Medicaid for Long Term Care

The cost of Long Term Care is staggering.  A private facility can reach as much as $10,00 a month for a private room and even a multiple bed setting facility is often several thousand dollars a month.  In the ideal world everyone would have Long Term Care insurance and be able to collect the daily benefit without any trouble. - Unfortunately, less than 10% of the US population even has this insurance.  Most people have the naive idea that they will pass on before needing to incur such expenses.

For most families, the initial costs of Long Term Care are met from personal resources.  When that care becomes significant, those costs escalate and resources are quickly depleted.  At some point, many families have to turn to government help in the form of Medicaid.

Medicaid is a Federal program that is State administered.  Medicaid benefits do not follow you across State lines and each State has their own set of rules and procedures in administering the benefit.  But there are some basic qualification guidelines that apply to Medicaid benefits for nursing home placement. 

First of all - understand that not all facilities qualify for Medicaid benefits.  Ask the facility if they accept Medicaid as a form of payment.

The basic requirements for Medicaid benefits are in two groups:  Assets and Income.
Assets
Documenting from the 1st day of each month and individual's total assets cannot be more than $2000.  If a person is married (but only one person is applying) the asset level is $109,560.00 + the individual $2000.  If both spouses are applying the limit is $2000 each.  (NOTE - there are special rules regarding the ownership of a home - potential exemption can be as much as $750,000 depending on State defined limits)

Income
While there is no limit to the amount of income a person can have, depending on the circumstances, some or all of it will be owed to the nursing facility. Except for a personal monthly allowance of $50, the "cost share" portion of the nursing home bill will be the rest of the monthly income.  NOTE - special rules apply to a spouse who is not applying for benefit.  Very often, if a person has private health insurance, the premium amount for that insurance will be deducted before the "cost share" amount is calculated.

Medicaid Planning
A thriving legal practice a few years ago was the practice of moving assets and income around to make it possible to qualify for Medicaid benefits without really spending your own funds on care first.  Today this is much harder to do and Medicaid analyzes the financial transactions in your life back 5 years and will disqualify you for the length of time they determine your own care could have been financed if you had not disposed of assets and/or income.  This can result in you being in quite a jam - no assets and income and no medicaid as well.  Talk to your local Elderly Affairs Office before acting on any Medicaid Planning Advice.  In Hawaii that number is 808-768-7700

The application process for Medicaid requires a number of documents and there are professionals who will go through the process with you for a fee.  There are also non-profit organization who can help (most hospital social workers have contacts with free services) and the State or County agencies on aging are usually able to help.  For a list of the documents you will need to provide email me at thecaregiverfoundation@yahoo.com and ask for the Medicaid Checklist.

Plan ahead for your aging years and plan today for the needs of those you love and care for.