Medicaid Planning Brochure

Medicaid Eligibility

Long Term Care in a nursing home is one of the greatest financial risks that a senior will face. What are the options?

  • Medicare provides only a short period of coverage, generally up to 100 days (if medical requirements are met) with deductibles.
  • Veterans may receive benefits if qualifications are met, but seldom offers enough funds to pay for all long-term care.
  • Family members may not be able to provide care. If they do, sustaining the care for a long period can be a significant challenge.
  • Long Term Care insurance provides a solution, but few own a policy.
  • Limited resources or spousal impoverishment prevent private pay.

Medicaid pays for long term care. These benefits are not just for the poor, but for those who meet eligibility requirements.

Medicaid eligibility is far more complicated than what most anticipate. There is no public education system that provides advice on how to qualify at the earliest time possible with the maximum savings of assets. Each year, rules change and policy clarifications are issued that require interpretation of the Law and the State of Texas is not allowed to give legal & financial advice. Also, one needs to be aware of MERP-Medicaid Estate Recovery Program.

Going it alone can be very costly! The Bond Law Firm is one of Houstonís best Elder Law Firms.

2013 Eligibility Criteria

Eligibility Criteria for a “Single” Applicant:

  • Must be a US citizen or a lawfully admitted Alien.
  • Must be a Texas resident.
  • Must meet a health assessment that certifies a need.
  • Must be in a nursing home (that offers Medicaid) for 30 days.
  • Must have income less than $2,130.00.
  • Must have Countable Resources Less than $2,000.00.
  • Must be free of all Pre and Post-DRA penalties for uncompensated transfers.

Eligibility Criteria for a “Couple” both filing (all criteria is the same except):

  • Must have combined income less than $4,260.00.
  • Must have Countable Resources Less than $3,000.00.

Exempt Assets:

  • Homestead less than $525,000.00.
  • Personal Property.
  • Automobile.
  • Irrevocable pre-paid funerals.
  • Burial plots.
  • $2,000.00 in cash or Countable Resources.

Spousal Impoverishment:

  • The applicant must divert all or enough of their monthly income to their spouse so that they may have gross monthly income of $2,898.00.
  • The Community Spouse is allowed to retain 50% of the couples combined Countable Resources with a maximum of $115,920.00 and a minimum of $23,184.00.

When Should I Start?

When is the best time to get help regarding how to finance long-term care and or qualify for Medicaid?

  • A recent trip from the doctors office has revealed a serious illness. Now is the time.
  • Accessing ones assets can be difficult because of the lack of a good POA (Power of Attorney). Don’t wait until a person looses capacity. Also note that many POA’s are outdated and lack the appropriate language to do Medicaid planning. Don’t wait for a hospital stay to take care of this important business.
  • If discharge from the hospital to a Skilled Nursing Facility, this is the time to call. While Medicare and insurance is paying for skilled care, you have time to seek Medicaid if custodial care is required.
  • Medicaid will look back three months and backdate benefits if qualified. Many applicants are not aware of this. Assistance with the application can save money in many ways.
  • Nursing facility expenses can impoverish the healthy spouse or the family. There is no reason to delay planning.
  • Children often wait to long to get involved in their parents affairs. Mom or Dad may not understand the urgency in getting competent advice. Getting a head start may prevent lost wages and downtime from work if that son or daughter needs to step in.
  • Decision making can be very difficult, especially when family dynamics are present. Waiting to deal with the inevitable will not make the problem go away. Getting education on the various Medicaid planning options and sharing with family members often avoids conflict.