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Nursing Homes and Medicaid – Some Facts

Does Medicaid pay for nursing home care? In short, yes. In all 50 states and the District of Columbia, Medicaid will pay for nursing home care for persons who require that level of care and meet the program’s financial eligibility requirements. Readers should be aware that the financial requirements and the level of care requirements vary based on the state. Not all nursing homes accept Medicaid for payment (they must be licensed to receive Medicaid funding). Making it more complex is that the financial requirements change based on the marital status of the Medicaid beneficiary/applicant. For those who are eligible and who are in a home that accepts Medicaid payments, Medicaid will pay for the complete cost of nursing home care, including room and board. Medicaid will pay for nursing home care on an ongoing, long-term basis for however long that level of care is required, even if it is required for the remainder of one’s life.

Medicaid should not be confused with Medicare. Medicare will only cover part of the cost of nursing home care and only for a maximum of 100 days. Short-term nursing homes are commonly called convalescent homes and these are meant for rehabilitation, not long term care.

Here are some facts about Medicaid, your assets and nursing homes:

  • Assets in a revocable living trust are not protected and must be used to pay for the costs of long-term care.

  • If you are married, your home is exempt and cannot be taken when applying for Medicaid. If you are single or widowed, your home is exempt up to $595,000. However, after you pass away, Medicaid will have a lien on your home and estate up to the amount of benefits paid on your behalf during your lifetime.

  • A common myth is that by transferring ownership of your home, you can avoid “losing it” if you must go to a nursing home. If you transfer your home to your children, not only will it result in immediate ineligibility for Medicaid, but it could also:

    • Trigger a gift tax,

    • Your children will pay higher capital gains taxes when they sell your home,

    • Result in the loss of any property tax exemption, and,

    • Result in your child’s spouse (the in-laws) inheriting your home.

  • Giving your assets away means losing control. It’s not safe even if you “trust” who you give it to. If that person divorces, goes bankrupt or is sued, all of the money you transferred is at risk. There are asset protection trusts that permit you to keep 100% control of your assets without the risk of losing them if long-term care is needed.

  • You do not have to wait 60 months to qualify for Medicaid. Eligibility is calculated on a case-by-case basis. It is possible to have over $250,000 in cash and qualify immediately. Get professional advice from one of the experienced asset protection attorneys at Fiffik Law Group and learn the facts.

  • It is never too late to protect your assets even if you are already in a nursing home. In fact, you can qualify for Medicaid sooner if you are already in a nursing home, than if you aren’t.

  • A nursing home or hospital that offers to file a Medicaid application for you has no obligation (and often can’t) advise you on how to protect your assets. Only a qualified Medicaid planning attorney will be looking out for your interests.

  • Applying for Medicaid prior to qualification could result in being disqualified for a longer period of time than you otherwise would have been (it’s not limited to 36 months).

  • Make sure the attorney you hire is experienced in Medicaid planning. Would you go to your regular doctor for a heart problem?

  • Consider long-term care insurance. An annual premium for a couple is usually less expensive than one month of nursing home care and with proper planning; it may also enable you to stay home if you become ill.

Don’t let fear stop you from planning. The earlier you start, the more you can protect and the more options you have. Contact the experienced elder law attorneys at Fiffik Law Group today to set up an appointment.


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