Medicaid and Nursing Home Planning

Older Americans are in a crisis situation. Though we are living longer due to advances in medical technology, we are also surviving in situations where we are not able to care for ourselves. The family unit has also changed dramatically.

Generally, our children do not live in close proximity to us and are not taking care of parents in their home. This has led to the creation of long term institutionalization among older Americans. And the cost can be astronomical. The nursing home costs in South Florida average $5,000 per month.

One method to combat the cost of nursing home and/or in-home care is the purchase of long term care insurance. If we are healthy enough to afford the insurance and young enough to qualify, it can be an excellent investment. However, if we do not qualify and cannot afford the insurance, what alternatives exist?

The primary alternative is through the Medicaid program. In Florida, in order to be enrolled on Medicaid, the Institutional Care Program, three criteria must be met: (1) medical criteria; (2) income criteria; and (3) asset criteria.

The medical criteria will be met if an individual is determined to be medically needy by the Department of Health and Rehabilitative Services ("HRS") or is unable to do a majority of the activities of daily living. In addition, the individual must be residing in a Medicaid qualifying nursing home.

In order to satisfy the income criteria, an individual who is applying for Medicaid must have an income of less than $1,635 per month. This includes social security, pension, disability payments, interest, dividends and other income payments. If the individual has a spouse who is not currently living in a nursing home, said spouse's income is unrestricted.

If the spouse is living in a nursing home, the spouse's income is also limited to $1,635 per month. However, is the applicant has income in excess of the limit, he or she may still qualify for Medicaid through the use of a Qualified Income Trust. This trust collects the income of the individual and permits the trustee to make the appropriate payments to the nursing home. This trust avoids Medicaid disqualification of individuals with income in excess of the income cap.

With regard to the asset criteria, a single individual living in a nursing home is only permitted to have $2,000 in assets. A married couple living in a nursing home is only permitted to have $3,000 in assets.

If an individual is living in a nursing home and has a spouse living in the community (not living in a nursing home), the individual is permitted to own $2,000 in assets and the spouse living in the community is permitted to own $89,280 in assets.

In addition to these asset limits, an individual may retain exempt assets such as a residence, one automobile, personal property and household furnishings and pre-need burial arrangements and burial plots.

If an individual exceeds the asset limit as stated above, and subsequently transfers his or her assets to his or her spouse, there is no penalty. However, if the couple's combined assets exceeds the asset limit stated above and one spouse transfers assets to a non-spouse, there is a thirty-six (36) month look-back period and period of ineligibility that may be incurred.

If these transfers come from a trust to a non-spouse or if the transfers are to a trust, the look-back period is extended to sixty (60) months. The look-back period and ineligibility period may be shorter, depending on the amount of assets that have been transferred.

The calculation to determine the period of ineligibility is the amount transferred to a non-spouse divided by $3,300. The solution to this equation equals the number of months of ineligibility for the Medicaid applicant. In addition, a transfer of an exempt asset to a non-spouse may also incur an ineligibility period.

We employ many different techniques in our office to preserve the assets of nursing home residents and potential nursing home residents within the Medicaid laws.

Spending down one's assets in order to qualify for Medicaid is one option but there are many more options that will allow one's life savings and hard earned assets to go to their spouse and/or children and grandchildren and allow the ill party to qualify for Medicaid in one to three months.

The rules stated above are the general rules to qualify for Medicaid in Florida. There are many alternatives and planning opportunities to utilize to qualify for Medicaid. Before any action is taken, you should consult a qualified Elder Law Attorney who can explain the Medicaid program and alternatives for preserving your assets.

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