Medicare & Medicaid
The ElderCare Law Firm Inc. is dedicated to providing seniors legal services that help them plan for their futures and protect their assets. Medicare and Medicaid are two programs that can provide benefits to help with health care costs if you qualify. Our skilled attorneys can help you understand how these programs affect you, and help you protect your assets if you do.
Medicare provides limited nursing home care benefits. To obtain Medicare benefits for nursing home care, you must have a 3 day hospital stay and then be released to a nursing home (or enter a nursing home within 30 days of your stay) for the same illness that put you in the hospital in the first place.
If you enter the nursing home having met this criteria, Medicare will pay 100% of your nursing home cost for the first 20 days. For up to an additional 80 days, you pay a significant copay, and Medicare picks up the rest. However, if at any time you no longer need daily skilled care, you will lose your Medicare benefits. For more information, please refer to the booklet put out by the Centers for Medicare and Medicaid Services entitled Medicare Coverage of Skilled Nursing Facility Care.
Medicaid is a federal program that is administered by the states. Each state has its own unique form of Medicaid, so it is very important to obtain information from a knowledgeable attorney in the state in which you or a loved one will reside or need care.
Medicaid will cover the entire cost of care in a nursing home after you pay your required portion. This is often referred to as your cost share. To be eligible for Medicaid you must meet the following criteria:
- Medical Necessity. Medicaid will not pay for you to stay in a nursing home unless that level of care is a medical necessity for you. This must be certified by a physician, and typically involves an inability to perform at least 3 of the activities of daily living (ADL’s). Activities of daily living include: bathing, walking, dressing, eating, using the toilet, and getting in and out of bed or a chair.
- Length of Stay. A Medicaid applicant’s expected stay in the nursing home must be 30 or more days. That does not mean that the applicant ends up staying the entire 30 days, it just must be expected that they will be there that long.
- Income criteria. In Utah, if your income (minus all allowable deductions such as a $45.00 personal needs allowance, health insurance premiums, and the amount your spouse is entitled to) is less than the private pay cost of care for the facility you are in, you meet the income criteria.
- Asset criteria
- If you are single you may not have more than $2000 of countable resources to be Medicaid eligible. Notable assets that are excluded for eligibility purposes include your home (so long as it has less than $500,000 of equity), one vehicle, a funeral plan or burial space, and personal items and effects.
- If you are married, the total countable assets you and your spouse have are totaled and divided in half. As of March 1, 2017, the at-home spouse was entitled to keep at least $24,180 of the assets owned when one spouse entered the nursing home, and no more than $120,900. For example, if a couple had $40,000 of countable assets, the at-home spouse would get to keep $24,180 and the remaining amount would need to be spent down to $2000. On the other hand, if a couple had $200,000 of countable assets, the at-home spouse would get to keep $100,000.
- Income Protection for Spouses. Under Utah Medicaid law, the at-home or community spouse is entitled to keep all of his or her income. Also, to the extent that the at-home spouse’s income is less than a certain amount, they can receive a portion of the ill spouse’s income to make up the difference.
- If you are in a nursing home, we can help you create a plan to qualify you for Medicaid as soon as possible and still preserve a portion of your assets. Many times we have saved families $10,000 or more with just a telephone call.
A Word of Caution about Gifting. Sometimes people try to protect assets by gifting or transferring them to others. There is a common myth that you can transfer up to $14,000 per person per year without any consequences from Medicaid. Unfortunately, that is a federal gift tax rule and does not apply to Medicaid. While there may be planning techniques that involve gifting, it should never be done without guidance from a qualified elder law attorney. If gifts have been made in the past, you should bring them to the attention of your attorney as soon as possible.
Don’t Forget About Estate Recovery. Everything discussed above is related to the conditions upon which a person becomes eligible for Medicaid. However, Medicaid law requires that states keep track of the benefits provided under Medicaid, and then seek to recover those benefits after the Medicaid recipient has died. Essentially, Utah will seek recovery against the assets of a recipient who was over the age of 55 at the time they received benefits, and so long as there is no surviving spouse, blind or disabled child, or child under the age of 21.
As you can see, Medicare and Medicaid are both complex programs that require the expertise of an attorney well versed in senior legal issues. The ElderCare Law Firm Inc. has the experience needed to help you—contact us today!