Medicaid Eligibility can be very complex to navigate. And, while it was set up in order to care for those that need help, the system is comprised of many rules related to eligibility. In this video I’ll be touching on some elements Medicaid includes in their evaluation so that you can be prepared before applying for Nursing Home Medicaid.
*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.
First, it’s important to know that there are many different Medicaid programs for nursing care and long-term care. Each program has its own set of benefits, payment structures and advantages. The requirements of each program define what is and is not acceptable as it relates to an individual’s assets, their marital status, as well as their medical history.
Navigating Medicaid Eligibility Requirements
Medicaid looks at three primary types of requirements for eligibility. The first type of requirement is based on the persons medical needs and whether the level of care required is provided in a nursing home setting. The second and third requirements are related to finances. It is important note that if the applicant is married, Medicaid will look at the spouse’s income and assets as well.
First Evaluation for Medicaid Eligibility
The first evaluation is the level of care requirements. This requirement is different based on the particular Medicaid program for which one is applying. It considers that persons needs to determine if the level of care required is high enough to dictate that the applicant needs to be in a nursing care facility.
Second Evaluation for Medicaid Eligibility
The second evaluation for Medicaid eligibility is related to income. The evaluation of income is based on actual monthly income being received when applying for nursing home Medicaid. This includes pension, alimony, social security, and any earnings from investments. Any income received will be factored into the cost of nursing home care. This requirement may not apply to people pursuing Medicaid waivers, such as HCBS or Home and Home and Community Based benefits.
Third Evaluation for Medicaid Eligibility
The third evaluation for Medicaid eligibility is related to assets. While income is a big factor, assets also are reviewed. And those include savings, investments, real estate, checking accounts, cash value and life insurance and many more items. While it is true a home value under $595,000 is exempt from this when applying, please know that without proper planning that is not exempt from a Medicaid lien or Medicaid estate recovery after the person passes. Many survivors of Medicaid recipients are very surprised.
At Paths Elder law, we work with our clients to help guide them through the process to determine which program fits their specific needs and what Medicaid will or will not cover. Preserving assets while qualifying, applying, and avoiding the state recovery, are important services we provide clients.
I’m Rusty Fracassa and if you need help navigating through the requirements of Medicaid and preparing a Nursing Home Medicaid plan, Paths Elder Law is here to help. Visit our website or give us a call.