Having to place a loved one into a nursing home can be an emotional experience for the entire family. To make matters worse, there is often a great deal of confusion about the Medicaid application process. Many times, clients come to our office with the mistaken impression there is nothing that can be done to protect assets from nursing home costs.
The key is to start your Medicaid planning early. Our elder law attorneys can carefully design a thorough Medicaid plan so that assets can be safeguarded for the spouse and a legacy preserved for the children.
Even if you are coming to us at the time of admission to a facility, there are still planning avenues we can take to maximize the benefits available to the spouse and/or applicant.
Click the PDF to download a checklist of documentation our office will need to help you plan and apply for Medicaid.
It is best to start Medicaid planning early; however, assets can still be protected after a nursing home admission has occurred
What should I bring to an appointment? If you are applying for Medicaid, we will eventually need all of the following documentation (see the PDF above): IDs (driver's license, social security card, birth certificate, marriage license, etc), income and asset information (social security statement, pension statement, bank statements, brokerage statements, real estate Deeds, automobile titles, etc), Power of Attorney, and insurance (health insurance ID and Medicare card). If you are not yet ready to apply for Medicaid, please have in mind your assets and liabilities and bring any current estate planning documents with you.
What is Medicaid? Medicaid is a government program that pays necessary medical costs for needy persons, including the elderly, blind, and disabled. The provider sends the claim to Medicaid, and Medicaid pays directly to the provider, such as the doctor, hospital, nursing home, or pharmacist. The recipient may have to pay part or all of the bill: (1) if the service is not covered by Medicaid; and (2) if the provider does not participate in Medicaid.
What does Medicaid cover? In Indiana, Medicaid will usually pay for the following medical services and for some services not listed. Some items require prior approval by the Division of Family Resources. The provider will take care of asking for the prior approval. Medical services include: physician services; in-patient and outpatient hospital care; laboratory and x-ray services; nursing home services; assisted living facilities (with a waiver); home health services and other non-medical personal care; prescription drugs; medical supplies and equipment; dental services with a $600 limit per year on most services; optometric services, including eyeglasses; speech pathology, audiology, and related supplies; respirators, therapy, and related supplies; chiropractic services; podiatric services; transportation for Medicaid-covered services; and burial assistance.
How do I apply for Medicaid? All Medicaid applications and eligibility materials are processed by the Family and Social Services Administration (FSSA) Document Center in Marion, Indiana. An applicant can obtain an application form online, by telephoning the FSSA Document Center at 1-800-403-0864, or by going to a local Division of Family Resources (DFR) office and using the computer there. Once the application is completed, the applicant may receive a call or notice from the Document Center to schedule an interview. If an application is denied, Medicaid must state the reason. If the application is approved, a blue credit-card sized Medicaid (“Hoosier Health”) card will be mailed to the applicant within about two weeks of approval. This card should be given to all medical care providers, including doctors, hospitals, pharmacists, etc. every time the recipient needs services.
How do I qualify for Medicaid? To be eligible, you must be aged 65 or older, blind, or disabled. There are income qualifications which change each year. For a single person, you can have $2,000 in countable assets. For a married couple in nursing home care, you can have $3,000 in countable assets. You cannot have any more than the allowable amount by the first of each month in order to remain qualified for Medicaid. Countable resources include things like cash, bank accounts, stocks, bonds, mutual funds, CDs, cash surrender value of life insurance, retirement accounts, negotiable loans, and revocable trusts. There are some resources that are exempt from Medicaid eligibility. Exempt resources include things like your home (so long as you, your spouse, or dependent child lives there or you are reasonably expected to return home), household goods, personal possessions, one motor vehicle, prepaid funeral trust, burial plots, and income-producing real estate.
Can Medicaid penalize me? There can be penalties if you make a transfer within the five-year look back period (Medicaid will look back five years to determine if you have made any transfers). A transfer occurs when you give property for less than fair market value. For example, if you give away real estate or add a person’s name to the title, Medicaid will consider this a transfer penalty. Also, you cannot make gifts over a combined total of $1,200 each year without being penalized. The transfer penalty period means that Medicaid will not cover your nursing home expenses for that period of time.
What if my Medicaid application has been denied? If Medicaid denies your application, it must notify you in writing. If you disagree with a decision or action by Medicaid, you have the right to appeal. To appeal, you must notify the county or state office in writing within thirty three days of the effective date of the disputed action. If a timely appeal is filed, the law will give you the right to a fair hearing. The hearing will be like an informal trial. Medicaid must notify you in writing of its decision within ninety days of the day the hearing was requested. The notice should tell you how to appeal further if unsatisfied with the decision. You must appeal within ten days of receiving the decision from the hearing. If the decision is still negative at that level, you may seek judicial review in Circuit or Superior Court. At that stage, you will need a lawyer.
What is the difference between Medicaid and Medicare? Medicaid and Medicare both help pay for medical bills, but the two programs are very different. Your eligibility for Medicare does not depend on your financial status. Medicaid, however, has income and asset based requirements. You can participate in both programs if you are eligible. Medicare is basically the same throughout the United States where as Medicaid varies from state to state. Medicaid also pays for more services than Medicare. For example, Medicare Part A may cover up to 100 days in a nursing facility. However, it only fully covers 20 of those days and partially covers the rest. On the other hand, Medicaid pays for long-term care costs for the elderly, blind, and disabled in a Medicaid-approved facility. This coverage lasts as long as the individual remains eligible. Waiver services are also available for an individual to receive Medicaid benefits while residing in an assisted-living facility or an at-home care program.
What if I want to receive care at home? Medicaid will pay for care at home or in assisted living facilities if it costs less than a nursing home. It does this through “Medicaid waivers,” or Home and Community Based Services (HCBS) waivers. Medicaid waivers pays for services that are specifically aimed at helping the individual remain living outside a nursing home. Applicants who choose this option are able to select their own personal care providers, monitor them, and fire them. Family members and friends can be hired to provide these services.
What if I am not currently eligible for Medicaid? If you do not qualify for Medicaid due to your income or assets, please contact our office. We can help you arrange your financial situation so that you qualify for Medicaid services. Excess income can be allocated into a Trust and assets can be converted into non-countable assets.