Nursing Home Medicaid For The Working Class

Medicaid, also known as “MO HealthNet,” in Missouri, can be extremely complex to navigate. While the system is set up to help those in need, the rules surrounding the program can be daunting for anyone. The program was originally created in 1965 to assist low-income residents with their healthcare needs and includes benefits for life including low-income residents, families, pregnant women, the disabled, and the elderly. To better understand nursing home Medicaid for the working class, it’s important to understand the eligibility requirements related to long-term care through home services, nursing homes, and/or assisted living.

*This blog is for educational purposes only and should not be considered legal advice. The use of the Paths Law Firm website does not constitute a client-lawyer relationship.

Understanding Medicaid

Medicaid programs are funded by both federal and state agencies. In its current state, Medicaid aims to fund costs that they consider to be relevant, associated with nursing home care. To do this, the program looks at a variety of factors to determine eligibility including financial status and an individual’s medical records.

Missouri offers a variety of Medicaid long-term care programs for senior residents. Each program offers a unique set of features, payment options, and location-based advantages. It’s important to note, each long-term care program comes with specific eligibility requirements. The requirements for each program define what is and is not acceptable regarding a person’s assets, marital status, and/or medical history. At Paths Elder Law, we can help you through the process to identify which programs best fit your needs and what Medicaid will and will not cover based on your situation.

Medicaid nursing home funding can come through various streams including:

1) Medicaid Waivers/Community-Based Services: A small percentage of participants reserved for at-home care or assisted living services.

2) Institutional/Nursing Home Medicaid: Specialized entitlement for eligible seniors staying at a Missouri-based nursing home.

3) Conventional Medicaid/MO Healthnet for the Aged, Blind, and Disabled: Specialized entitlement for eligible seniors for at home or adult daycare.

Medicaid Eligibility for Nursing Home Care

For the Elderly, Medicaid has two primary types of requirements to be eligible: functional and financial. From a functional standpoint, based on the type of program, individuals applying must have medical needs that require the level of care that is provided in a nursing home setting. From a financial standpoint, Medicaid will look at the applicant’s income, and at times the spouse’s income, and assets. 

1) Income Criteria for Nursing Home Medicaid Eligibility


Please note, when applying as a married couple for nursing home care, at an eligible facility in Missouri, only the applicant’s income is counted during the evaluation period. This means funds involving a non-applicant, even if they are living in the same house are not counted as a part of the eligibility criteria.
The first eligibility requirement looks at the applicant’s income at the time they are applying for nursing home Medicaid. This income can come from one or multiple sources. According to Medicaid rules, income can involve things such as pension payments, alimony payments, general employment wages, Social Security Income, stock dividends, IRA withdrawals, and/or Social Security Disability Income.

paying for nursing home care

However, this does not apply to those pursuing regular Medicaid without the HCBS (Home and Community Based Services) Medicaid waiver. In that case, both incomes (including the non-applicant spouse) will be accounted for when determining an individual’s eligibility.

Income Criteria for Married Couples

Married couples that apply for community-based services using a Medicaid waiver or nursing home Medicaid will be eligible for MMMNA (Minimum Monthly Maintenance Needs Allowance). The idea is to provide a set monthly income for the non-applicant spouse. According to MO Healthnet in Missouri, the Minimum Monthly Maintenance Needs Allowance is listed as $2,114/month (2020) and can continue to increase each year while accounting for inflation. This income limit applies to individuals applying for nursing home Medicaid. There is also a separate maximum monthly maintenance needs allowance in place for expenses such as utility bills and/or mortgage payments. The maximum limit is set at $3,216 (2020). With the help of this allowance rule for spouses, it’s possible to account for specific income streams in the same household. However, all of this doesn’t apply to those moving forward with regular Medicaid where eligibility requires you to be at the poverty level.

Any income that an applicant receives is factored into nursing home care expenses. While keeping this in mind, it’s important to note there are exceptions to the rule. For example, all program participants can keep $50/month as a personal needs allowance. These participants can also set up an allowance for their non-applicant spouse while also accounting for potential medical insurance expenses.

There are also specific limits in place for the aged and disabled. The income limits are slightly higher when it comes to those that are blind. As of 2020, the income limit is set at $1,041/month for blind applicants and $1,410 for a blind married couple, assuming both are applying for long-term care.

2) Assets Criteria for Nursing Home Medicaid Eligibility


Asset Criteria for Married Couples

While income streams are heavily considered during the eligibility process for nursing home care, Medicaid also considers assets an applicant may have. These can include a variety of “countable” assets such as life savings, investments, stocks, cash, bonds, credit union, real estate, residential and non-residential, and/or checking accounts. Aside from these assets, there are specific assets that are exempt. Assets that are considered exempt include things such as household furnishings, vehicles, your primary home, personal belongings, and irrevocable burial trusts. It’s also important to note the property that you’re residing in must be valued at under $595,000.

nursing home medicaid preparation

With married couples, countable assets can be retained by 50% if the application is filed for a Medicaid waiver or nursing home Medicaid. This is only reserved up to a maximum of $128,640. There is also a minimum in place for people with limited countable assets according to Medicaid eligibility standards. For example, if the couple’s joint assets are less than $25,728 in value, the non-applicant spouse can retain 100% of those assets. This is listed as a separate eligibility requirement termed as “Community Spouse Resource Allowance” (CSRA) to ensure the non-applicant spouse has a reasonable amount of countable assets in hand to avoid poverty. Please note, all these allowances are taken out of the equation for regular Medicaid applicants.

Additionally, there is a built-in Medicaid Look-Back Period (5 years). This is used by Medicaid to assess the applicant’s assets to determine whether some or all of them have been sold based on fair market value. These assets can be counted in the asset limit for Medicaid. If the process leads to uncovering falsifications and/or violations, the applicant will become ineligible for funding.

Because of the complexity of the Medicaid asset rules, it is important to plan for Medicaid. To learn more about Medicaid planning for individuals or married couples that exceed the allowed asset limits, contact Paths Elder Law.

3) Level of Care Requirements for Nursing Home Medicaid Eligibility

The requirements related to level of care for seniors seeking Medicaid assistance, is different based on each Medicaid program. For nursing home care through a Medicaid waiver, an individual must need a high level of care to qualify. Whereas the Aged, Blind, Disabled (ABD) program requires that the individual be over the age of 65, blind, or determined to be disabled.

nursing home medicaid

At the very minimum, individuals applying must require assistance within regard to their daily living activities. This includes things such as bathing, grooming, getting dressed, eating, using the bathroom, and any assistance with mobility.

In addition, it can also be considered for seniors as to whether they can perform activities such as cooking means, the ability to shop for their essentials, cleaning their home and management of their medications. An assessment to determine an individual’s level of care is performed to determine eligibility. It is also important to note that Alzheimer’s, Dementia, and Parkinson’s disease does not automatically qualify an individual for the level of care requirements.

Supplementary Eligibility Options for Nursing Home Care Through Medicaid

While it can be challenging to go through the Medicaid application process and fail to meet the criteria, it’s not the only way to gain funding. Instead, the applicant, if they are 65+ in age, can participate through other programs. 

  • Qualified Income Trusts (QITs)/Miller Trusts:

This is reserved for HCBS Medicaid Waiver and nursing home Medicaid applicants if they are above the established income limit. Upon assessment, this can be used to determine eligibility if the applicant can prove they can’t afford long-term care despite being over the established limit. This can become a way to qualify for long-term care in Missouri despite being above the income limit. To do this, money goes into a Qualified Income Trust ensuring it doesn’t count against an individual’s asset limit during the application process. By doing this, the applicant lists a trustee that has legal control of the funds. To regain access, the applicant must list specific reasons for doing so such as covering HCBS long-term care expenses, general medical expenses, nursing home care costs, or health-related purchases (i.e. wheelchairs, crutches). Once the Qualified Income Trust has been signed and sealed, it cannot be reversed and if the individual passes away, the funds go directly to the state of Missouri as listed in the contract. 

  • Medically Needy Pathway:

The premise of this solution is to assist those that are disabled, aged, or blind. When individuals are over the established income limit for Medicaid, it’s possible to sign up for what is called the “Spend Down” program. This program is designed to assist those with excess income that pushes them above the eligibility limit for Medicaid. With this program, excess funds can be used to purchase health-related items or services such as prescription drugs, eye care services, dental services, long-lasting medical equipment, hospital services, and/or home nursing services. For married applicants, the Spend Down program can also be used for the non-applicant spouse if it is reserved for their health-related expenses. To qualify using this pathway, an applicant must prove they have met the spend-down period for a month. By doing this, the rest of the month becomes eligible for Medicaid.

applying for nursing home medicaid

While both pathways are unique and helpful depending on a senior citizen’s long-term care requirements, they are still not enough while managing extra assets. This means even if an individual meets the income-based requirements using these pathways, they may still not pass the asset-based requirements for Medicaid. The only solution becomes to start tapping into non-countable assets, such as car-related modifications (pedal extenders) or home-related modifications (wheelchair access, wheelchair ramps, stairlifts).

Nursing Home Medicaid Planning

In general, studies show the average senior citizen in Missouri will have to deal with having extra income and/or assets under their name. However, these individuals will also face the predicament of not being able to afford long-term care. As a result, Medicaid planning becomes vital moving forward. Paths Law Firm can help with Medicaid planning and provide you with information on what works and what doesn’t in order to become eligible for funding in your unique situation.

Medicaid Penalties 

There are set penalties in place when it comes to Medicaid applications depending on the applicant’s fiscal decisions. For example, if the applicant receives a gift (monetary or non-monetary) during the 5-year period, there’s a penalty to pay. This penalty comes under the “Look-Back” period meaning applicants lose eligibility status for a set amount of time. During this period, Medicaid doesn’t provide funding to the individual. This is based on how much the gifts were valued at divided by $4,889. These penalties can add up due to the increasing costs associated with nursing home care in Missouri.

Application Process for Nursing Home Medicaid

Before you file an application or move forward with the process, it’s important to go through the MO Health net requirements. This includes understanding specific income and asset limits. To better understand your options for nursing home care through Medicaid, contact Paths Elder law. We will explain the different options available to you. As well as answer questions and concerns for safeguarding your assets. The application process for Missouri seniors goes through an online platform, myDSS, designed by MO Health net. However, applicants can also apply through a separate form. Or, they can speak to a qualified specialist at the MO Department of Social Services, Family Support, by calling 1-855-373-4636. The Family Support Office can help clarify specific program-related information along with the accompanying benefits.

nursing home medicaid application

At Paths Elder Law, we focus on providing legal support to our clients. As we age the more care we need. And, during these times it is important to understand all the available options. Our staff will listen to your concerns and needs to come up with a plan that meets your unique requirements. We can guide you through the process of Nursing home Medicaid and provide legal advice on the next steps. Schedule a consultation with Paths Law Firm today.

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Community Relations

Jeane M. Fracassa

Community Relations

Jeane M. Fracassa

Jeane Fracassa – a dedicated and accomplished professional who retired with an impressive 38-year service record from the Kansas City Missouri Police Department. Throughout her illustrious career, Jeane served as a Civian Supervisor in the Communications Unit, where she played a pivotal role in ensuring efficient and effective communication within the department.

Even in retirement, Jeane’s commitment to community service remains unwavering. Currently, she serves in various capacities within Community Relations at Paths Law Firm. Actively engaged in the Lee’s Summit and Overland Park communities, she proudly represents the law firm.

In all aspects of her life, Jeane Fracassa exemplifies the values of community, compassion, and family. Her commitment to making a difference and her love for exploration make her a remarkable individual, whose presence brightens the lives of those she encounters. Whether at work, with family, or during her travels, Jeane’s genuine care for others and her zest for life make her a truly remarkable and inspiring person.

Administrative Assistant

Laura E. Messer

Administrative Assistant

Laura E. Messer

Laura is the Law Firm’s marketing assistant, supporting all marketing tasks, including managing calendars, researching upcoming events, updating marketing software and spreadsheets, and partnering with organizations to maintain relationships that benefit Paths Law Firm’s clients.  Laura is also the law firm’s professional photographer as she provides the professional photographs for the headshots, organizations, events, and networking.

Laura has over 10 years of experience as a professional photographer.  She is also Adobe and Microsoft Certified.  She graduated from Columbia College, Columbia, Missouri with her Bachelor of Arts degree, Magna Cum Laude, in Behavioral Psychology (minors in Social Work and Criminal Justice), and her Photographic Craftsman degree from Professional Photographers of America. She is certified as a Qualified Mental Health Professional, Certified Gentle Teacher, Medicaid Billing Certified, Crisis Intervention Counselor, and a Missouri Notary.

Laura has been married more than 26 years and has a daughter and a son. She has four brothers, a niece, and a nephew. Her four spoiled pets that love her attention. A lot of Laura’s off time is spent taking photos and she is an internationally published photographer. Laura owns a studio on the historic Independence Square. 

Administrative Assistant

Holly D. Bramble

Administrative Assistant

Holly D. Bramble

Holly is our newest member of the administrative team. She is hardworking, has proven organizational skills and excellent communication skills. Holly has transitioned to the Estate Planning field from healthcare administration where she gained valuable knowledge that has contributed to her success here at Paths.

Holly enjoys spending time with loved ones, cheering for the Chiefs, and relaxing on the beach.

Administrative Assistant

Tressa L. Purdy

Administrative Assistant

Tressa L. Purdy

Tressa has the important role of being a client’s initial point of contact as the law firm’s receptionist for all locations.  She also welcomes, assists, and cares for clients at the Lee’s Summit office. Additionally, she provides support in an administrative capacity for the attorneys, staff, and clients.  When you meet Tressa, the first quality many note is her readiness to be of assistance.

 

Tressa is a graduate of Park Hill High School with extensive administrative experience and executive level management. Tressa brings a stability and comfort to the law firm experience having worked in a variety of industries and having lived in six different major metropolitan cities.

 

Tressa has a daughter, two sons, and one grandchild.  In her free time, she enjoys her family and friends, loves being outdoors, gardening, bike riding and bird watching. Indoor hobbies include scrapbooking, painting cookies, and cheering on Chiefs football. She is a Kansas City native but enjoys traveling but is always happy to be back in her hometown.  

Attorney

Kathleen E. Overton

Attorney

Kathleen E. Overton

Kathleen Overton is an attorney and owner at Paths Law Firm. She has more than 17 years of experience advocating for those with special needs and navigating the state and federal agencies formed to help the disabled and elderly. At Paths Law Firm, Kathleen’s practice focuses on helping the elderly qualify for nursing home Medicaid, creating estate plans to protect beneficiaries, as well as a lot of time planning and forming businesses. Kathleen also enjoys helping clients form non-profit organizations and obtain 501(c)(3) tax exempt status.

 

After attending law school at the University of Oklahoma, Kathleen began representing clients before the Social Security Administration. Eventually her practice switched to federal court appeals and Kathleen spent years representing clients before the Eastern and Western District of Missouri, the District of Kansas, and the Eighth Circuit Court of Appeals. Kathleen has since focused her practice on estate planning and elder law after watching clients struggle to find ways to financially care for loved ones with special needs or aging parents.

 

Kathleen lives in the Northland with her husband and four children. She spends her free time attending soccer matches and ballet performances with her children and starting endless home improvement projects with her husband. 

Medicaid paralegal

Tena K. Dooley

Medicaid Paralegal

Tena K. Dooley

Tena is a Medicaid Paralegal.  She is very meticulous and organized.  She works closely with the attorneys, clients, and State representatives. 

Tena has an associate in applied science and has over 20 years of office management experience. She has two daughters and one grandson.

Tena enjoys spending time with her family.  She enjoys everything outdoors and her hobbies include fishing and gardening.

PARALEGAL & ACCOUNTANT

Sydney R. Morris

PARALEGAL & ACCOUNTANT

Sydney R. Morris

Sydney is the law firm’s internal accountant and one of their experienced paralegals having been with Paths Law Firm since 2017. She is a primary point of contact for estate planning and business planning.

Sydney graduated with honors from the University of Missouri Kansas City in 2022 with her Bachelor of Science Degree in Accounting. She is a Bloch Launchpad, Phi Theta Kappa, and National Honor Society alumni.

In her free time, Sydney enjoys spending time with her husband, reading, baking and going on long walks. 

SENIOR ADMINISTRATIVE ASSISTANT

Christy L. Phillips

SENIOR ADMINISTRATIVE ASSISTANT

Christy L. Phillips

Christy has three years of experience in elder law working for seniors and their families. She is currently the Senior Administrative Assistant and organizes the day to day functions of the office and makes sure everything runs smoothly. When asked why she loved what she does, Christy said at Paths Law Firm, she gets the opportunity to help clients in more ways than one. Her favorite parts of the job are getting to know the clients and helping them get their questions answered. 

Christy’s experience in the finance industry has been extremely beneficial to her role as the Senior Administrative Assistant. Christy has a special place in her heart for the elderly and attributes this to the relationship she had with her grandparents. 

Christy was raised in Ogden, Utah and moved to Independence, MO, when she was ten years old. She has been with her high school sweetheart for 25 years and they have two beautiful children together. Her daughter works in the medical industry, and her son currently attends High School and plays Baseball. When Christy is not working, she enjoys crafting and spending time with her family and friends.

Christy’s experience in the finance industry has been extremely beneficial to her role as Benefits Coordinator. There have been many influences that went into her decision to select the field of Elder Law. Christy has a special place in her heart for the elderly and attributes this to her relationship with her grandparents.

When asked why she loves what she does, Christy said that at Paths Elder law, she gets the opportunity to help clients in more ways than one. Her favorite part of her job is getting clients approved for Medicaid or VA benefits as it is a huge relief for them and their loved ones.

Christy was raised in Ogden, Utah, and moved to Independence, MO, when she was ten years old. She has two children that keep her busy and fill her life with joy! Christy’s daughter cheers for Avila University, and her son plays competitive baseball for the Bucks and races BMX locally for the Motorcycle Closeout Team.

When Christy is not working, she enjoys crafting and making homemade gifts for her loved ones and raising her kids to be healthy, happy, and positive humans.

 

Practice Areas

  • Medicaid Benefits
  • VA Benefits

 

Professionalc Memberships and Affiliations

  • Missouri Notary

FINANCIAL MANAGER

René A. Fracassa

Rene A. Fracassa, Paths Law

FINANCIAL MANAGER

René A. Fracassa

René is the Financial Manager at Paths Law Firm overseeing all aspects of revenue, expenses, and financial planning. She is also responsible for general office management, including assisting in many of the administrative matters that periodically arise. 

 

René earned her Bachelor of Science in Hotel and Restaurant Management from Central Missouri State University in Warrensburg, Missouri and soon thereafter worked her way through management at The American Restaurant where she worked almost 17 years before relocating to the country of China.

 

René is the Financial Manager at Paths Law Firm overseeing all aspects of revenue, expenses, and financial planning. She is also responsible for general office management, including assisting in many of the administrative matters that periodically arise. 

 

René earned her Bachelor of Science in Hotel and Restaurant Management from Central Missouri State University in Warrensburg, Missouri and soon thereafter worked her way through management at The American Restaurant where she worked almost 17 years before relocating to the country of China.

 

René is the Financial Manager at Paths Law Firm overseeing all aspects of revenue, expenses, and financial planning. She is also responsible for general office management, including assisting in many of the administrative matters that periodically arise. 

 

René earned her Bachelor of Science in Hotel and Restaurant Management from Central Missouri State University in Warrensburg, Missouri and soon thereafter worked her way through management at The American Restaurant where she worked almost 17 years before relocating to the country of China.

 

René is the Financial Manager at Paths Law Firm overseeing all aspects of revenue, expenses, and financial planning. She is also responsible for general office management, including assisting in many of the administrative matters that periodically arise. 

 

René earned her Bachelor of Science in Hotel and Restaurant Management from Central Missouri State University in Warrensburg, Missouri and soon thereafter worked her way through management at The American Restaurant where she worked almost 17 years before relocating to the country of China.

 

In her spare time, René is currently quite active managing multiple generations of her family, including parents and grandkids.  René has had great impact on the lives of many women teaching discipling and teaching and abundance of Bible Studies. Her former career in management and event planning trained her well to juggle all the activity.

MARKETING MANAGER

Hilary R. Tichota

MARKETING MANAGER

Hilary R. Tichota

Hilary plays a vital role in managing the Marketing Department at Paths Law Firm.  She is excellent at bringing new ideas and sharing valuable resources with the law firm and our community. Hilary has been with the law firm since the beginning, working in nearly every role which is invaluable in her marketing endeavors as she brings a unique set of skills into the Marketing Department.

Hilary is nearly complete in her Bachelor’s of Arts Degree in Marketing at Park University.  She has earned the honor of being listed in National Honors Society, Phi Theta Kappa, and the Dean’s List. Hilary is always looking for new and innovative ways to share the law firm’s message.

While not working, Hilary spends her time with her family at their rural home. They tend to their chickens and honeybees and enjoy the solitude of country living.

SR. PARALEGAL & OPERATIONS MANAGER

Jennifer A. Bronson

SR. PARALEGAL & OPERATIONS MANAGER

Jennifer

Jennifer is the Sr. Paralegal and Operations Manager at Paths Law Firm.  She oversees the firm’s probate department as well developing, implementing, and managing all the firm’s administrative processes having been with the law firm almost from the beginning.  She enjoys client contact as well as behind-the-scenes operations.

 

Jennifer began her legal career in 1990 as a legal secretary.  She has worked in small and medium sized firms, as well as court operations.  She has her Paralegal Certificate from Boston University, Law Office Management Certificate from University of Central Missouri, and she is a Master Financial Coach. 

 

Jennifer has two daughters, twin sons, and twin grandsons.  She spends as much time as she can with them.  She enjoys reading, listening to podcasts, and tending her yard. 

ATTORNEY

Russell A. Fracassa (Rusty)

ATTORNEY

Russell A. Fracassa (Rusty)

When asked what he wants to do, his reply was “I just want to sit at the kitchen table and work directly with people.” Rusty enjoys working with clients providing experienced advocacy and supporting them through their unfamiliar and overwhelming situations. Due to all the challenges faced by seniors, it is essential to work with an experienced elder law attorney who has expertise in the law, issues, and concerns affecting seniors and their families.

Rusty brings more than 30 years legal experience and expertise working for seniors and their families as an elder law attorney in Kansas City and surrounding. Prior to law school, Rusty was an accountant and his first couple years practicing law was as a tax attorney. This provides invaluable experience in his current practice of law. Rusty’s focus is helping protect seniors’ assets from taxes and long-term care costs, benefit qualification, and navigating more complex family scenarios in their estate planning.

Rusty has personally experienced the loss every parent fears, caring for a spouse suffering with cancer and the treatment, and working with aging parents through all stages of their lives.  He intimately understands the challenges faced by individuals and their caretakers when capacity or health declines, how to prepare for it, and the legal matters while in the midst of it.  He may not be able to eliminate his client’s grief, but he strives to provide clients with peace of mind.

In 2010, Rusty’s faith and love led him and part of his family to China as Christian missionaries. He and his wife, went permanently, but ended up dedicating 3 years to that ministry. They returned to Missouri to help with grandchildren after a family tragedy and later began anew with Paths Elder Law. The goal is providing compassionate care through legal advocacy.

Rusty has multiple degrees and advanced study spanning his Bachelor’s of Arts in Business Administration – Accounting at Rockhurst College (now Rockhurst University), Masters of Arts in Accounting and in Intercultural Studies, as well as his Juris Doctorate from the University of Missouri at Kansas City School of Law.

When Rusty is not practicing law, he enjoys spending time with his family, grandchildren, and excessive eating at local restaurants.

Practice Areas

  • Wills and Trusts
  • Estate Planning
  • Asset Protection
  • Medicaid Benefits
  • VA Benefits
  • Probate
  • Guardianship and Conservatorships
  • Education

 

BSBA and Master’s in Accounting, Master’s in Inter-Cultural Studies, and Doctorate in Juris Prudence

  • Rockhurst University
  • Liberty University
  • University of Missouri – Kansas City


Admissions to Practice

  • Missouri


Professional Memberships and Affiliations

  • State Bar of Missouri
  • National Academy of Elder Law Attorneys (long-time Member)
  • Elder Counsel (Charter and Ongoing Member)
  • Missouri Association of Trial Attorneys (Past Member)
  • Kansas City Metropolitan Bar Association
  • Missouri State Bar Committees – Elder Law, Estate Planning, Probate