Medicaid Planning and the Caregiver Crisis
Frequently, caregivers call us after being referred by a hospital or nursing home. They explain that their loved one has recently sustained an injury and/or suffers from a medical condition such as heart disease or dementia. Whether they are still living at home, in assisted living, or recovering in a skilled nursing and rehabilitation center, the concern is the same – they need a higher level of care and a way to pay for it. Compounding the caregiver’s crisis is the emotional and physical strain produced by family tension and a prolonged state of alert. There is a better way. (offer them the ability to take the Medicaid Planning tour on the home page.)
FAQs: Nursing Home Medicaid
What do Medicaid nursing home benefits cover?
There are approximately 42 Medicaid programs in Texas. It is important to understand that each program has its own eligibility criteria and benefits. If the Medicaid applicant in a Medicaid certified nursing home meets the functional and financial eligibility criteria, Medicaid will cover most of the medical and support needs of the person. As the payer of last resort, Medicaid only begins to pay once other healthcare coverage, long-term care coverage, or other coverage is exhausted.
Nursing home Medicaid does not pay for dental care. If a Medicaid nursing home recipient needs a noncovered medical service such as dental care, and the medical service is not paid for through Medicare or private health insurance, the Medicaid recipient can pay for the care and submit a copy of the paid invoice to HHSC. Provided the medical service is medically necessary, HHSC will reduce the Medicaid recipient’s copayment and pay the nursing home the difference. It is a good idea to check with the HHSC caseworker and billing office prior to paying out of pocket for a noncovered medical service.
What is a Medicaid transfer penalty and how is the penalty calculated?
HHSC imposes a transfer penalty for assets gifted or sold for less than fair market value within five years of applying for Medicaid nursing home services. When an exception to the transfer penalty does not apply, HHSC determines the fair market value of the transferred resource and imposes a penalty on the difference between the amount received for the asset and its equity value. This number is divided by the transfer penalty divisor in effect in the month in which application for Medicaid assistance for long-term care is made. For Medicaid applications filed on or after September 1, 2013, HHSC uses a transfer penalty daily divisor of $156.34. (Note: HHSC periodically changes the transfer penalty divisor to correspond with the average daily rate of nursing home care in Texas.) The resulting figure equals the number of days the Medicaid applicant will be penalized from receiving Medicaid nursing home services. This penalty period does not begin until the Medicaid applicant is otherwise eligible to receive Medicaid nursing home assistance.
What resources are excluded for purposes of determining Medicaid eligibility?
The following is a cursory list of excluded resources in assessing a Medicaid applicant’s eligibility for Medicaid nursing home services:
1. Homestead residence – principal residence.
2. Real estate for sale.
4. Household goods and personal effects.
5. Burial spaces.
6. Irrevocable prepaid funeral plan.
7. Burial funds.
8. Term life insurance.
9. Other life insurance in certain situations.
10. Business property essential to self-support.
12. Retirement benefits.
For a more thorough discussion of each of these items, see our relevant frequently asked questions page here.
Contact Our Elder Care Attorneys
Our elder law attorneys and licensed social workers offer peace-of-mind throughout the Medicaid eligibility process. With The Hale Law Firm you know that knowledgeable experts are providing the assistance your family needs, including:
- Creating a Medicaid Eligibility Plan
- Preparing a Qualified Income Trusts (“QIT” or “Miller Trust”);
- Choosing a nursing home;
- Coordinating Medicare and Medicare Supplement benefits;
- Filing a Medicaid application for assistance;
- Representing your loved one before the Texas Health and Human Services Commission (“HHSC”);
- Preparing a Medicaid Contingency Plan to insure continued Medicaid eligibility;
- Creating a Medicaid Asset Protection Plan to protect the home and other assets against the Texas Medicaid Estate Recovery Program (“MERP”).
This segment of our firm’s practice has enormous personal significance to us. For this reason, we have consciously priced our Medicaid Planning services at a flat fee rate that is significantly less than locally prevailing rates. Please take a moment to watch Our Story and call us today for a free initial consultation.