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Paying for Long Term Care:
Medicaid for a Single Individual

Marks Elder Law Michael H. Marks, Esq.

Michael H. Marks

Linda Law Carroll

412-421-8944

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Medicaid is a needs-based, means-tested joint Federal and state program that pays for your nursing level care when you are unable to pay for the care from your own funds. Medicaid most often pays for nursing care in a nursing home, but can also pay for care in a patient’s private home. Middle-class families can qualify for Medicaid benefits to pay for catastrophically expensive nursing care by rearranging their finances.

In return for receiving a high level of monetary benefits for nursing home care, the big disadvantages for a single individual are:

  • You must do substantial planning and financial rearrangement of your assets to qualify, and
  • You will endure bureaucracy, paperwork and annoyance to apply and be approved, and
  • You must plan ahead to protect assets from Medicaid’s “Estate Recovery” program after your death.

These are the basic eligibility rules:

  1. “Nursing Facility Clinically Eligible”: To be eligible for any Medicaid paid benefits you need to be assessed and determined to need a certain level of care and assistance, referred to as “Nursing Facility Clinically Eligible.” If you are a patient already in a nursing home, this is usually obvious. If you are still residing at home and seeking Medicaid services, Medicaid will perform an assessment to determine your appropriate level of care. If Medicaid determines that you can safely stay in a personal care home and would not need nursing facility level care, then you will not be deemed medically eligible, and Medicaid will not pay. You will be approved only if Medicaid determines that you need nursing-level services.
  2. Financial Eligibility And Gifting Rules: Medicaid has a number of complex rules for determining your financial eligibility for benefits:
    1. Rule number one is that you are required to spend almost all your own money on your own care first, before they start to pay anything for you.
    2. However, rule number two is that if you give away anything of value within the five years before applying for Medicaid without receiving value in return – that is, if you make a gift – you will suffer a penalty period of ineligibility which delays the beginning of Medicaid benefits. The period of ineligibility arising from the gift corresponds to how much longer you could have paid for your own care if you hadn’t given the gift.
      Nonetheless, we use gifting techniques all the time. We just need to do so in a planned, strategic way that will be effective to accomplish the goals for you.
    3. To be eligible for Medicaid, your income can’t be greater than your base cost of care in the nursing home.
  3. Exemptions: You can also keep certain amount of value in certain categories of property, and still become eligible for Medicaid. Standard exemptions available to everyone can be used to safeguard some of your assets from being counted as available resources. These are often referred to as exempt, non-countable, protected resources. For example, you can:
    • Protect up to about $560,000 equity in a primary residence;
    • Protect an unlimited amount of value in a single motor vehicle;
    • Shelter a reasonable amount in a prepaid funeral or irrevocable burial trust account;
    • Shield a certain amount of cash of either $8,000 or $2,400 depending on your monthly income.

    Call today to meet with an elder law attorney in Pittsburgh, with offices in Monroeville. Contact Marks Elder Law today to start the planning process.

    We will gladly review your planning for long term care to ensure it is up-to-date.