Medicaid coverage for long term care can be a great help in paying for in-home care or a place in a care facility, but the qualification and application process can be complicated and presents dangers to be avoided.
In general, Medicaid provides coverage for in-home care or placement in a care facility for elderly or disabled individuals who meet certain financial requirements if that care is deemed necessary by a medical professional. Individuals must apply for Medicaid in the state in which they reside. The residency requirement is important because every state has its own rules, regulations, and implementation of Medicaid.
In terms of financially requirements for individuals, states use one of two general systems. Income Cap states set a limit on income to determine Medicaid eligibility. Spend-down states, also called “medically needy” states, consider an applicants total assets and then deduct medical costs to determine qualification. These states are called spend-down states because individuals can then spend down their assets to reach the qualifying limit. Both Missouri and Illinois are spend-down states. Even within these two qualification methods, different states have different interpretations of how income caps or spend down requirements are applied.
Where the expertise of an elder law attorney comes in is in the ability to devise a Medicaid application strategy that minimizes out of pocket care costs and preserves family assets. For a couple where one spouse needs long term care, spending down assets may qualify someone for Medicaid, but done poorly, this may leave the remaining spouse with few resources. An elder law attorney can figure out the best way to get someone the long term care they need while using available legal means to shield assets. Given enough time, an elder law attorney can also advise clients on how to minimize, or even avoid altogether, transfer penalties that can occur when an individual disposes of assets for less than fair market value within the five years prior to applying for Medicaid. An elder law attorney can also determine when the best time to file the Medicaid application is. Merely delaying the initial Medicaid application for a few months may make a significant difference in coverage levels.
Please see an elder law attorney in your area to help devise a plan that helps you and your loved ones get the long term care they need while preserving family assets.