Nursing Home Medicaid Applications: What You Need to Know About Eligibility

If you or a loved one need nursing home care or long-term care in the home, the thought of applying for Medicaid to secure that care is daunting. Try Googling “Medicaid Application” and you’ll find thousands of results that are essentially worthless. Here are some points to know, if you are faced with applying for long-term Medicaid to pay for care:

  • Assets: Medicaid has an asset threshold of $2,000, meaning that the person applying for Medicaid cannot have more than $2,000 in countable assets available to pay for their care. For a married couple, the spouse that remains at home is permitted to keep a sum of the couple’s money called the Community Spouse Resource Allowance. The amount of assets the well spouse is permitted to keep is a somewhat complicated calculation that depends on how much money the couple had when the ill spouse went into the nursing home or began needing long term care services.
  • Exempt Assets: Not all assets are considered “countable.” The home, for instance, can be transferred to the well spouse or, in the case of a single person, can be exempt if the applicant signs a letter of intent to return home. Other exempt assets include tangible personal property, irrevocable funeral contracts, a car, burial plots, and assets in a pooled Medicaid payback trust.
  • Income: If an individual who is applying for long-term care Medicaid has gross income over $2,382, then they will need to establish, fund, and utilize a Qualified Income Trust, where the excess income is deposited into the trust and then used to pay for the care of the individual. An individual’s income is applied to their health insurance bills, income allowance for the well spouse, and the remainder is paid over the facility as a monthly patient liability (less $50, which the individual is allowed to keep). Medicaid pays the facility or provider the balance owed.

One of the most important aspects of a Medicaid application is the timing. For instance, if you apply for eligibility in November, the County may not process the application until February, when you get an approval that is retroactive to November 1st. That means that, upon application, you need to show the County that the individual meets the $2,000 asset test and the income is properly handled through a Qualified Income Trust, and all exempt assets and the Community Spouse Resource Allowance are properly calculated and identified. If one of these tests isn’t met, the application will be denied and Medicaid will not cover November, December, or January, potentially causing liability to the facility exceeding $20,000.

We have helped thousands of clients through this process and take a tremendous amount of pride and gratification in taking the burden and uncertainty of applying for Medicaid from the loved ones that are struggling through all aspects of placing their beloved in long-term care. Give us a call, we are here to listen.

Posted in Blog, Caregiving, Elder Law, Estate Planning, Medicaid, Older Adults.