for the facility where he or she is residing, the applicant cannot qualify and must pay out of pocket. Except for a small monthly allowance, a Medicaid recipient’s income goes to the nursing home to pay for their care.

Resource rules:
Medicaid places resources into two distinct categories: countable and non-countable. Please note that there are rules that limit the amount of countable resources that a single Medicaid applicant can own or that they can own with a spouse.

Countable resources include items such as:

  • Checking and savings accounts
  • CDs
  • Savings bonds
  • Stocks, bonds, annuities, and mutual funds
  • Cash
  • Life insurance cash value
  • Non-resident property
  • Retirement accounts

Non-countable resources are those resources we generally cannot consider available to liquidate and spend:

  • Primary residence
  • Household belongings
  • Primary automobile
  • Irrevocable burial accounts

Rules regarding transfers of resources

Federal law imposes restrictions on when and if you will qualify for benefits to cover long-term care expenses. For example, if you transfer assets, it may make you and/or your loved one ineligible for Medicaid for a period during what is known as the “look back period.” The larger the sum of the assets given away, the larger the potential ineligibility period.

Medicaid for the aging waiver program

This program provides in-home care, respite care, adult day care, and other types of assistance for those living in the community. The personal care attendant benefit typically provides approximately 55 to 70 hours of in-home care per week. To qualify, an applicant must be over 60, found to require nursing home care, have a limited monthly income that is below the max allowable, and have no more than a very limited amount of countable resources in their name. As we said earlier, the income for both spouses is used to determine eligibility.

Care is also available in specific locations in many states through PACE (Program for All-Inclusive Care of the Elderly). This program provides comprehensive health care and supportive services that enable participants to remain at home and live as independently as possible. The program is limited to a specific service area and is not available in all locations. Also, the qualification requirements are the same as the Medicaid long-term care waiver program.

Medicaid Estate Recovery

If an individual receives Medicaid benefits for long-term care after 55, their probate estate may be subject to what is called Medicaid Estate Recovery. This means that if your home remains in your probate estate, the state where you live has an automatic lien on your home to the extent of its expenses for your care. Resources owned by a trust at the time of death are not subject to this estate recovery. The amount of the estate recovery is equal to the amount of Medicaid long-term care benefits received by the individual after 55, or the entire amount of the individual’s probate estate — whichever is less minus certain allowable exclusions.

Call Leigh Hilton PLLC today!

Determining if you qualify for Medicaid can be an overwhelming chore when trying to do it on your own. That’s why we are here to help, no matter what your need may be. At Leigh Hilton PLLC, our goal is to protect and preserve your most valuable assets while also educating you and your family every step of the way. We want you to feel empowered so that you can confidently embrace your estate planning strategy — even in the face of a devastating disease such as Alzheimer’s.

Leigh Hilton PLLC wants to be your first call every time for any estate planning need. We look forward to serving you.

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