MEDICAID & VETERAN'S BENEFITS FOR LONG TERM CARE

Medicaid for Long Term Care

Medicaid is a joint program managed by the U.S. Department of Health & Human Services’ Centers for Medicare and Medicaid Services, and the Virginia Department of Medical Assistance Services. It is an insurance program that covers medical costs to the extent that other medical insurance does not pay. To qualify, Virginia applicants must:

• be able to prove status as a US citizen or legal alien, and a Virginia resident.
• demonstrate medical need, by showing that they need someone to help them with basic activities of living, such as bathing, grooming or eating.
• demonstrate financial need (see below).
• not have made any gifts that would cause a disqualification period.

Financial Need

Financial need for Medicaid purposes varies depending on whether the applicant is single or married.

Single:

• Resources: a single Medicaid applicant may have $2,000, plus their personal property (their “stuff”), a vehicle if necessary for medical transportation, and some funds for funeral and cremation or burial.
• Income: in addition, the Medicaid applicant can keep enough income monthly to pay for Medicare, and for any Medicare supplement the applicant has, plus a Personal Needs Allowance of $40 per month.

Married:

• A married Medicaid applicant has the same resource and income entitlements as a single applicant.
• A Community Spouse is a spouse who is living at home or in an assisted living community. A Community Spouse can keep:
  • Resources: the home, a vehicle, their “stuff”, funds for funeral and cremation or burial, and one half of the family investments, within a floor and a ceiling. The floor at this time is $21,912; the ceiling is $109,560. So, if the husband and wife had a home, a car, and $80,000 in investments, the Community Spouse could keep $40,000.
  • Income: In addition, the Community Spouse is entitled to income of no less than $1,750 per month (and may be as much as $2,739 per month if the Community Spouse is entitled to a housing allowance). If the Community Spouse does not have at least this much income, the Medicaid spouse can contribute monthly to raise the Community Spouse’s income to this level.

At Susan I. Jean & Associates, LLC, we have over fifteen years of experience advising families about techniques to preserve sufficient funds to allow a dignified standard of living for the families of Medicaid applicants. We use techniques such as:

• Gifts
• Revocable Trusts with Medicaid Triggers
• Irrevocable Trusts
• Reverse Mortgages
• Annuities
• Smart Spending
• Residential Choices
• Half a Loaf Gifting

We pride ourselves on our ability to explain the process in plain English. We employ case managers who work with our clients to assist with all aspects of Medicaid qualification and retention of eligibility.

What to Expect at Your Appointment

When you make an appointment for a long term care consultation, you will be mailed some documents to review and complete. Please take this seriously; our advice to you is only as good as your information to us.

The first step is normally a meeting with the case manager assigned to your case. The case manager, either Donna or Annie, will meet with you to review your finances and be sure that we are aware of all relevant financial information. This generally lasts a half hour. It is followed by a meeting with the attorney.

Your appointment will be with attorney Susan I. Jean or attorney Elizabeth E. Bircher. The appointment will usually last about one and a half hours. During this time, the attorney will review the situation and the information you have provided, will determine what your questions or concerns are, and will provide a recommendation in short written format. That will end the consultation.

If after the consultation you believe we have demonstrated the expertise you want in your Elder Law attorney, you may become a client of the firm by retaining us to assist in implementing the plan. Such a retainer is appropriate when the client is not able to execute the plan on his or her own. This may happen when the spouse is committed to visiting the spouse in the nursing home and does not have the time to collect the information needed for a Medicaid application, or when the spouse is not financially astute, or when the applicant is single and the family needs assistance, or when there are many undecided aspects to the plan such that it is likely to change. The retainer normally combines:

• a detailed, written Long Term Care plan; and
• any necessary estate planning to support the plan; and
• case management to assist with executing the plan; and
• assistance with filing the Aid & Attendance or Medicaid application, and representation through first level appeal if necessary.

In many instances there are estate planning issues to be addressed. Our estate planning attorneys, Christina C. Balaban and William H. Carmines would meet with you and assist in this regard.

Your case manager will keep in close contact with you to review the status of spend-down, gifts, and other elements of your government benefits plan. The case manager will assist with getting the needed documentation for the application, and will assist with completing the application. The case manager will speak with the attorney if there are any legal issues to address. Of course, you always have the right to speak with your attorney as well.

We will stay in touch with the Department of Social Services and will answer any questions they may have. If the application is delayed beyond what is considered appropriate, we will file an appeal, or take other actions designed to expedite the approval.

When approval is received, we will review the results to be sure that you are receiving every benefit to which you are entitled.