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The statistics on aging are grim; nine out of every ten Americans will need some form of care as they age, while only about 5% of Americans have long-term care insurance. If you suddenly need round-the-clock skilled nursing care and don’t have long-term care insurance your options can be limited if you do not have family members who can take care of you.
Most people know that Medicaid is for low-income US. citizens, but unless you have had to find out about nursing home care, you may not know that it is Medicaid, not Medicare, that pays for nursing home care. (Medicare can pay for an initial 20 day stay in a nursing home, and partially for 100 days but only Medicaid pays for long-term care.)
So, the question most people have is, do I have to be broke to qualify for Medicaid? Not entirely. Medicaid will look at both income and resources; these amounts can change every year. As of 2015, your monthly income must be $2199 or less, though income can be artificially lowered with a “Medicaid trust”sometimes called a Qualified Income Trust or Miller trust, to qualify for Medicaid.
All the money must flow in—and out of---the trust each month. The spouse who wants to stay in the home can receive support from the nursing home resident’s income (up to $2980.50 per month, depending on whether the community spouse receives any income themselves) so that they can stay in the home and pay their bills. The nursing home resident gets a $60.00 personal needs allowance, then Medicaid pays the costs of a nursing home that the nursing home resident’s remaining income does not cover.
As for assets, the general rule is that a couple’s assets are split in half, and the person going into the nursing home has to spend down their half to $2,000.00 before a Medicaid application can be approved. You can only have resources of $2,000.00 ($3,000.00 for a couple) but some resources are not counted, such as your home, a car (regardless of value), and a burial policy.
When resources are split in half to qualify for nursing home Medicaid, the community spouse can keep their half of resources, up to $119,220. If, however, the spouse staying in the family home will receive less than their maximum allowance, (because their allowance will be less than $2199 per month) spending down assets may not be required.
You can get free help applying for benefits from your local Area Agency on Aging benefits counselor. The benefits counselor can help anyone 60 or older or disabled or disabled and on Medicare, plan for a Medicaid application, for themselves or a loved one, while the Area Agency on Aging ombudsman has the authority to advocate for a nursing home resident.
Disclaimer: Elder Options of Texas is not rendering any legal or professional advice. If legal advice is necessary the reader should consult a competent attorney.
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