Medicaid could turn out to be one of the most important social safety net programs that you can take advantage of as you get older or if you become disabled. If you need nursing home care or costly medical care, Medicaid may be the best and only option for you.
Unsworth LaPlante, PLC can help you to understand rules for receiving Medicaid benefits and can help you to ensure that you are prepared to get Medicaid coverage when you need it. Give us a call at (802) 879-7133 or contact us online to get personalized help with Medicaid planning. You can also take a look at this guide to Medicaid to find out what you need to know about why Medicaid benefits are important and how you can qualify for Medicaid coverage.
This guide to Medicaid can help you to understand how to qualify, what Medicaid covers, why coverage is so important, and how you can ensure you are able to become eligible for Medicaid when needed.
What is Medicaid?
Medicaid is a social welfare program provided though a partnership between the state and federal government. It provides comprehensive insurance to people with low incomes. It also provides coverage for nursing home care and certain other services that most insurers, including Medicare, do not offer. Medicaid offers services with low or no co-pays and can even pay for transportation to medical appointments under certain circumstances.
The federal governments sets broad guidelines that states must follow to receive federal Medicaid funding, but each state establishes its own specific rules and processes for obtaining Medicaid benefits. Some states, including Vermont, expanded coverage under the Patient Protection and Affordable Care Act (PPACA) to cover more low income families.
What are the eligibility rules for Medicaid in Vermont?
Vermont has different Medicaid programs through Green Mountain Care which provide services for different groups of people. For example, eligible children may become eligible for care under Dr. Dynasaur until their 19th birthday. Seniors, on the other hand, are covered by Medicaid for the Aged, Blind and Disabled.
Medicaid considers both family income and assets/financial resources when assessing eligibility for MABD. Income and resource limits for qualifying for care depend upon family size. For seniors qualifying for MABD, a household of two people can have a maximum monthly income of $1,083 in Chittenden County and $1,008 for other Vermont counties. Seniors may also have a maximum of $2,000 in resources or $3,000 per couple.
What does Medicaid cover?
MABD covers physical health, mental health, and dental care up to a cap of $510 per year. Limited chiropractic care and limited transportation services are also provided. There is no monthly premium, and the copay for prescriptions for those without Medicare Part D is between $1 and $3.
MABD also covers nursing home care for eligible seniors. Medicaid is the only source for insurance coverage for custodial care in a nursing home, which is the most common type of care seniors and the disabled receive. Medicare and private insurers typically cover only skilled care for a limited time period, which means seniors who don’t qualify for MABD could have to pay for nursing home care out of their own pockets.
How can you get covered?
If you have too many resources or too much income, you cannot get Medicaid benefits. You should talk with an experienced attorney about Medicaid planning to make certain that you can get Medicaid to pay for your nursing home care when you need it. You can use trusts to structure income and asset ownership so you are not disqualified for benefits. However, you must take action at least five years before applying to get MABD to cover nursing home care, because otherwise you could face a period of disqualification under the five-year lookback rule.
What is the five-year lookback rule?
Under Medicaid’s five-year lookback rule, Medicaid applicants will be disqualified for a certain number of months if they made transfers or gifts of assets or sold assets for less than market value in the five years before applying for Medicaid. The rule exists to stop people from just giving away their wealth to loved ones when they need nursing home care. The number of months of disqualification can be calculated by dividing the value of transferred assets by average nursing home care monthly costs.
What is Medicaid planning?
Medicaid planning involves finding strategic ways to make certain your income and assets do not disqualify you from Medicaid and do not force you to spend down assets to get Medicaid benefits. Unsworth LaPlante, PLC can provide assistance with using tools available under Vermont law so you can make a Medicaid plan. Medicaid planning will also help you to reduce the risk of asset loss due to Medicaid estate recovery.
What is Medicaid estate recovery?
Medicaid estate recovery is required by the federal government, which mandates that states try to recoup some of the funds spend on providing care through Medicaid. In certain situations, such as when Medicaid paid for nursing home care for seniors, Medicaid will try to recover the funds paid out after the death of the benefits recipient. Medicaid does this by making a claim on the estate of the deceased person who had received Medicaid coverage for care. This can result in a substantial loss of assets to heirs or beneficiaries, but Medicaid planning can help to ensure that this does not happen.
Who should get help with Medicaid Planning?
If you have assets you do not want to lose due to a need for nursing home care, you should talk with a Vermont Medicaid planning lawyer. Unsworth LaPlante, PLC can offer you comprehensive assistance making your Medicaid plan so you can get covered by Vermont’s Medicaid program when you require care. Give us a call at (802) 879-7133 or contact us online to find out more about the ways in which a Vermont Medicaid planning lawyer can help you to protect assets and get covered.