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Key Medicaid Facts to Know When Trying to Qualify for Coverage

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SorrowKnowing some basic Medicaid facts can help you to protect your assets and can help you to make sure you get your nursing home care paid for if you need it.

A Rutland Medicaid planning lawyer at Unsworth LaPlante, PLLC can provide you with comprehensive advice about Medicaid qualification rules in Vermont. An attorney can also help you to create a plan to protect assets and to get Medicaid to pay for nursing care. To learn more, contact us today, as the sooner you act the sooner you can take steps to qualify for Medicaid coverage.

Medicaid Facts You Need to Know

According to The Henry J. Kaiser Family Foundation, Americans spent $143 billion in 2010 to pay for care in nursing home facilities across the United States. Medicaid financed the majority of this spending, with Medicaid serving as the primary payer for more than 63 percent of residents in nursing facilities. To receive Medicaid funds, nursing homes must be voluntarily certified. In 2011, 95 percent of nursing care facilities throughout the United States had received certification and were able to accept payments from both Medicare and Medicaid.

While Medicaid is the primary payer of nursing home care, seniors do not qualify for Medicaid coverage unless their income and assets are both limited.

In Vermont, adults may qualify for general Medicaid coverage if they make up to 133 percent of the poverty level, according to Medicaid.gov. Medicaid for the Aged, Blind and Disabled (MABD) has different rules for eligibility than other types of Medicaid coverage. To qualify for MABD, a household of two may have a maximum monthly income of $1,008 in most counties in Vermont and a maximum monthly income of $1,083 in Chittenden County. These amounts are considered the protected income level and they do not need to be spent on nursing home care as they are protected to pay for non-medical needs of seniors and their spouses.

In addition to income limits, there are also limits on resources.  To qualify for MABD, you may have up to $2,000 in countable resources for individuals or up to $3,000 in countable resources for couples. A primary home is not counted as a resource if the Medicaid recipient who needs nursing care or his or her spouse is living in the home. Certain other assets may also be kept and not counted as resources, up to maximum limits. For example, a Medicaid recipient and his or her spouse can have up to $10,000 in separate burial funds.

With income and resource limits, many seniors could find themselves disqualified from the Medicaid coverage that they need because they have wealth they have amassed over the course of their lifetime. Seniors would be required to spend down their assets, sometimes even selling property, to pay for a nursing home. Only when the money and property have been spent down and seniors fall below the allowable resource limits would Medicaid begin to pay for coverage.

Many people want to avoid having to spend down their assets to get benefits. Working with a Medicaid planning lawyer can make it possible to preserve and protect your nest egg. However, Medicaid looks back five years to determine if you have transferred any assets when assessing eligibility. If you have transferred assets within the five year look back period, you’ll be temporarily disqualified from receiving Medicaid.

The period of disqualification is determined by dividing the value of transferred assets by the average monthly cost of nursing home care. You are disqualified by the number of months that is reached by doing this division.  Getting help well in advance of the time you need nursing care means you will not need to worry about the five year look back rule since your assets will already be protected.

Medicaid.gov also explains that estate recovery may be required. When an individual aged 55 or older receives Medicaid benefits, states are required to seek recovery of the benefits paid for certain types of care, including nursing facility services, community-based services, hospital services, and prescription drug services. The recovery is sought from an estate after the recipient passes away. If you have engaged in Medicaid planning, this will also not be an issue for you because your assets will have already been transferred and will not belong to your estate.

How a Rutland Medicaid Planning Lawyer Can Help

To learn more, join us for a free seminar or contact us to get personalized advice that is tailored to your situation. You can give us a call at (802) 879-7133 or contact us online today so we can get started on protecting your future.

Stephen Unsworth
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