Medicaid Frequently Asked Questions

It is important for seniors to know eligibility requirements for Medicaid because many seniors will need to successfully apply for Medicaid coverage to get nursing home care paid for. As you get older, your chances of needing care in a nursing home rise.

Unfortunately, Medicare only pays for skilled care, such as when you’ve had surgery and must have the bandages changed by a nurse. Outside of these circumstances, Medicare provides no coverage for nursing homes. Most seniors don’t need skilled care in a nursing home setting but instead move to a home because they can’t live alone due to medical conditions like dementia or simply due to old age.

When a senior needs to move into a nursing home due to old age or infirmity, the senior needs custodial care. Medicaid will pay for custodial care for eligible seniors even while virtually no other insurance will. Seniors thus need to know if they’re eligible for Medicaid so they can take advantage of the benefits if they are and so they can try to make a plan to become eligible if they aren’t.

Making a Medicaid plan is essential if you want to ensure you can get Medicaid to pay for the nursing home bills you incur as you get older and must move into a nursing care environment. Unfortunately, many people make Medicaid planning mistakes that end up costing them the ability to get the care that they require.

Some common Medicaid planning mistakes include waiting too long to make a Medicaid plan, using the wrong kind of trust for Medicaid planning, and not getting legal help with the planning process. If you wait too long, you may not be able to protect all of your assets that you would have hoped to keep shielded from Medicaid. If you use the wrong kind of trust as a part of your plan, the assets that are held within the trust may not actually be protected at all, even if you think that they are.

All of these mistakes can be avoided by working with an experienced attorney. Unsworth LaPlante, PLLC can guide you through the entire process of Medicaid planning and ensure you don’t make any errors that could cost you the money and property that you worked a lifetime to acquire.

If you do not already have a Medicaid plan in place, you should reach out to an attorney and start the Medicaid planning process today. When you apply to get Medicaid overage, Medicaid looks back at five years of financial transactions. If you transferred ownership money or property, including giving money or property as a gift, this could temporarily disqualify you from being able to get Medicaid coverage.

This review of five years of transactions is called the Medicaid five-year lookback rule, and it is a rule meant stop people from gaming the system by just giving away all of their money and property if they get sick and need nursing home care.  If you gave away money or property (or sold it to a family member for much less than it was worth), this could result in a period of temporarily disqualification from getting Medicaid to cover you.

The temporary disqualification period is determined by dividing the value of the transferred assets by average monthly nursing home costs in the location where you reside. A larger transfer, therefore, would result in a longer disqualification period. The calculation gives you the number of months of disqualification.

If you transferred $50,000 worth of assets and the average monthly cost of nursing home care where you live is $5,000, then the calculation would be $50,000/$5,000 = 10 months. During this disqualification period, you would not get coverage for nursing home care though Medicaid.