Medicaid

Why plan for Medicaid?
One of the greatest fears of older individuals is that they may need nursing home care at some point in their life. This not only means a loss of personal freedom, but also carries the potential for great financial expense. Many people will unnecessarily privately pay for nursing home care for themselves or their spouse until their life savings is totally depleted. With careful and individualized planning, whether in advance or as the result of an unanticipated need, it may be possible to protect significant assets. After seeking qualified legal advice, many couples discover that they may preserve significant assets and still qualify one of the spouses for Medicaid coverage of nursing home care.


What is the difference between Medicare and Medicaid?
Medicare is a program that serves as an insurance plan for people with disabilities or who are age 65 or older who have worked and earned qualifying quarters to make them eligible for medical coverage without regard to income. Medicare is funded by the federal government and is governed by the Social Security Administration.

Medicaid is a program that provides health coverage to eligible people who lack the money or sufficient health insurance coverage to provide for their medical care. Both the federal government and the State of Ohio fund this program which is administered by the Ohio Department of Jobs and Family Service of each county.


If I have Medicare medical coverage, can I be covered by Medicaid also?
You may be eligible to receive coverage through both Medicare and Medicaid. Medicaid may cover expenses not normally paid by Medicare. Individuals who qualify for both Medicaid and Medicare can receive assistance with all or part of their Medicare Part B premiums, deductibles and co-payments.


Who can qualify for Medicaid?
Medicaid supplies health care coverage for different groups of people who are able to meet certain requirements. Several of these groups include persons needing nursing facility care who are age 65 or older, blind or disabled. Individuals applying for Medicaid are required to meet tests for state residency, income limits, and asset limits.


What benefits are provided by Medicaid?
Generally, coverage for medically needed health services is provided through means of the two benefit packages known as the Basic Health Package and the Long-Term Care Health Package.

Services covered by the Basic Health Package include things such as hospital care, doctors visits, preventative health care, prescription drugs, dental and vision care, mental health and substance abuse treatment services and assistance with transportation for Medicaid approved medical appointments.

The Long-Term Health Package can provide additional services to Medicaid-covered persons who are aged, blind or have disabilities and who can satisfy added Medicaid criteria requirements. This program is most frequently used by individuals who reside in a nursing home or an Intermediate Care Facility for Mental Retardation, but does also provide a home health care option that permits eligible persons to receive care in their homes. People utilizing the Long-Term Health Package also receive coverage offered by the Basic Health Package, regardless of whether they are institutionalized or are at home.


If I own my home, do I have to sell it before my spouse or I can get Medicaid?
No. You do not have to sell your home as long as you, your spouse, or dependent children reside in the home.


If I have to go into a nursing home, but have no spouse or dependent children living with me, will I have to sell my house before Medicaid will pay for my care?
No. Medicaid rules provide for a home exemption period of 13 months in which an individual’s health is given the opportunity to improve, thus allowing the person to return home to live. Once you are eligible for Medicaid and your nursing facility stay exceeds 13 continuous months, the home may then need to be put up for sale.


If I need to go into a nursing home, but know that I have too much money to financially qualify for Medicaid, can I give my money to a child or grandchild and then qualify for Medicaid?
If you give assets away, you may be ineligible for a period of time in which Medicaid will not cover your nursing home payments. The period of ineligibility depends on the value of the property gifted, and in some cases is for 5 years or more. It is best to consult a qualified attorney before transferring or giving away your property or money.


My parent is currently in the hospital and will be moved to a Medicare-certified skilled facility when released. I know that Medicare will pay for the nursing care for a short time, but it is expected that the stay in the nursing home will be quite a long time. We do not know how my parent will be able to pay for this care… is there something we should do?
If your parent requires a skilled level of care upon release from the hospital, Medicare will only pay for a certain number of days. Your parent should consider Medicaid planning right away and should not wait until Medicare coverage runs out.


Medicaid Planning can be very unique to each individual or family situation and therefore, you may have many additional questions to those answered above. If so, please feel free to contact our office to discuss your Medicaid Planning options in greater detail.