For senior citizens, health care is one of those needs that cannot simply be wished away or ignored. Though modern medical science has had great success in the area of expanding life expectancies, it has had less success when it comes to preventing illness and age-related disease and injury. As a result, seniors are living longer than ever before, but that long life can come with even more burdensome health care costs than they faced in their working years. The Medicare program was created to help cover those expenses. But what happens when Medicare benefits don’t cover certain care? One of the best examples of that lack of Medicare coverage is found in the area of long-term care. For seniors who require such care, the program is of little use – covering only certain long-term care situations, and limiting payments to no more than 100 days of care. When these older Americans need nursing home care that lasts longer than those 100 days, they often turn to another program to cover the costs: Medicaid. That, of course, leads many elderly Americans and their families to ask one fundamental question: what is Medicaid and how can it help?
Like Medicare, Medicaid was created as a result of the Social Security Amendments of 1965. Unlike Medicare – which was specifically tasked with providing health care insurance to seniors age 65 or older, Medicaid was enacted to cover other groups of low-income Americans, regardless of age. The program is a jointly funded operation by the federal and state governments, with states participating on a voluntary basis and managing their individual programs. Despite its voluntary nature, every state in the United States now has some version of the Medicaid program in operation. As a result of the Affordable Care Act, millions of Americans who previously failed to qualify under the previously existing guidelines now benefit from the program’s coverage.
Today, this health care insurance program for low-income Americans has grown to the point where the average state devotes more than 16% of general funds to the program. In addition to providing medical insurance to low-income and other groups of children, the program also helps many pregnant women, disabled individuals – along with senior citizens whose Medicare coverage won’t pay for nursing home and other long-term care needs. In fact, Medicaid’s role in long-term care for seniors has risen dramatically in recent decades, and the program now provides at least some financial support to roughly six-in-ten nursing home residents.
How it Works
Medicaid is a means-tested program, which means that it is only available to those who meet its strict asset and income financial guidelines. For seniors, the guidelines require that an individual have no more than $2,000 in assets – not counting the family home and certain other belongings, and no more than $2,199 in monthly income. There are certain ways to get around these limits, of course, including exemptions for spouses that help to ensure that they are not impoverished when their loved one takes up residency in a care facility.
For residents who qualify, the program pays the nursing home directly, once the resident’s income has been applied to the bill. Each resident is left with a small amount of income each month that can be used as a personal allowance for various needs. In instances where the income of the patient’s community spouse fails to meet certain minimum levels, some of the patient’s income can be provided to that spouse to help provide support.
Why it Matters for Your Elder Law Needs
Nursing home costs are high and getting higher with each passing year. As a result, few seniors can afford to pay for care on their own, since most seniors lack the resources needed to cover expenses that can amount to more than two hundred dollars each day. Those costs typically leave seniors with several options: 1) pay for their care out of their own pockets; 2) rely on family to help pay for the care; 3) maintain long-term care insurance; or 4) rely on the Medicaid program.
The first two options are often impossible, since neither the senior not his or her family typically have the resources needed to fund any long-term stay in a nursing home. Long-term care insurance is difficult to manage as well, since the monthly premiums can be extremely high. That leaves the fourth option, but even that can be difficult for seniors whose assets or income are even one dollar more than the eligibility limits allow.
Fortunately, there are ways to plan ahead and prepare for those eligibility restrictions. Through the use of various Medicaid planning techniques, you can ensure that your assets are protected in a way that helps to secure at least a portion of your estate for your own needs and those of your family. You can also use different strategies to meet the income limits. Ultimately, the goal is to secure Medicaid eligibility without being forced to spend all of your assets on nursing home care.
An elder law attorney can help with these efforts, and ensure that you make full use of the benefits allowed by law while still enjoying the benefits of some portion of your estate. That can ensure that your loved ones are properly cared for while you’re in any long-term care facility, and help you avoid the dependency that would otherwise occur were you to be forced to impoverish yourself just to obtain program benefits.
The Help You Need
For more than fifty years, the Medicaid program has been providing critical benefits to low-income Americans of all ages. For seniors with elder law needs, the program remains a vital part of any effort to fund nursing home care on a long-term basis. At Kulas & Crawford, Medicaid & Estate Planning Attorneys, our team can help you protect your assets and secure the program benefits you need to pay for your care. If you’d like to learn more about how our Medicaid planning experts can assist you, contact us at our website or call us today at (772) 398-0720.