If you live in Florida and have watched a loved one struggle to pay the high cost of nursing home care, then you may have some idea about just how expensive that care can be. For many seniors, long-term care can cost $7,000 a month or more – an amount that is far more than the average retiree could even hope to manage on her own. That’s why so many residents in Florida and around the United States rely on government benefits from the Medicaid program to help them cover the cost of their nursing home care. Of course, there’s one question that must be answered before you can receive that assistance: can you meet the eligibility requirements for Medicaid?
Medicaid: Not as Simple as You Might Imagine
Medicaid has always been a somewhat unique benefit program. Since it was first created a half-century ago, the program has been an effective partnership between the federal and state governments. It’s jointly-funded and managed at the state level, where it provides health care benefits to low-income Americans and legal residents. Since its creation, however, the program has expanded in ways that most Americans probably never would have dreamed possible.
For one thing, it now provides critical coverage not only for children and low-income adults, but also for seniors whose Medicare benefits won’t cover certain types of care – namely, the expenses associated with long-term care. For while Medicare is the primary health care benefit for seniors in the United States of America, it has one unique quirk that can spell trouble for older adults whose health care needs require more in-depth attention than they can typically receive at home. That quirk? Medicare is all but useless for any real long-term care in a nursing facility.
The problem is that Medicare only provides up to 100 days of nursing home coverage, and only under certain conditions. Given that so many seniors end up staying in those facilities well beyond that 100-day limit, Medicare really cannot be seen as any sort of solution for long-term care. Yes, it provides adequate coverage for ordinary care needs. And yes, it has helped generations of seniors enjoy better care regardless of their financial situation. Still, when it comes to nursing homes, Medicare is not a program on which anyone should be forced to rely.
Medicaid, on the other hand, routinely provides coverage to seniors who are faced with exorbitant nursing home costs. The program is the single largest payer for nursing home expenses, and there’s no denying that millions of seniors would have to forgo the long-term care they need if the program didn’t exist. That makes Medicaid eligibility a vital concern for seniors everywhere.
What Are Those Eligibility Requirements?
Medicaid eligibility involves four basic criteria. You must meet all four of these requirements to qualify for the benefits that you need:
- You must be a resident of the state. People who live in other states can only qualify for benefits in their own jurisdictions.
- You must have an actual medical need for long-term care. Medicaid will not pay benefits unless there is a medical assessment that says that you require the type of care that only a nursing home can provide.
- Your income must be no more than $2,199 per month. That requirement is based on your gross income rather than net income, which means that any automatic deductions (such as those for Medicare premiums) are included in the eligibility calculations. Income includes Social Security payments, disability benefits, pensions, annuities, and most other sources of personal income.
- Assets are limited to $2,000. If that sounds like a very restrictive limit, there’s a reason. This is, after all, a program for low-income persons. There are certain properties that are exempt from consideration, however. For example, your home is exempt if your equity is no more than $552,000 and you have a spouse or other dependent family member living there. You can also exempt one vehicle, personal items in the house, retirement accounts, prepaid burial packages and plots, and properties that produce income. Life insurance, annuities, and business interests are also not counted.
What If My Income or Assets Exceed these Limits?
The problem many seniors face is that their wealth is insufficient to handle those high nursing home costs, but still too high to qualify for benefits. Does that mean that they’re simply out of luck? Fortunately, the answer to that question is a resounding “no!” There are ways to still achieve eligibility, even when your income, assets, or both are too high to meet those statutory limitations.
On the income front, the answer can be as simple as using a Qualified Income Trust. Known as the Miller Trust, this legal option allows excess income to be placed into an irrevocable trust bank account. Those funds are then directed to the nursing home to cover a portion of the cost of care. That structure enables the patient to secure eligibility so that Medicaid can provide part of those care costs too.
Where assets are concerned, a variety of options can be employed. These range from spend-down strategies to the use of trusts, gifts, and other Medicaid planning techniques. Again, the goal is to remove assets from the patient’s estate so that he or she can meet those hard eligibility requirements. With assets, however, it is also sometimes possible to protect that wealth so that it can benefit the patient’s heirs and other loved ones.
Don’t Try This on Your Own
Of course, these strategies should never be attempted without proper legal assistance, since the consequences of any mistakes could be costly. At Robert J. Kulas, P.A., Medicaid & Estate Planning Attorneys, our Medicaid planning experts can help. We’ll work with you to develop the strategies you need to ensure that you meet the eligibility requirements for Medicaid and secure the funding you need to cover nursing home costs. If you want to enjoy the peace of mind that comes from knowing that your long-term care needs will be properly met, contact us online or call us today at (772) 398-0720.
