Medicaid for Long Term Care

How can we help you with Medicaid qualification?  And what are the requirements to qualify for Medicaid? 

How can we help you? 

At The Heritage Law Group, our attorneys have more than twenty years of combined 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:

• Smart Spending
• Residential Choices
• Investment Real Estate exemptions
• Exempt Gifting
• Half a Loaf Nonexempt Gifting
• Annuities and Promissory Notes
• Revocable Trusts with Medicaid Triggers
• Irrevocable Trusts

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 are the requirements for qualification?

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 pays 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.

Medicaid can provide care for those who remain in the home, or in the PACE program (see below), or in a nursing home. 

Financial Need

Financial need for Medicaid purposes varies depending on whether the applicant is single or married, and whether the application is for nursing home care, or for in-home care or PACE.  The following are general requirements; there are certain exceptions that may apply in specific situations. 

Nursing home care, Single Person:

• Resources: a single Medicaid applicant may have $2,000, plus his or her tangible personal property, a vehicle if necessary for medical transportation, and some funds for funeral and cremation or burial.  The home may be exempt for up to six months. 
• 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.  The balance must be paid for care before Medicaid will step in. 

Nursing home care, Married Person:

In most nursing home care, married Medicaid cases, the spouses are composed of an “Institutional Spouse” who is in need of Medicaid funded health care (even though he or she may be living at home), and a “Community Spouse” who is living at home or in assisted living.  The Medicaid rules governing married cases require that both spouses resources and income be considered in evaluating eligibility in most cases.  However, as you will see below, the Community Spouse can protect a significant amount of both resources and income for his or her own needs. 

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 a certain amount of resources and income.  What can be kept?

• Resources: a Community Spouse may keep the home as long at the Community Spouse is living there, 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 $22,728; the ceiling is $113,640. So, if the husband and wife had a home, a car, and $80,000 in investments, the Community Spouse could keep the home, the car and $40,000 in investments.
• Income: In addition, the Community Spouse is entitled to income of no less than $1,838.75 per month (and may be as much as $2,841 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.  However, the Community Spouse's income is not counted as a co-pay toward care; the Community Spouse can keep his or her income free of Medicaid claims. 

Home Health Care and / or PACE, Single Person

• Resources: a single Medicaid applicant may have no more than $2,000, plus his or her tangible personal property, a vehicle if necessary for medical transportation, and the home in which the applicant is living. 
• 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 living allowance of $1,151 per month.

Home Health Care and / or PACE, Married Person

• A home health care or PACE 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 a certain amount of resources and income.  What can be kept?
  • Resources: a Community Spouse may keep the home as long as the Community Spouse is living there; a vehicle; his or her "stuff"; funds for funeral and burial or cremation; and one half of the family investments, within a floor and a ceiling.  The floor 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 the home, the car, and $40,000 in investments. 
  • Income: In addition to the Resources, the Community Spouse is entitled to income of no less that $1,838.75 per month (and may be as high 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. 

Program of All-Inclusive Care for the Elderly (PACE)

For those who are financially and medically qualified for long term care Medicaid, but who can remain safely in their home, the PACE program provides an interdisciplinary team whose focus is on maintaining the senior at home. To qualify, the senior must be at least 55 years of age, must reside in the coverage area for the local PACE program and must meet medical criteria for nursing home care. The PACE program accepts both Medicaid and private pay clients. It provides day care, with a physician, pharmacy, recreational therapy, meals, transportation, and other supportive elements to maintain the senior in his or her own home. 

Please see the section titled "What to expect at your Long Term Care Planning appointment" to get an idea of what to bring, and what to expect.