When a family member needs long-term care in a facility, the process of navigating the various programs available for assistance can be very overwhelming. Working with an experienced elder law attorney on the application and review process can be incredibly beneficial. With many years of experience in long-term care planning, we are well-versed on the eligibility requirements and planning tools available to bring about the best outcome for the applicant and their family.
Medicaid eligibility from a financial standpoint is determined by looking at a person's assets and income. In a long-term care situation, so long as a person's monthly income does not exceed the private pay rate at the facility, their income will not affect their eligibility for long-term care benefits. It is important to note that a long-term care applicant will be required to pay their income to the facility, less certain deductions.
In 2023, we saw some positive changes to the asset limits for single and married long-term care applicants. A single applicant can retain $17,500.00 in assets and still qualify for long-term care benefits. This positive change to the rules allows for a smooth transition from receiving benefits while living in the community to receiving benefits in a long-term care facility, without the stress of a spenddown or the fear of losing coverage. In addition to the increased asset limit for a single applicant, the asset limit for a community spouse of a married applicant was also increased. A married couple can retain a total of $138,280.00, with this amount being split between the Medicaid applicant ($17,500) and the community spouse ($120,780.00).
Beyond the asset limits mentioned above, there are also some assets that are exempt under certain circumstances, and therefore are not considered available for care when applying for Medicaid benefits. Such assets include, but are not limited to, certain prepaid funeral/cremation plans, certain life insurance policies, vehicles with a value less than $4,500 or which meet specific criteria, as well as the amount of damages recovered by a resident of a nursing home under the Nursing Home Care Act. There are also special rules in place related to a person's homestead that when applied can protect the home as an exempt asset. For example, if a community spouse or dependent relative of the applicant continues to live in the home, it would be exempt.
With so many factors playing a role in the Medicaid planning process, it is advisable to discuss your situation with an experienced practitioner, who can review the various options available to bring the most beneficial outcome for the applicant and their family.