Need a lawyer for Medicaid planning in Fairfax?
Nearly half of all Americans who turn 65 in any given year will need to
enter a nursing home at some point in time. For most people, the nursing
home stay will be short term, less than a year. But a fourth of the people
who go in a nursing home will stay a year or longer and ten percent of
those will stay at least five or more years. Many elderly persons who
do not need a nursing home level of care nonetheless will still require
some form of long term care, either in their homes with assistance or
in an assisted living facility.
The cost of nursing home care is frightening. In Northern Virginia it can
average $5,000 to $9,000 per month. Hiring a home health care giver is
equally expensive. The average cost of a home health aide is $17 per hour;
a licensed practical nurse is $37 per hour. A live in home health aid
is equally expensive, running $150 to $200 per day, or $4,500 to $6,000
per month. Assisted living usually is less expensive, but still can stretch
a senior’s budget to the breaking point.
Will Medicare pay for your nursing home care?
provides a limited amount of coverage to persons in a nursing home who need
skilled nursing care. Usually this is care for rehabilitative purposes, such as
therapy following breaking a hip. Medicare does not pay for custodial
care, which is frequently what persons staying long term in a nursing
home require. Medicare pays less than 5% of the total cost of nursing
home care in America.
Is long term care insurance an option?
Long term care insurance
policies are becoming more widely available. The benefit packages are
getting better. Long term care insurance can be an important part of planning
for long term care, for those who can afford it and are healthy enough
to be insured.
Will Medicaid pay for your nursing home care?
Medicaid is a public assistance (welfare) program intended to pay for medical
care for the poor and medically needy. No one is entitled to Medicaid.
means-tested. To be eligible for Medicaid, you need to meet residency and citizenship
criteria, need a nursing home level of care and have income and resources
below certain levels.
Residency and Citizenship
To participate in the Virginia Medicaid program you need to be a resident
of Virginia, residing in a nursing home or in your own home in Virginia.
A citizen, naturalized citizen, or permanent legal resident of the United
States meets the citizenship requirement for
The Medicaid applicant cannot have more than $2,000 in countable resources.
Most every thing an applicant owns will be a countable resource. Non-countable
resources include the applicant’s home if the applicant or his spouse
lives in it, one automobile of any value, a prepaid funeral plan or money
set aside for the applicant’s funeral and burial, clothing and personal
jewelry such as a wedding ring.
The Medicaid applicant’s income must be less than the cost of his
care. If the applicant’s income is less than 300% of the Supplemental
Security Income level, currently $2,022 per month in 2009, he is deemed
medically indigent and is income eligible for Medicaid. If the applicant’s income is
higher than this level, then his income will be compared to the cost of
his care. If his income is less than the cost of his care, he will be
income eligible. If his income is higher than the cost of his care, the
applicant will not be financially eligible for Medicaid. For example,
if the applicant has income of $6,000 per month and his nursing home care
costs $5,300 per month, the applicant will not qualify for Medicaid.
In Virginia, it is presumed after six months that an unmarried Medicaid
applicant residing in a nursing home is not going to be returning home.
Their home is considered a countable resource. It will have to be listed
for sale and sold. Medicaid eligibility can be retained while the house
is being sold if state prescribed rules on the pricing of the house are
followed. If the Medicaid applicant is married, the house is not a countable
resource as long as the spouse, who is known as the
community spouse, resides in the home.
Community Spouse Resource Allowance
If the Medicaid applicant is married, his
community spouse will be allowed to keep half of their countable resources up to a maximum
of $109,560. The minimum
community spouse resource allowance is $21,912. So if half of the couple’s resources is less than $21,912, the
community spouse will be allowed to keep the whole minimum allowance, even though it is
more than half. The state does not care how family resources are titled.
An asset titled to the
community spouse, for example an individual retirement account or a 401k plan, is a countable
resource and is considered in determining the applicant's eligibility
Community Spouse Income Allowance
In assessing income eligibility for Medicaid, the applicant’s income
is determined without any deductions, even if the applicant is the main
source of support for the husband and wife. If the
community spouse’s income is less than $1,650 per month, she will be entitled to an allowance
from her husband’s income to bring her income up to this minimum
community spouse income allowance. This allowance can be increased up to $2,739 per month, depending on
the cost of the community spouse’s housing.
Personal Needs Allowance
Once an applicant is approved for Medicaid, all his income is paid to
the nursing home, less a deduction for his Medicare/health insurance premiums
and any allowance granted to his
community spouse. In addition, the Medicaid recipient can keep $40 per month as his
personal needs allowance. This allowance is supposed to pay for things Medicaid does not cover
such as clothes, shoes or a newspaper subscription. There are many nuances
to these general rules. At Hale Ball Carlson Baumgartner Murphy, PLC,
our Virginia Medicaid Attorneys can help your family plan for future Medicaid
eligibility and make wise choices if a Medicaid spend-down is needed.