How Medicaid Works
You may not qualify for or be able to afford long term care insurance. If you meet financial and clinical eligibility requirements, you will qualify for Medicaid to pay for your nursing care. Medicaid is a joint state and federal program that helps pay for long-term care for people who need a nursing home level of care. Medicaid will pay for intermediate or custodial care in a licensed nursing facility.
The Waiver program may also pay for certain other care costs in the home or elsewhere if you are eligible. The Waiver program is part of Medicaid so you will need to meet similar eligibility requirements.
ELIGIBILITY FOR THE WAIVER PROGRAM:
• You must be 60 years of age or older.
• You must have no more than $8,000 in liquid assets (does not include exempt resources).
• You must have income of less than 300% of SSI (Supplemental Security Income) which is currently $2,250 per month in 2018.
Once an applicant successfully completes the eligibility process, Medicaid will pay for nursing home costs, and certain home and community based (Waiver) services. In most nursing home cases, the individual receiving Medicaid benefits must pay his or her income to the facility, less a $45 allowance for personal needs, and less an allowance for the community spouse. A short-term resident in a nursing home, certified for 6 months or less, may also be allowed a housing allowance to pay some of the expenses of maintaining a home.
Benefits are available only to individuals who meet these Medicaid eligibility standards. An applicant for Medicaid benefits must prove medical and financial eligibility. The main challenge is verifying financial eligibility. All income and resources must be disclosed to the Medicaid caseworker. The applicant’s non-excluded, available resources must not exceed the applicable limit. Single applicants with income over $2,250 must have total resources under $2,400. Single applicants with income less than $2,250 have a resource limit of $8,000.
The eligibility rules for married Medicaid applicants are much more complicated. An elder law attorney familiar with Medicaid planning should be consulted in order to make sure you do not spend down more money on nursing home costs than is required under Medicaid rules. Medicaid rules provide that the person in the nursing home will have the $2,400 or $8,000 limit described above. The spouse of the nursing home resident (The Community Spouse) must also meet certain resource limits but planning can maximize what that spouse can keep.
Gifts or transfers for less than fair market value will make the applicant temporarily ineligible for Medicaid long term care benefits even if all of the other eligibility requirements have been satisfied. Transfer penalties can be severe.
Pennsylvania is required by federal law to seek reimbursement from the estates of certain deceased Medicaid recipients, including those over age 55 who received nursing home care or home and community-based long term care services through the Pennsylvania Department of Aging (PDA) Waiver program. In some cases, advance Medicaid planning with a reputable elder law attorney can reduce or avoid estate recovery.
VERY IMPORTANT NOTE:
Qualifying for Medicaid or the waiver program is complex. Figuring out the necessary steps to properly preserve assets for the healthy spouse or your loved ones can be overwhelming. Qualification for public benefits while preserving assets has potential risks and should be done only with the advice of an experienced Elder Law attorney. Proper planning can lead to a substantial savings and most importantly, peace of mind.
If you would like to consult with Slutsky Elder Law please contact us at (610) 940-0650 or check out our website, www.slutskyelderlaw.com.