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What is Medicare?
Medicare is a government sponsored insurance program for the elderly and disabled. To qualify for Medicare you must:
- Be over 65 and eligible for social security or railroad retirement, or
- Be disabled and have received social security or railroad retirement for at least two years, or
- Be over 65 and pay for Medicare coverage.
Medicare covers certain basic services, including:
- Inpatient hospital services;
- Doctor visits
- Surgery;
- Medical and surgical dental services;
- Laboratory and x-ray services
What is Medicaid?
Medicaid is a health care program financed by both the state and federal governments. Unlike Medicare, which is an entitlement, Medicaid is a form of
welfare available only to impoverished persons.
How can I become eligible for Medicaid nursing home assistance?
To be eligible for Medicaid nursing home assistance in Missouri, the applicant must be a U S citizen or resident alien, age 65 or older, or disabled or blind,
a resident of the state for at least 30 days, have less than $5,000 in non-exempt assets, and require full time skilled nursing home care.
Can I give away my assets to receive Medicaid benefits?
When applying for Medicaid nursing home assistance, you must
disclose all transfers of your assets for the five year period
preceding the application. A transfer penalty will be imposed on all
transfers made within five years before applying for benefits
(termed the “look-back period”). For each $6,894 you have given away in the applicable look-back period, you will be ineligible for nursing home assistance for one month. Without proper planning and legal advice, you should never give away your assets in anticipation of applying for Medicaid.
If I receive Medicaid, can the state take away my home when I die?
Your home is considered an exempt asset when you apply for Medicaid nursing home assistance, meaning it will not prevent you from being approved for Medicaid. However, when you die the state of Missouri has a lien against your property for up to the full amount of Medicaid assistance paid on your behalf.
Are there any exceptions to the Medicaid transfer penalties?
With regards to the home, the Medicaid recipient may transfer the home, with approval of the state, to a child who is disabled or under age 21, to a sibling who has lived in the home at least one year prior to the recipient's institutionalization who already has an equity interest in the home, or to the recipient's caretaker child (adult child of the applicant who has lived in the applicant’s home at least two years prior to institutionalization and who, during that time period, provided a level of care that, but for the adult caretaker child, the applicant would have been institutionalized).
If my spouse enters a nursing home, will all our assets be depleted on his or her care?
Under the Medicaid “spousal impoverishment” rules, when one spouse enters a nursing home, the at home or “community” spouse is entitled to one-half of the couple’s assets, up to a maximum of $148,620 in Missouri.
Without proper planning and legal advice, the couple will be
required to spend down all of their assets in excess of $148,620 before the institutionalized spouse can be eligible for nursing home assistance.
Will Medicaid take all of my institutionalized spouse’s income?
When one spouse is eligible for Medicaid nursing home
assistance, the at home or community spouse is guaranteed under the
Medicaid rules a minimum monthly income of $2,289 in Missouri. If the community
spouse’s income is below $2,289 per month, part of the income of the institutionalized spouse will be allocated to the community spouse to insure a monthly income of $2,289. To the extent that the income of the community spouse is still below the minimum after transferring the income of the institutionalized spouse, additional assets may be transferred to the community spouse to make up the shortfall.
Do I need an attorney to apply for Medicaid?
Applying for Medicaid is cumbersome and tedious. Every fact asserted in the application must be verified by documentation. The process can drag on for several months. If you have made any transfers of assets, you must take great care in timing the application for Medicaid benefits or be faced with a transfer penalty far in excess of the five year look-back period. Legal assistance in this process is not mandatory, but highly recommended.
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