How do I qualify for Medicaid?
If you have no assets or money, then Medicaid (“Medical Assistance”) will usually pay for your care. In the nursing home setting, Medical Assistance covers room and board, pharmacy and incidentals. Basically, Medical Assistance provides for your basic care, but does not cover certain expenses like haircuts, beauty shop charges and clothing. However, if you qualify for Medical Assistance, you can retain sixty-eight ($68) dollars per month from your income / social security to meet any of these needs.
Medical Assistance planning is to offset the concerns of seniors regarding the high cost of long term nursing care. Generally, the purpose behind Medical Assistance planning is to make the individual eligible for Medical Assistance, while preserving as much of the individuals resources for the benefit of his or her loved ones. Medical Assistance planning occurs in a pre-planned stage or in a crisis stage. The pre-planning stage occurs when you are expected to enter a nursing home at sometime in the future. Generally, pre-planning techniques include: long term care insurance, gifting, and utilizing trusts. Medical Assistance crisis planning occurs when you enter a nursing home without any planning, and you are not expected to return home or to the community and you are paying the nursing home out of your own pocket. Medical Assistance crisis planning is more common because the majority of seniors are of the opinion that a nursing home stay will never happen to them. When the nursing home stay becomes a reality, you or your family, realizing the cost of nursing home care, will have to address the situation.
To qualify for Medical Assistance, you must be over sixty-five, or blind/disabled and have limited income and assets. If you are a single person, the only assets that you can maintain (non-countable assets) are basically, twenty-five hundred ($2500) dollars, some life insurance and your burial plot. Every other asset is considered available to pay for the nursing home costs (countable assets). Non-countable assets for a married couple are some savings, your home, household goods, a motor vehicle, some life insurance and burial plots. Savings accounts, checking accounts, 401K, pensions and CD's, life insurance policies, in excess of the non countable allowances, second homes, and other motor vehicles are all considered countable assets. Therefore, if you have assets in excess of the resource limitation, you will not qualify for medical assistance. Consequently, you must “spend-down” the excess amounts.
In lieu of giving all your money to the nursing home, you can “spend-down” your assets, with some proper planning techniques such as: purchasing prepaid funeral arrangements, paying off some debts, purchasing a new car and making home improvements. Additionally, the remaining “spend-down” amount can be eliminated through the purchase of a Medicaid Annuity. The Medicaid Annuity is designed to convert the “spend-down” amount into a stream of income. With the “spend-down” amount now eliminated, you become eligible for Medical Assistance benefits.
What will you do when the government does not provide for your long-term care?
Most seniors have tremendous concerns about how they will finance their long term care either in a nursing home, assisted living facility or staying at home. These concerns are very real, when you consider a congressional survey that states seventy (70%) percent of single nursing home residents reach poverty after thirteen (13) weeks in the nursing home. This is because the annual cost of a nursing home can range between sixty (60) thousand and a hundred (100) thousand dollars a year.
Additionally, states are being put into fiscal distress by their share of Medicaid expenditures. As a result, they are seeking to restrict eligibility to Medical Assistance. The states will make it harder to qualify for Medicaid by restricting financial eligibility, asset and income protections of spouses not in the nursing home, and they will limit eligibility through regular level of care reviews. Also, the National Governors Association is pressuring for changes in Medicaid that will further impose restrictions on services and eligibility.
The Bush administration tried to transform Medicaid into a bloc grant program. With a bloc grant, the annual federal contribution to a state would be capped at a defined level regardless of how many persons qualify for Medicaid or what level of care they need. In return, states will have the ability to define scope of services, eligibility requirements, and cost recovery programs – collecting your assets when you die. With a bloc grant program, long-term care programs will become radically different. However, we do not know what the Obama administration will do.
You have worked throughout your lives to care for yourselves and to plan for your security. However, since the government / state will not provide for your long-term care or security, what will you do? The question becomes “How can I find, get and pay for good care?” How will you and your children, use your income, savings and property acquired through your lifetime of hard work, to provide for appropriate living conditions and maintain access to quality health and long-term are for the remainder of your life? You must plan for your future to achieve and maintain access to quality care.
A Life Care Plan contains the tools for the client to achieve and maintain access to quality care at the right time through the exercise of individual responsibility and realistic goal setting. Effective planning and financing of long-term care requires a thorough review of your personal and financial circumstances, as well as individual strategies that can be adapted for the changing governmental, economic and health care circumstances. Because of changes to Medicaid, and the instability of the long-term care environment, a flexible Life Care Plan is essential.
It is advisable that you take action before a crisis hits your family. A disastrous long-term care experience does not have to happen to you. A plan must balance ongoing developments with your income, assets, spouse, family, federal and state government programs, health care strategies and funding, and long-term care strategies and funding. Long-term care planning can no longer be only about financial planning for eventual Medicaid nursing home assistance for a simple reason: Long-term care is the most expensive, direct, health care expense for which you have personal liability.
As recently as the early 1990s, the common long-term care options included family help at home, inpatient hospital care and nursing home care when you could not stay at home. The long-term care environment for the 21st century has changed. Because of economic and government regulatory pressures, quality of care issues have fallen to the bottom of the list of priorities. Therefore, it is more important than ever to provide realistic and flexible care options and financing strategies. What kind and how much care or assistance do you need? Where is the best place to receive services? How do I pay for these services? Are my needs being met? What does my spouse and family need?
With the ever-present possibility of federal and state legislative or regulatory changes, the future of Medicaid is too uncertain for rational planning. Congress and the courts will continue to transfer major aspects of Medicaid eligibility, coverage and responsibility to the states and to your families. Several years ago, Congress considered, but did not pass legislation that would permit states to impose liability on children for Medical Assistance their parents received. Therefore, a thoughtfully constructed life care plan will help you depend on your own legal, financial and long-term are plans much more than you can rely on Medicaid.