Long-Term Care Medicaid
Basics & Medicaid Planning

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Who Can Senior Resource Planning Help?

Long-Term Care Medicaid Planning

Applying for Long-term Care Medicaid is a personal decision, and although thousands of people complete the process each year, it’s different for everyone. Many things can impact the Medicaid process and its outcome. Whether you have assets to preserve, only need help with the application, want care at home or a facility.  We are here to help.  Senior Resource Planning helps you navigate the red tape of Medicaid and cover the vast expense of long-term care while preserving your life savings.

Understanding Your Options

Applying for Long-term Care Medicaid is a personal decision, and although thousands of people complete the process each year, it’s different for everyone.

Many things can impact the Medicaid process and its outcome.

It’s important to understand the basics of Long-term care Medicaid including the eligibility requirements and the options to become eligible if you are not.

Too often families are told that their loved one has to spend down all of their savings to qualify.  This is simply not true.  There are Medicaid compliant strategies available to prevent or decrease the amount that would have to be spent down.

Why Medicaid Planning?

The process of applying for Long-term care Medicaid is both time-consuming and frustrating. There are often long delays. Only to find out a small error on one form means you have to start the process all over, and if you answer incorrectly, you could be locked out of Medicaid benefits. 

This can negatively impact the comfort, happiness, and even the individual’s health and their entire family.

In addition to the challenging process, most people seek out Medicaid planning for three reasons.

  • Because their income and resources are over the financial eligibility limits, they are concerned about spending down their savings to apply.

 

  • They have a barrier to eligibility like a rental property, and they don’t know how and if they can overcome it.

 

  • They are overwhelmed by everything going on and caring for their loved ones. They do not have eligibility issues, but they want a Medicaid planner to assess their case, complete the application and file it.

What is Medicaid Planning?

The term Medicaid planning encompasses a wide variety of services provided by professionals. It can be as simple as assisting with documents and the Medicaid application or as complicated as re-structuring one’s financial assets while following Medicaid’s strict guidelines.  A Medicaid planner will give you a broader view of  your options so that you can make an educated decision on what is the best choice for your loved one and family

Medicaid Planning Will Generally Address

  1. EXPOSURE: Which assets are subject to the spend-down and which are protected.
  2. STRATEGY: Develop a strategy to protect the exposed assets from the spend-down regardless of where you are in the process.  Savings can still be reallocated even for those who are already in a facility or receiving homecare and spending down money.
  3. ELIGIBILITY:  Prepare and file the Medicaid application as well as seeing the process all the way through to approved Medicaid benefits. Dealing directly with the county assistance office for you.  So that you don’t have to spend hours on the phone. 
Help From Experienced Professionals
Protecct Life Savings
Qualify For Benefits Faster
Get the Care Your Loved One Needs

Long Term Care (LTC) Medicaid Basics

What is LTC Medicaid?

Medicaid refers to more than one program, as there are many different eligibility groups within each state’s Medicaid program. Long-term care Medicaid is for the elderly and disabled and it’s what is used to pay for care.

Medicaid definitions & details on programs click here

Important to Note

Long-term care Medicaid and Medicaid waivers can be used for home care, assisted living (some states), or nursing home care.

Am I Eligible for Medicaid?

To be eligible for Medicaid long term care, one must be both financially qualified and have a medical need for care. Eligibility requirements are specific to the state, the Medicaid program or waiver, and one’s age group. Therefore, there are hundreds of different sets of eligibility rules for Medicaid long term care services throughout the USA. Having said that, there are some general rules that apply. 

 Check to see if you qualify using our FREE Medicaid Eligibility Form

Medicaid's Strict Physical and Financial
Eligibility Requirements

Medical

The medical requirements  for Medicaid long-term care differ significantly by state. In general, any individual who requires continuing skilled nursing care has Alzheimer’s or dementia or cannot care for themselves qualifies. If professional nursing care is not required, then many Medicaid programs link eligibility to the number of ADLs (activities of daily living) with which an individual requires assistance. This can include dressing, bathing, eating, cooking, etc. Most states demand a “nursing home level of care,” but each state defines it differently.

Financial

When determining eligibility for Medicaid long-term care, each state considers finances differently.  However, in all states, both one’s income and assets are considered factors.

Assets

For a single person in most states, the asset cap in 2022 is $2000.

Married couples can have considerably higher asset limits, but only if one spouse is not applying for Medicaid. The non-applicant is referred to as the “community spouse.”  In 2022, the community spouse is permitted up to $137,400 in countable assets in most states. This is in addition to the assets the applicant’s spouse can keep.  Whose assets exceed Medicaid’s countable limits should not automatically consider themselves ineligible.

Income

In most states, for someone going into a facility, their income simply can’t be enough to pay the average cost of care in a facility in their area.  Home care/waiver programs are a little more complicated and vary a lot from state to state. 

**For all requirements we are speaking in general terms. It's important to find out the specific requirements and rules for your state.

Free Consultation and Analysis

Applying for Medicaid is both time-consuming and frustrating. There are often long delays only to find out a small error on one form means you have to start the process all over, and if you answer one question incorrectly, you could be locked out of Medicaid benefits.  Senior Resource Planning can speed the process along by developing a personalized strategy for you BEFORE any form is ever filed. We can help you conserve your assets, keep your home, leave an inheritance for your children, and protect your peace of mind. It all starts with a FREE  phone call.

Our Simple Process Will Help you Identify:

  1. EXPOSURE: Which assets are subject to the spend-down and which are protected.
  2. STRATEGY: We can develop a strategy to protect the exposed assets from the spend-down no matter where you are in the process. We can even help protect assets for those who are already in a facility or receiving homecare and spending down money!
  3. ELIGIBILITY: We not only help protect the assets, but we see the process all the way through to approved Medicaid eligibility – for home care, assisted living, or nursing home care.
  4. ESTATE RECOVERY: All of our Medicaid eligibility plans also involve looking at estate recovery possibilities.

What If I’ve Been Denied for Medicaid Coverage Before?

If you’ve already applied for Medicaid and been denied, don’t give up! Senior Resource Planning can help you through the appeals process and hearings. With the high cost of care on the line, you need to use every tool at your disposal to protect your lifestyle and your legacy. Claimants who go into the appeal and hearing process with a qualified representative presenting their case have a dramatically higher success ratio than those attempting Medicaid Appeals without any help.

Medicaid Planning Examples

Meet Peter and Alice

Peter is 79 and has just entered a nursing home. His monthly bill will be $8,000 a month. His wife Alice who is also 78 tells us she is worried the nursing home cost will quickly drain their assets.

She was informed that Peter’s income would go to the nursing home and she would have to “spend down” their assets to cover the balance. Once her assets are spent down to meet Medicaid eligibility she could apply for Medicaid for Peter. Alice was in tears. She did not know how she would be able to live on just 1,600 a month.

  • Peter’s Income form social security is $2,100 a month
  • Alice’s income from social security is $1,600 a month
  • Assets totaled $400,000
  • Obtain immediate Medicaid eligibility for Peter
  • Increase Alice’s income
  • Preserve their assets

Following a thorough intake and the purchase of two funeral expense trusts equaling $14,000 we were able to determine that based on their states Medicaid eligibility rules they had to spend down $253,000.

Peter’s IRA of $150,000 was put into an MCA -Medicaid compliant annuity with the monthly payment going to Alice utilizing the “name on the check” rule.  The remaining $103,000 was put into another MCA in Alice’s name.

Purchasing the MCA’s eliminates their excess countable assets, and Peter becomes immediately eligible for Medicaid benefits.  With the payments from both MCA’s Alice’s income goes from $1,600 a month to $4,795 a month.  We also took over the whole process of applying for Medicaid so that Alice could focus on everything else that was happing with Peter going into the nursing home.

  • Peter received immediate Medicaid eligibility. His cost of care was now changed to the amount of his social security minus his $50 personal needs allowance.  Making his co-pay is now $2,050 saving the couple $5,950 a month.
  • Alice’s income increased from $1,600 a month to $4,795 a month.

If they chose not to move forward with the plan, they would have exhausted their entire spend down amount of $253,000 in less than 32 months and Alice’s income would have remained at $1,600 a month.

Meet Sally

After being diagnosed with dementia, Sally (82) enters a nursing home that costs $8300 per month. In order to avoid losing her life savings to pay for long term care, she wants to make a wealth transfer to her children. She also owns a piece of rental property with her daughter which they purchased just one year ago. Sally’s daughter was really concerned about what to do. She did not want to sell the rental property.

  • Sally’s income from social security $1,800 a month
  • Assets $150,000 including the rental property
  • Cost of care $8,300 a month
  • Obtain Medicaid eligibility for Sally as quickly as possible.
  • Preserve her assets
  • Create a wealth transfer to the next generation including the rental property

Following a thorough intake it was determined that after the purchase of a $10,000 funeral trust Sally had to spend-down $138,000.

The first step was to transfer the property with a value of $50,000 to the daughter.  This created a $50,000 gift.

Along with the property an additional $25,000 was gifted to Sally’s children.

With a total gift to her children in the amount of $75,000 that left a balance of $63,000

The $63,000 was put into an MCA for Sally.  The income from the MCA paid the nursing home during the penalty period that we had created by gifting the $75,000.

  • Sally made a wealth transfer to her children of $75,000.
  • The property was transferred to the daughter so that she now had full ownership and did not have to sell it to achieve Medicaid eligibility for her mom.
  • We utilized an MCA with the balance of Sally’s assets to pay the penalty period created by gifting the property and money to her children.
  • Once the penalty period was over Sally’s MCA would be fully paid out and she would qualify for Medicaid.

Walter Needs Homecare

Walter is 78 and needs homecare.  His wife Pam is unable to provide all the care he needs and she doesn’t want him to go to a nursing home.

Pam inquired about applying for Medicaid to help with costs.  She was told she had too many assets and that she would have to spend them down first.  Pam and Walter depend on the income from their investments to live.  She did not know what to do.

  • Walter’s Income from social security is $1,800 a month
  • Pam’s income from social security is $900 a month
  • Assets totaled $200,000
  • Obtain immediate Medicaid eligibility for Walter
  • Have enough income
  • Preserve their assets

Following a thorough intake we were able to determine that based on their states Medicaid eligibility rules they had to spend down 100,000.

$100,000 was put into an MCA -Medicaid compliant annuity in Pam’s name.  

Purchasing the MCA’s eliminates their excess countable assets, and Walter becomes immediately eligible for Medicaid benefits.  With the payments from the MCA Alice and Walter maintain enough income to live on. We also took over the whole process of applying for Medicaid so that Pam could focus on everything else.

  • Walter received immediate Medicaid eligibility for homecare services. His cost of care was now covered by Medicaid.
  • Pam’s income increased by $1,388 a month with the use of the MCA replacing the income that they used to get from their investments.
  • Pam and Walter maintained $100,000 liquid for emergencies and othe expenses.

If they chose not to move forward with the plan, they would have exhausted their entire spend down amount of $100,000 in less than 19 months and their income would not cover their expenses.

*These examples are for educational purposes only

Who Can Senior Resource Planning Help?

If your loved one is currently  in long-term care, assisted living or getting homecare services and rapidly draining your life savings.

If you’re worried that your loved one’s health situation is worsening and you may soon be forced to seek long-term care either at home or in a facility.

If you’re making financial and medical plans now and want to cover the probable expense of long-term care without bankrupting yourself or spending your children’s inheritance.

Discover how SRP can Help You

If you’re ready for a  conversation to see how we can help you obtain Long-Term Care Medicaid  without forced financial hardship for you or your loved ones…

Contact us

Who Is Eligible?

To be eligible for Medicaid long term care, one must be both financially qualified and have a medical need for care. Eligibility requirements are specific to the state, the Medicaid program or waiver, and one’s age group. Therefore, there are hundreds of different sets of eligibility rules for Medicaid long term care services throughout the USA. Having said that, there are some general rules that apply.

Meet the physical criteria based on an assessment

Be 65 or older, have a permanent disability, or be blind

Be a US citizen or (qualified non-citizen)

Meet residency rules in your state

Meet the income and asset limits