Questions & Answers
Qualifying for Medicaid
How Does Medicaid Qualification Work
for the Single (Unmarried) Patient?
Q1: What is the difference between MediCARE and MediCAID, and doesn't MediCARE cover a nursing home stay?
A1: MEDICARE is your government health insurance. It covers medical expenses such as hospital and doctor charges. It has a limited benefit for a nursing home stay, but only if you were hospitalized for at least three days prior, require skilled nursing care, and are continuing to benefit medically (usually undergoing rehab of some type). Under those circumstances, you may be entitled to benefits (100 days, at the most, but usually much shorter).
Under any other circumstances, you're on your own. MEDICARE does not pay for long-term care. MEDICAID, on the other hand, is the Federally funded, state-administered program designed to provide long-term care (nursing home and, depending on the particular state, other types of facilities or care), but only after the patient meets certain financial conditions.
Q2: What types of long-term care does Medicaid cover?
A2: Medicaid, depending on the particular state, covers the full range of long-term care, including nursing home, adult foster care, assisted living, as well as at-home care. Remember, Medicare is your Government health insurance, and, except for a limited benefit for skilled nursing care, does not cover long-term care. Medicaid, on the other hand, is the program that can provide benefits for long-term care.
Q3: Do I have to be broke to get Medicaid?
A3: Technically, yes! As a single person, you can only qualify for Medicaid benefits once your countable assets are below your state's maximum resource limit (in most states $2,000). But as long as you are receiving in-home care, or you are in a care facility but are expected to return home, or indicate an intent to return home, you would not be forced (in most states) to put your home up for sale. However, in most states there is a $500,000 limit on the equity value of your home, although some states have raised the limit to $750,000. But all these requirements are waived if your home is occupied by your minor son or daughter, or your adult blind or disabled child.
Q4: Will I have to sign over my home to Medicaid in order to get help?
A4: No, you will not be required to sign over your home (or any other asset) to Medicaid in order to qualify. Depending on your state, there may be circumstances under which you would be required to put your home up for sale in order to maintain Medicaid eligibility. In addition, after you pass away, your state Medicaid agency may have an estate recovery claim against the home, but that depends on a number of factors.
Q5: What is the Medicaid income limit?
A5: About half the states observe the Federal cap of $2,022 per month. But even if the your income exceeds the cap, an "Income Cap" or "Miller" Trust can be established to bring the income (for Medicaid eligibility purposes) to within the Medicaid income standard. The remaining states have no cap, as long as your income is less than the cost of care.
Q6: How is Medicaid eligibility determined for a single person?
A6: Medicaid eligibility is based primarily on three criteria: 1) the need for care (specific state standards), 2) income and 3) countable assets/resources. Assuming a sufficient level of care is required and your income is less than the cost of care, your countable assets would then be examined. To qualify for Medicaid benefits, you would have to have no more than your state’s Medicaid resource limit ($2,000 in most states) in countable (or non-exempt) assets.
Q7: Will transfer (or gifting) of assets result in denial of Medicaid benefits?
A7: The transfer of assets between spouses is not a problem. However, if you transfer or sell an asset to someone other than your spouse, you must get fair market value in return for it, or you risk Medicaid disqualification. Medicaid has a five-year "look-back" provision. (In many cases there are special exemptions for a blind or disabled son or daughter, as well as a caretaker son or daughter who lived with the parent. And if you know how to take advantage of these exceptions, you may be able to protect up to 100 percent of the assets.) If you sell or transfer an asset for less than fair market value, the difference between the price you received and the actual value would likely be considered an "uncompensated transfer of assets," resulting in a period of disqualification from Medicaid benefits.
Contrary to what most people think, that disqualification period is not five years. It can actually range from a few days to decades, depending on the value and timing of the transfer and the state in which you are applying for Medicaid. In addition, there are exceptions, which may reduce or eliminate the Medicaid penalty period.
Q8: Will putting an offspring's name on my account (for example, joint savings account) protect it from Medicaid? What about a revocable "Living Trust?"
A8: No! The account will still be counted by Medicaid, no matter how long ago it was done. And since the trust is revocable, it provides no protection from Medicaid either.
Q9: As a single person, are there any steps I can take to conserve my assets while still qualifying for Medicaid?
A9: Absolutely! Although the rules for a single person are particularly rigid, and with no spouse to shift assets to, for most people there really is no effective way to protect 100 percent of your assets from Medicaid. However, there are specific strategies that you (or your representative) might be able to employ to ultimately protect a significant portion of those assets from Medicaid. And that is exactly what the MEDICAID ASSET PROTECTION PLAN (MAPP) Video Package was designed to do – teach you how to effectively protect assets from Medicaid.
Q10: Won't the Medicaid caseworkers tell me how I can save my assets?
A10: No! The Medicaid caseworker’s primary responsibility is to perform assessments and determine eligibility for the various Medicaid programs. It is not their responsibility to help you save your assets. In addition, they would not normally have the intimate knowledge of the various strategies and financial tools required to save assets. Besides, as government employees they are not allowed to give specific financial or legal advice, nor are they licensed or trained to do so.
The MEDICAID ASSET PROTECTION PLAN (MAPP) was designed specifically to empower individual families to take action to protect the assets of an unmarried long-term care patient from Medicaid. Click Here to learn how to protect assets from Medicaid while qualifying a single patient for nursing home or other long-term care Medicaid.