| Read Time: 4 minutes | Medicaid

Big changes to Medicaid could impact who qualifies for this form of government insurance, especially for those seeking community-based care. Last month we discussed the critical changes, and now this month, we focus on what you can do to qualify for Medicaid in 2020 and beyond. The biggest changes affect those seeking long-term care in the community.

While you may not need Medicaid or even long-term care right now, there is a chance you could in the future. According to one article, 87.9 million Americans who will be over the age of 65 by 2050 will need long-term care – almost double the 47.8 million Americans in 2015. It is estimated that 52 percent of those turning 65 will need long-term care services at least at some point. Not all individuals over the age of 65 need long-term care permanently. Some may need it as they recover from surgery, an illness, or another ailment. Others may need long-term care permanently.

Note: Medicaid Law Update – October 2021

New York finally adopted several regulations that imposed a major change in Medicaid eligibility. These regulations also introduced a “look-back” period into New York’s state’s Medicaid program.

A 30-month look-back provision gives the state the power to review the financial statements of anyone who is applying for home health care, private nurses, and other kinds of assisted living.  By “looking back” at these records during the time period prior to their Medicaid application, the state can limit applicants’ eligibility.

Learn more about these changes if you’re planning to apply for Medicaid. Let our trusted attorney assist you with your Medicaid application.

What Is Community-Based Long-Term Care

One term you hear along with the new Medicaid changes is “community” long-term care. Community care refers to in-home and out-of-home long-term care services and is a broad term that encompasses both supportive care, assisted living, and full-time care. These services are home-based, allowing a person to live at home, maintain independence, and not forgo the care they need.

Those staying at home will require assistance from paid care providers along with family members to help with things like cleaning, meal preparation, medication management, and hygiene. Some individuals will need more hands-on care than others, and sometimes family cannot do it without professional assistance.

Community care can also refer to services like assisted living facilities and long-term skilled care.

These services are not cheap. They cost hundreds (if not thousands) per month for full-time care. Medicare does not cover these services unless they meet a specific criterion, and even then, it is not a long-term solution. Therefore, most individuals will turn to Medicaid as a supplement to cover these in-home and community-based care services.

Medicaid services may cover programs like:

  • Personal and hygiene care providers
  • House cleaning services
  • Adult daycare facilities
  • Skilled nursing home care facilities
  • Physical therapy in-home or out-of-the-home
  • Respite care

How the New Medicaid Changes Impact Your ability to Unlock Medicaid Coverage

While Medicaid is a go-to for helping pay for these services, the new changes taking effect October 1, 2020 will affect how and when you can apply for Medicaid when you are seeking out community care.

As we discussed last month, the new changes allow a full review of your finances, including assets, for 2.5 years if you are seeking Medicaid to cover community-based care services. If you are looking to enroll in a long-term care services program like the Consumer Directed Personal Assistance Program, you must provide 2.5 years of financial records.

How to Qualify for Medicaid for Care in the Community after October 2020

Even with the new 2.5-year lookback period, there are ways to qualify for Medicaid. Furthermore, if you are starting the process now – before you require community care – you put yourself in a prime position to qualify for Medicaid when the time comes around.

Medicaid planning, ideally, should start years before you need it. After all, by the time you need Medicaid coverage, you are subject to a 2.5-year lookback, which means you cannot go back and adjust your assets and you must endure the penalty period if those financial records show you do not qualify for Medicaid yet.

Planning ahead of time means that you are prepared and ready, and you will qualify for Medicaid at the time you need it – saving yourself and loved ones thousands in community-based care costs.

Exploring the Financial Limits under the Medicaid Eligibility Test

For Medicaid waivers, which are for home and community-based services, you must meet the financial limits, which are:

  • $875/month income, $15,750 maximum assets for a single individual;
  • $1,284/month income, $23,1000 maximum assets for a married couple both applying for coverage;
  • And $875/month income, $15,750 maximum assets for an applicant, and $128,640 maximum assets for non-applicant, when one spouse is applying for Medicaid and the other is not.

Income, under Medicaid eligibility, is any source of funds you generate monthly. That can include pension payouts, retirement plans, Social Security Disability, gifts, annuities, and more.

Spend Down Assets

You want to start the spend-down process early, which means gifting away your assets to children or those you can trust.

You may be able to set your assets aside in a trust, which removes them from your name and places them into a family trust as part of your estate plan. Not only will this assist with your Medicaid qualification, but it ensures that loved ones will not endure the hassles of probate court if you were to pass away. Instead, the trust would automatically pass assets to named beneficiaries.

Enlist the Help of an Estate Planning Attorney Early

You need an estate planning attorney to help you not only plan for the future but the potential need for Medicaid coverage in the future. An attorney can help establish a trust, remove assets from your name, and discuss your options if you are over the income limits to qualify for Medicaid and even Medicare.

Remember, 2.5 years is a long lookback period. And if you are transferring assets within that lookback period, it will affect your eligibility. Therefore, you should start the planning process now before it is too late. Waiting until you need care in the community will only increase your costs and lengthen the time you wait for coverage. Starting the process now could save you, and your loved ones, thousands and give you peace of mind knowing that you are prepared.

To get started, schedule a free case evaluation with the Law Office of Andrew M. Lamkin P.C. We can meet using a video teleconference so that you do not have to leave the comfort of your own home. Call us to schedule an appointment or request more information online about our estate planning services.

Author Photo

Andrew Lamkin is principal in the law firm of Andrew M. Lamkin, P.C., where he focuses his practice in the areas of elder law, estate planning and special needs planning, including Wills and Trusts, Medicaid planning, estate administration and residential real estate transactions. He is admitted to practice law in New York and New Jersey.

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