Common Questions About Medicaid For Long-Term Care

Many people have questions about long term care regarding Medicaid. Here, we’ll be able to give a general rundown about the program’s eligibility requirements before you look into planning further.

This can help you refrain from planning around care that may not be available or information that may not be true about Medicaid. 

Medicare is the federal health insurance program for people who are over the age of 65 or meet other specific criteria if they are younger, and it can be broken down into four different parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Advantage Plans, and Part D (prescription drug coverage). You pay a monthly premium for your coverage, and it is typically deducted from your Social Security benefit every month. Often someone’s first 20 days in a Long Term Care facility is covered by Medicare.

Medicaid, contrarily, is federally mandated and provides payment for skilled nursing care for individuals who meet certain criteria. Even though Medicaid is created by the federal government, it is left for the states to administer because it is not mandated.

There are many differences between each state, though overall the rules are similar, because of this division between the state administration and the federal rules. This is just a general introduction to these requirements, and an expert is highly recommended to be consulted with when planning further.

What Are Requirements To Qualify For Medicaid Coverage In A Long-Term Care Facility?

1.   Be a U.S. citizen or an alien lawfully living in the U.S. and reside in the state where they are applying for benefits

2.   Be over the age of 65, disabled or blind

3.   Have a gross monthly income of less than approx. $2,000.00.

4.   Meet “medical necessity” requirements for skilled nursing care

5.   Meet certain asset requirements

6.   Live in a facility that accepts Medicaid

What if My Income Is Too High?

If your income is higher than the requirements, it is still possible to qualify for Medicaid. If you fit the requirements otherwise for Medicaid long-term benefits, you (or your spouse or duly appointed agent) can create a Qualified Income Trust or “Miller Trust.” This allows you qualify for Medicaid long term care benefits by transferring your income into the trust. 

Which Assets Can I Keep to Still Qualify for Medicaid?

The state will examine your “countable resources” when applying for Medicaid. To qualify, a single individual’s countable resources cannot surpass $2,000. For a married couple, their combined countable resources cannot surpass $3,000 for applying for long-term care benefits.

If only one person in a married couple is applying for long-term care Medicaid, all non-exempt resources of both spouses will be considered countable resources.

There are strategies to increase the maximum amount allowed for the spouse who is staying at home, but they can be complex. Be sure to contact an expert to find ways to get the greatest value for you and your spouse. 

Interested in Working With Us?

If you need any help regarding your estate or other legal matters please reach out to us directly here and schedule a call with one of our paralegals on our scheduling page here.