Nursing Homes and Medicaid; 5 Things You Need to Know

Medicaid is a federal program that is regulated and managed by each independent state.  It is designed for impoverished individuals requiring long-term-care medical benefits. Medical and housing are typically the largest expenses for all individuals, many of whom are unable to pay for the ever increasing costs of medical care and housing costs. If qualifying individuals are unable to care for themselves in their own home or need arrangements in a nursing home, these individuals can apply to Medicaid for payment, but only if their income and assets are at a certain level and they medical help with areas of daily living.

The Massachusetts branch of Medicaid is called MassHealth. As someone looking into nursing home care for yourself or a relative, here are 5 things you need to know:

1.  The Applicant for MassHealth is only allowed to have up to $2,000.00 in countable assets to be eligible for long-term medical care under MassHealth. Fortunately, non-countable assets include many items necessary for daily living including but not limited to:

– Assets contained in special needs trusts

– Assets in pooled trusts

– Inaccessible assets—these can include assets subject to probate or a divorce proceeding

2.  A spouse of an qualified applicant is permitted to retain up to $117,240.00 in countable assets. This amount increases periodically.

3.  When the individual applies for MassHealth, he or she must provide all account statements for the past 5 years, which may mean that certain gifts made during this period may be considered as disqualifying transfers and render the individual ineligible for benefits. A disqualifying transfer includes but is not limited:

– Any sale of real estate in the past 5 years for less than market value

– Gifts given in the past 5 years for amounts more than $100.00

You can “cure” the disqualifying transfers by having the gifts given back, though this may be a countable asset.

4.  A trust established in a Will for the surviving spouse is not to be considered by MassHealth regarding the spouse’s eligibility. Having an estate plan that considers the possibility of a spouse needing nursing home care by setting up a testamentary trust for the other spouse is highly advisable.

Because the rules, regulations, and interpretations of Medicaid and MassHealth eligibility are constantly in flux, consult an elder lawyer to assist you in applying.

More and more individuals are needing nursing home care because of advancements in medicine and care that is prolonging the life of many. Unfortunately, your quality of life may not necessarily improve as you age. Nursing home care is very expensive. Accordingly, it is imperative that you consult with Elder Law Attorney Patricia Bloom-McDonald who can properly advise you on eligibility for Medicaid in your home or in a nursing home. She can also counsel you on how to structure your estate so that you can qualify and you and your spouse can continue to have access to assets accumulated during the marriage. Contact her today for a free, initial consultation regarding all your estate and elder law planning needs.