We got a call yesterday that my mother-in-law was back in the hospital. At 91, both she and my father-in-law struggle with complicated health issues. Her goal is to return to their apartment, but she’ll likely need additional care. She’s not sick enough for an extended hospital stay, but not healthy enough to manage on her own.
It’s a familiar scenario for many of us with aging loved ones. Even with the benefit of financial stability, finding care can be complicated. If money is tight, it can seem impossible. The following story, provided by Solomon, Steiner & Peck, has good information for finding help if your loved one needs help but doesn’t have enough money to pay for it.
-Marie Elium
Takeaways
- Many older adults prefer to age in place with home care assistance.
- Medicaid can provide financial assistance for home care, but eligibility requirements vary by state and can be complex.
- Elder care lawyers can help older adults navigate Medicaid planning, the application process, and spousal impoverishment protections.
The option to receive health care at home is a growing need. Home health care is not without its costs, though.
Medicaid can provide financial assistance for home care services for older adults who are struggling financially. However, since the federal government and the individual states run Medicaid jointly, benefits coverage is different in each state.
Qualifying for Medicaid is not only state-specific but also can be a complicated process. With the help of an elder care lawyer, older adults can navigate the Medicaid application process and more easily realize the benefits that will help them live more comfortable, independent lives.
Medicaid Eligibility Requirements for Home Care
Medicaid covers various long-term care services, including home health care, caregiver support, and personal care services for such activities as dressing, bathing, and meal preparation. However, qualifying for Medicaid home care involves meeting stringent financial and functional eligibility criteria, which vary by state.
Income and Asset Limits
Medicaid has strict income and asset thresholds that determine whether an applicant qualifies for assistance. The limits depend on the state in which the applicant lives, but they generally require individuals to have limited income and assets. Individuals with too much in savings, investments, or other assets might be denied Medicaid coverage.
Functional Needs Assessment
Besides financial eligibility, Medicaid requires applicants to demonstrate a functional need for home care services. A comprehensive assessment is often conducted to evaluate the applicant’s ability to perform daily activities.
How Elder Care Lawyers Help Older Adults
Navigating Medicaid’s complex requirements can be overwhelming for families. Elder care lawyers specialize in helping older adults manage legal, financial, and health care issues, including qualifying for Medicaid. Here’s how they can help:
Medicaid Planning and Asset Protection
Elder care lawyers can play a crucial role in Medicaid planning. This may involve legally structuring an elder’s finances to ensure they meet Medicaid’s strict asset limits using strategies such as:
- Spending down: This refers to using excess assets to pay for medical care, home improvements, or other approved expenses, reducing the senior’s assets to Medicaid-qualifying levels.
- Creating a trust: An elder care lawyer can help a senior transfer assets into certain types of trusts. For example, a Medicaid Asset Protection Trust (MAPT) or a Miller Trust can remove those assets from one’s personal estate so that they don’t count toward Medicaid’s asset limits.
- Gifting strategies: Medicaid has a lookback period (usually five years) that penalizes asset transfers or gifts made below fair market value. An elder care lawyer can help structure gifts and transfers in a way that minimizes penalties.
To make the most of Medicaid planning, be sure to work with your elder care attorney before you need long-term care.
Navigating the Medicaid Application Process
The Medicaid application process is complicated and often requires submitting extensive documentation, including proof of income, assets, and medical needs. Elder care lawyers help:
- Collect and organize necessary documentation: They can help ensure that all paperwork is in order before submission, reducing the risk of delays or denials.
- Avoid mistakes: Errors in the application process, such as misreporting assets or failing to disclose relevant financial information, can lead to delays or even disqualification. Attorneys specializing in elder law can help clients avoid these pitfalls.
- Appeal denials: If a Medicaid application is denied, elder care lawyers can represent older adults in the appeals process, helping them address any issues raised by Medicaid.
Protecting Spouses Through Medicaid’s Spousal Impoverishment Protections
For married older adults, qualifying for Medicaid can be especially challenging since one spouse may need Medicaid while the other does not. Elder care lawyers can assist in navigating spousal impoverishment protections. These standards, which vary by state, allow the healthy spouse to retain a certain amount of assets and income while the other spouse qualifies for Medicaid. With the help of your elder care lawyer, the healthy spouse can therefore remain financially secure.
Originally, spousal impoverishment rules applied only to married couples where the Medicaid spouse received care in a nursing home. Lawmakers have temporarily extended these protections to the spouses of patients receiving home health care through Medicaid waivers. Under current law, spouses of Medicaid patients receiving home health care will have these protections only through September 2027. Unless lawmakers extend this deadline, some states may no longer offer the same impoverishment protection for these spouses.
Paying a Family Caregiver
The majority of older adults who receive care in their homes rely at least partly on family members or friends for their care. Often the family members and friends provide this care for free. This can strain the finances of some caregivers if they have to take time off from work or leave the workforce entirely.
The good news is that Medicaid in most states will pay a family member to provide home care to an aging relative. The requirements to qualify for this Medicaid benefit vary by state. An elder care lawyer can help you navigate the process of getting compensation for a caregiver.
Long-Term Care Planning
Medicaid home care can be a solution for immediate needs, but elder care lawyers also help older adults plan for future long-term care needs. This may include:
- Developing a comprehensive estate plan that aligns with Medicaid eligibility while ensuring that the senior’s assets are distributed according to their wishes.
- Establishing a guardianship or conservatorship if a senior is no longer able to make decisions for themselves. This ensures that a trusted individual manages their financial and medical affairs.
Veterans’ Benefits and Medicaid
Older adults who are veterans may be eligible for additional benefits. For instance, Aid and Attendance through the Department of Veterans Affairs can supplement Medicaid home care services. Elder care lawyers with experience in both veterans’ benefits and Medicaid can help coordinate these programs to maximize care.
Learn More About Medicaid
Qualifying for Medicaid home care is essential for low-income older adults who wish to receive care at home rather than in a nursing home. Elder care attorneys can provide critical support by helping older adults navigate Medicaid’s often complex financial and functional requirements. They can help older adults protect their assets and ensure that they receive the care they need while maintaining their financial well-being.
For families facing the challenge of securing care for aging loved ones, the guidance of an elder care lawyer can be invaluable, providing peace of mind and a clearer path forward. Speak with your elder care lawyer. They can discuss your specific situation and potential options with you.
