|
Medicaid:
Medicaid Medicaid is a federal program that pays part of the cost of long term care in a skilled nursing facility (nursing home). In most cases, the individual receiving these benefits must contribute his/her monthly income, less a small allowance for personal needs. Some benefits are available for at-home care. Eligibility
Benefits are available only to individuals who meet these Medicaid eligibilty standards:
Medical:
An applicant for Medicaid benefits must acutally need long term care in a skilled nursing facility or, in limited cases, at home. Usually the nursing home requests a medical assessment automatically when an application for Medicaid benefits is made. To avoid delay, one should be certain this assessment is completed.
Financial and General:
 The applicant must be 65 or older or disabled;
The applicant must be a citizen of the USA or equivalent;
The applicant must be a resident of Pennsylvania;
The applicant's monthly income (not including the spouse's income, if any, but including the applicant's Social Security, pension, salary, interest, dividends, etc.) must be less than about $ 1,692.00 after medical expenses have been subtracted. In Pennsylvania, the cost of nursing home care is considered to be a medical expense.
The applicant's available assets, i.e., what one owns, must amount to less than $ 2,400.00, unless applicant's income is below $ 1,692.00 per month. In that case, applicant cannot have assets that exceed $ 8,000.00. For married couples, the available assets consist of all assets owned by athe applicant, all assets owned by the spouse, and all assets owned jointly. Special rules for married couples allow them to keep some of their assets and possibly even some of the applicant's monthly income.
Some assets are temporarily exempt and are not counted when determining initial elibibility. Other assets are not available and are not counted when determining initial eligibility. See the section on Medicaid Planning below.
Disqualification:
Certain gifts or transfers for less than fair market value will make the applicant temporarily ineligible for Medicaid benefits even if all of the stated criteria have been satisfied.
Medicaid will review all transfers of gifts made within five years before the "trigger date." The trigger date is the date on which the applicant resides in a nursing home and applies for Medicaid. Based on the size of the transfer, when it was given away and the average cost of nursing home care determined by the State, there may or may not be a period of ineligibility for benefits after the trigger date.
Transfers made more than five years before the trigger date do not cause ineligibility. However, if nursing home care and Medicaid benefits are needed within five years after the date of the transfer, the transfer may cause ineligibilty for a very long time.
A transfer to a spouse does not cause ineligibility. Neither does a transfer to a trust for the benefit of a disabled child. In some circumstances, transfer of a home will not cause ineligibilty.
Recovery:
Upon the death of a person who has received Medicaid benefits. The law requires the Department of Public Welfare to attempt to recover the amounts paid to a nursing home for that person. At present, recovery is permitted only from the "probate estate" of that person, i.e., any assets titled in the individual's name alone at the time of death.
Medicaid Planning:
Under certain circumstances, Pennsylvania law allows individuals or their spouses to keep their homes and much of their money without becoming ineligible for Medicaid benefits. For example, an individual could give away certain assets without causing ineligibilty or could make certain assets unavailable so that they wouldn't count against the asset standard. However, relevant laws are extremely complicated and extremely vague, so Medicaid planning should not be attempted without the assistance of an elder law attorney.
|
