The costs associated with long-term care can be astronomical, costing upwards of $10,000 a month for some individuals in nursing homes. These costs can threaten an individual’s ability to preserve their estate. Taking advice from people who lack experience in Medicaid law can be problematic, and can lead to costly litigation and penalties.
Medicare is a federal health insurance program designed to insure basic health care for people who are 65 or older, people with End-Stage Renal Disease (ESRD), or those who have been disabled for two years. Eligibility for Medicare is not based on income or assets. Medicare is broken down into four different “Parts,” Part A, B, C, and D. These cover, respectively, hospital insurance, medical insurance, Medicare Advantage, and prescription drugs. Medicare does not pay for long-term care beyond the first 100 days.
Medicaid, on the other hand, is a joint state and federal program that assists individuals with limited resources in paying their healthcare costs. Medicaid covers some services that Medicare does not, such as long-term custodial care. There are currently only three ways to pay for long-term care: (1) private pay; (2) long-term care insurance; or (3) Medicaid.
Because each state administers the Medicaid program subject to its own rules and criteria, eligibility requirements vary from state to state. At a minimum, to qualify for Medicaid, you must:
Individuals who meet these requirements are eligible for nursing care facility costs as well as the cost for ancillary services.
The rules that govern the calculation of countable resources are extremely complex. That is why it is important to contact an experienced Towson Medicaid lawyer who can help you draft a Medicaid plan that will protect your loved ones. Some resources are exempt from being counted, according to local law and regulations. For example, often a family marital home is exempt so that the other spouse who is not in long-term care can continue living there.
Because some people try to transfer assets to loved ones just before filing for Medicaid benefits, certain rules require an examination of your assets during a given “look back” period. Assets transferred for less than fair market value five years before filing for Medicaid benefits will result in something called a divestment penalty. There are numerous other penalties that can apply when assets are transferred in violation of the Medicaid rules.
There are different types of Medicaid: community based, custodial long-term care, and Medicaid Waiver programs. The Waiver program is an alternative to nursing home care. It allows an eligible candidate to stay at home, with support services paid for by Medicaid if the costs to Medicaid are less than the costs of round the clock nursing home care.
For Medicaid purposes, there is no mingling of marital income. Therefore, your spouse’s paycheck does not count towards the determination of your own Medicaid eligibility. There is also something known as the Community Spouse Resource Allowance Rule, which allows a spouse to keep 50 percent of the couple’s resources up to a certain amount. This amount varies by jurisdiction, and changes yearly, but it is around $150,000.
If you have questions about how to apply for Medicaid in Maryland, whether you are eligible, or need help formulating a sound Medicaid plan, the Towson Medicaid lawyers at the Law Offices of Jayme L. Levy can help. To schedule a consultation, call us today at 410-512-6605 or contact us online. We advocate for families in Baltimore County, Howard County, Baltimore, Ellicott City, and Columbia.