Medicaid can help cover the cost of services for nursing home care, assisted living or in-home care. Many who need help paying for long term care believe that they are not eligible for Medicaid. However, despite this belief, there are many families who actually are eligible for Medicaid.
Generally speaking, a person’s eligibility for Medicaid is based on four tests: (1) medical eligibility (2) income eligibility, (3) resource eligibility and (4) transfer eligibility. Because each state can establish its own criteria for Medicaid eligibility, eligibility requirements vary state by state. The following information focuses on eligibility requirements in Idaho.
- Medical Eligibility
To be eligible for Medicaid, a person age 65 or older must have a medical need. This is determined by analyzing certain activities of daily living, which include the following:
- Bathing
- Dressing
- Eating Meals
- Emergency Response
- Medication
- Mobility
- Night Needs
- Personal Hygiene
- Supervisions
- Toileting
- Transferring
- Income Eligibility
A Medicaid applicant cannot have more the $2,333.00 per month of gross income. However, a person who has too much income may still be eligible if they first establish a Miller Trust. A Miller Trust allows you to divert any excess money into a special trust account. The money can then be used for the Medicaid applicant’s care costs. An experienced elder law attorney can assist you with setting up a Miller Trust.
- Resource Eligibility
A Medicaid applicant must also meet the resource eligibility test. Certain assets, such as a house and two cars, are typically not considered part of the “countable” resources. A single Medicaid applicant must have two thousand dollars ($2,000) or less in countable resources. However, different rules apply to married couples. For example, if only one member of a married couple is applying for Medicaid, the healthy spouse may keep a range of countable resources, typically between $25,284.00 – $126,420.00, based on the couple’s unique situation. While not always the case, a couple may be allowed to keep more than the $126,420.00 if they meet certain income requirements. If both members of a married couple are applying for Medicaid and reside in a skilled nursing facility, they may only keep three thousand dollars ($3,000) in countable resources.
It is important to work with an experienced elder law attorney who can direct you on which assets will be countable and how much exactly you can keep.
- Transfer Eligibility
If a Medicaid applicant transfers assets for less than fair market value during the sixty (60) month period prior to the Medicaid application, the Medicaid regulations impose a penalty period of ineligibility. For example, if Mom transfers $10,000 to her three children as an early inheritance or transfers the family RV to a child during the five year period prior to a Medicaid application, this most likely will cause a penalty for Medicaid purposes.
If such gifting has occurred, that person usually must either wait until five (5) years has passed before applying or he or she will be subject to a penalty period. It is important to discuss any transfers with an elder law attorney in order to determine what options may be available.
It is important to understand how each eligibility test applies to your situation. The Medicaid application process can be very complex and should not be completed without the advice of an elder law attorney familiar with your state’s Medicaid rules. If you wish to discuss Medicaid eligibility for yourself or a loved one, please contact our office at (208) 387-0729.
