Medicaid and Long-Term Care Planning

A WORD OF CAUTION – Long-term care planning requires a detailed knowledge of tax law, expertise in estate planning, and a thorough understainding of the Medicaid laws and regulations, which are constantly updated and changing. Long-term care estate planning and Medicaid planning should only be done under the supervision of an attorney with expertise in the areas of Elder Law and Medicaid rules and regulations. Certain transfers of property can have significant tax ramifications that should be discussed with your attorney. Furthermore, improper transfers or gifts can disqualify a Medicaid beneficiary and result in a significant period of ineligibility for Medicaid benefits.

Please review the information below and contact our office today to schedule a consultation.

Click on the links below to read the answers to your commonly asked questions.

  1. What is the likelihood that someone will need some form of long term care?
  2. Will Medicare pay for the cost of care at home, in an assisted living facility or in a nursing home?
  3. What type of care does Medicare pay for?
  4. What is long term care Medicaid and what type of care does it pay for?
  5. Does a person have to spend-down their assets to qualify for Medicaid?
  6. Do I need an attorney to help me qualify for Medicaid benefits?
  7. How can an attorney help me or my loved one qualify for Medicaid long term care benefits?

Planning for Long Term Care

Good news – Americans are living longer lives than ever before! As the senior population grows rapidly, so does the need for legal services for this age group. This area of law is called “Elder Law”. Attorneys who practice elder law deal with the emotional, logistical and financial needs of the elderly. One major problem that many seniors face is the real possibility of needing long term nursing home care. Here are some sobering statistics about long term care:

  • After age 65, there is a 48 percent chance that you will need care at a skilled nursing facility.
  • After age 80, there is a 90 percent chance
  • If you are married and over 65, there is a 70 percent chance that you or your spouse will need skilled nursing care.
  • The average nursing home stay is 2.5 years. At a cost of at least $6,500 per month in the Tampa area, that’s $195,000!

As a person gets older, there is an increased chance of developing an injury or illness.
This can occur slowly or gradually (as with degenerative diseases such as Alzheimer’s), however sometimes it strikes suddenly (such as with a fall or acute illness). Whether slow or sudden, the result is the same – you may need to be cared for in your home, in an assisted living facility, or in a skilled nursing home facility.

Medicare will not pay for long term nursing care or for non-rehabilitative care received at home or in an Assisted Living Facility.

Often times, people will assume Medicare will take care of them when they’re older. Unfortunately, for many people, Medicare does not provide the assistance they need. Those with an illness like Alzheimer’s disease need care to assist them with their activities of daily living. Medicare DOES NOT cover care for the basic activities of daily living. These basic activities, however, are some of the primary functions of nursing home and assisted living facilities, and can include basic and necessary assistance with:

  • Bathing
  • Dressing and undressing
  • Eating
  • Transferring from bed to chair, and back
  • Using the toilet
  • Walking (not bedridden)
  • Assistance with bodily functions for bedridden individuals

What DOES Medicare pay for?

Medicare covers what is considered to be “skilled or rehabilitative care,” and may pay for up to 100 days in a nursing home for rehabilitation purposes, but only if the patient had a prior 3 day stay in a hospital before entering the nursing home. While Medicare may cover the first 20 days of skilled nursing home expenses, coverage for days 21 through 100 requires a co-payment of around $119.00 per day and is only available if the patient continues to show improvement in his or her condition. Additionally, the 100 days is not guaranteed, and Medicare will only keep paying if the patient is improving with therapy. Once the patient plateaus, Medicare stops payment. That is when the patient is required to pay the nursing home bill.

If eligible, Medicaid can pay for the costs of long term care

Unlike Medicare, Medicaid, could provide benefits to help a person pay for the costs of long term care at home, in an Assisted Living Facility or in a Nursing Home if the patient is eligible for the program. Medicaid will continue to pay for skilled nursing home expenses indefinitely, regardless of whether or not the patient continues to show improvement.

Important Facts About Medicaid:

  • Medicaid is a federal and state program that pays for long term care for those who qualify.
  • Qualifying for Medicaid is based on certain financial criteria and physical criteria that varies from state to state.
  • In Florida, a patient must physically qualify for the program and also be below certain income and asset levels.
  • • Patients do not need to be “poor” to qualify for Medicaid and do not need to “spend down” all of their assets in order to qualify.
  • • A skilled Elder Law Attorney can help patients legally manage their assets to qualify for Medicaid while protecting their assets.

Medicaid Planning and the Important Role of an Elder Law Attorney

“Medicaid Planning” is a form of estate planning where an attorney examines your assets and then assists you in managing your estate to help you qualify for Medicaid without eliminating the assets. It is very important that a skilled attorney assist with this process. Your attorney should be very familiar with both the ever-changing Medicaid regulations and process as well as in-depth legal knowledge of estate planning and asset-management. Without relying on the advice of an attorney with a comprehensive understanding of the law in both areas, individuals risk not qualifying for Medicaid and/or having their assets mis-managed or unnecessarily relinquished. With the guidance of a knowledgeable elder law attorney, it is legal to implement various estate-planning techniques in order to qualify for Medicaid benefits while preserving and protecting your assets.

Potential for Error in Medicaid Planning

Medicaid rules and regulations disallow the gifting of assets to qualify for the program. Without proper counsel, an applicant could do something to disqualify themselves from the program without even knowing it. Unfortunately, many people are misinformed about the criteria Medicaid uses to determine eligibility. Such misinformation is likely due to the ever changing and complicated Medicaid regulations. Despite what you might have heard, you do not have to be destitute in order to qualify for Medicaid benefits. It is very important, however, that you have an attorney examine your assets and assist you in planning your estate for Medicaid qualification.

How can we help?

Our law firm is experienced in developing and implementing various Medicaid planning techniques to quickly qualify an individual for Medicaid benefits and to minimize or completely eliminate any state recovery for benefits received. Medicaid planning is our passion and we take great pride in developing sound planning options for our clients tailored to their unique circumstances. If you or someone you love may need care at home, in an assisted living facility or in a nursing home, we may be able to help. If someone you know is already receiving care in a nursing home, there are still some planning options that can be used to protect assets. In most cases, it is not too late to qualify for Medicaid benefits.

What We Do:

We understand that Medicaid planning can be an emotional undertaking for you and your family and that expert advice and prompt attention and Medicaid qualification are of primary importance to families facing these issues. To that end, our office provides the following services:

  • Asset Review – Thorough examination of assets for Medicaid qualification and estate planning purposes:
  • Detailed Explanation of Options for Medicaid Qualification Estate Planning – Preparation and explanation of Medicaid planning strategies and estate-plan options available for your specific situation;
  • Full-Service Estate Planning – Implementation of the selected Medicaid-Qualification Estate Plan as well as the preparation of necessary estate planning documents;
  • Completion of the Medicaid Application Process – including preparation of forms and follow-through – Our office will deal directly with Medicaid on your behalf throughout the completion of the application process;
  • Preparation of all documents necessary to reduce or eliminate Medicaid recovery (if applicable);


Download our medicaid brochure

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