“Helping families plan for long life, obtain quality care and navigate the long term care maze”

  • Text size
  • A
  • A
  • A

Medicaid Explained

Medicaid is a complicated federal program that pays part of the cost of long term care in a skilled nursing facility (nursing home). In most cases, the individual receiving these benefits must contribute his/her monthly income, less a small allowance for personal needs. Some benefits are available for at-home care. The application process can be tedious and requires complete documentation.

At the Law Office of Leslie Wizelman, we develop a plan to accelerate Medicaid eligibility in appropriate cases. We guide our clients through every step of the implementation of the plan. We complete and submit the Medicaid application so our clients never have to visit the Department of Public Welfare.

Eligibility

Benefits are available only to individuals who meet specific Medicaid eligibility criteria.

Medical

An applicant for Medicaid benefits must actually need long term care in a skilled nursing facility or, in limited cases, at home. Usually the nursing home requests a medical assessment automatically when an application for Medicaid benefits is made. To avoid delay, one should be certain this assessment is completed.

Financial & General

  • The applicant must be a citizen of the USA or equivalent;
  • The applicant must be a resident of Pennsylvania;
  • The applicant's available assets, i.e., what one owns, must amount to less than $2,400 or $8,000 depending upon the applicant's income. For married couples, the available assets consist of all assets owned by the applicant, all assets owned by the spouse, and all assets owned jointly. Special rules for married couples allow them to keep some of their assets and possibly even some of the applicant's monthly income.
  • Some assets are temporarily exempt and are not counted when determining initial eligibility. Other assets are not available and are not counted when determining initial eligibility. See the section on Medicaid Planning below.

Disqualification

Certain gifts or transfers for less than fair market value will make the applicant temporarily ineligible for Medicaid benefits even if all of the stated criteria have been satisfied.

Medicaid will review all transfers of gifts made within five years before the "trigger date." The trigger date is the date on which the applicant resides in a nursing home and applies for Medicaid. Based on the size of the transfer, when it was given away and the average cost of nursing home care determined by the State, there may or may not be a period of ineligibility for benefits after the trigger date.

Transfers made more than five years before the trigger date do not cause ineligibility. However, if nursing home care and Medicaid benefits are needed within five years after the date of the transfer, the transfer may cause ineligibility for a very long time, depending upon the amount of the transfer. When gifting has occurred, it is important to contact an Elder Law attorney to begin planning immediately to minimize the impact of the transfer. You should not wait the five years to consult counsel.

A transfer to a spouse does not cause ineligibility. Neither does a transfer to a trust for the benefit of a disabled child. In some circumstances, transfer of a home will not cause ineligibility.

Estate Recovery

Upon the death of a person who has received Medicaid benefits, the law requires the Department of Public Welfare to attempt to recover the amounts paid to a nursing home for that person. At present, recovery is permitted only from the "probate estate" of that person, i.e., any assets titled in the individual's name alone at the time of death.

Medicaid Planning

Under certain circumstances, Pennsylvania law allows individuals or their spouses to keep their homes and much of their money without becoming ineligible for Medicaid benefits. For example, an individual could give away certain assets without causing ineligibility or could make certain assets unavailable so that they wouldn't count against the asset standard. However, relevant laws are extremely complicated and extremely vague, so Medicaid planning should not be attempted without the assistance of an experienced and qualified Elder Law attorney.