Nursing Home Care and Medicaid Eligibility

Think again if you thought Medicaid planning only included meeting strict income and asset limits for long-term care coverage. You will also need to demonstrate you need the level of care typically provided in a nursing home setting. These health eligibility rules are valid if you apply for nursing home coverage or a Medicaid waiver program for coverage in your home. Each state has a level of care requirement and its own criteria to determine if you meet the mandated level of care. It can get complicated because eligibility criteria are not always clear.

Qualified Income Trust or Miller Trusts

Medicaid is designed to assist low-income individuals and those over the age of 65 to pay for nursing home care. People with significant assets may be disqualified from obtaining assistance for long-term care from Medicaid. However, one way to keep Medicaid eligibility for people with assets that exceed the eligibility threshold is to take advantage of Qualified Income Trusts. 

Establishing a Qualified Income Trust (QIT) or Miller Trust is one alternative for Texans who do not meet the income requirement for Medicaid. Assets that go over the threshold of Medicaid eligibility can be transferred into the trust. There is also a five-year “lookback” period for determining Medicaid eligibility. The lookback period is a set period of time before the person’s Medicaid application where the state agency reviews the financial transaction that the applicant has made. Furthermore, a Miller Trust can also be used to hold income instead of assets. 

Speaking to an experienced Medicaid planning lawyer can help you explore your options when it comes to qualifying for Medicaid benefits. Our team of estate planning attorneys at the Law Office of Whitney L. Thompson may be able to assist you with the process. Contact us today to schedule a consultation.

Understanding Medical Services Covered by Medicare

Medicare still covers the medical services you may need beyond nursing care along with institutional Medicaid. If you need to see a specialist or go to a doctor’s office, Medicare pays first, and Medicaid will cover your remaining costs like copayments, coinsurances, and deductibles. When applying for institutional Medicaid, consider the following:

• The program considers you and your spouse together when counting assets and income. Typically, you can set aside a certain amount of assets and income to protect your spouse’s standard of living. This spousal amount does not count when applying for Medicaid.
• You will still be able to keep a small amount of income for your allowance even though you qualify. The amount varies by state, and your local Medicaid office can provide more information. The remainder of your income will pay for the nursing home.
• There is a look-back period of up to five years for institutional Medicaid in most states. When determining your eligibility, your state will count any assets you have transferred in the past five years. If Medicaid determines any transfers violate the Medicaid eligibility rules, you may be penalized. Medicaid may opt to pay only a portion of your nursing home stay or none at all.
• Owning your own home affects Medicaid eligibility and coverage. An elder law attorney can characterize your specific circumstances and how the equity in your home may count as an asset. When long-term care is no longer necessary, or you are deceased, these assets may repay Medicaid for your care coverage.

Nursing home level of care, also known as nursing facility level of care (NFLOC), Is not an easily definable term as there is no formal federal definition. Each state has the task of defining the term, and rules are not always consistent from one state to the other. Generally, there are four areas of concern, though not every state considers all four; physical functional ability, medical needs/health issues, cognitive impairment, and behavioral problems.

For those families with a loved one who requires more care than they can provide at home but do not require a high enough level of care to qualify for nursing home admittance, there is an in-between care type typically provided in assisted living. However, Medicaid coverage of this type of assisted living is very limited in numbers.

Nursing homes are experiencing very limited capacity, and waitlists can be years. Medicaid is adapting to provide this coverage type in-home to those applicants who may meet NFLOC Medicaid eligibility requirements but not pose a danger to themselves or others in a home environment. Perhaps using this as a springboard as a potential nursing home residence is waitlisted for full-time care.

Before applying to become eligible for Medicaid nursing home coverage, there is much to consider. Applications that are insufficient or incorrectly filed can create delays, and with limited space available, it can be several years on a waiting list before admittance can take place.

The need is more significant than ever before for long-term care in a nursing home. Meeting your state’s eligibility requirements can be a long and complex series of providing documents, answering questionnaires, having assessments and reviews, and filling out and filing forms. The scope of the project can be overwhelming. To get to your best outcome, don’t wait. Proactive planning with an estate planning attorney will help you understand and address all criteria you need to act on to succeed.  Please contact our Houston office at 281-214-0173 or the Bay City office at 979-318-5079 today and schedule an appointment to discuss how we can help you with your legal matters.