Medicaid benefits for long-term care are difficult to obtain. Each case is different, and it’s hard to know how the rules and regulations apply in your particular circumstances.
These cases studies are intended to help you understand how Medicaid eligibility works, and how Certified Medicaid Planners can help in your case.
Meet Helen, who’s 88-years-old, widowed and lives with her daughter Amy. Amy and her husband both have full-time jobs, and they don’t feel like they’re giving Helen the level of care she needs and deserves. They think she needs nursing home care, but they’re not sure how any of them can afford it.
Helen has early symptoms of Alzheimer’s disease, and a recent stroke has left much of her right side paralyzed. She needs assistance with all five of the Activities of Daily Living as defined by Medicaid: mobility, bathing, dressing, eating and, occasionally, toileting. Requiring help with just three of the five Activities of Daily Living constitutes needing a Nursing Facility Level of Care (NFLOC) in the state where Helen and Amy live, and needing that level of care is the medical requirement for Medicaid’s nursing home coverage.
In addition to meeting the medical requirement for Nursing Home Medicaid, Helen also meets the income limit. The other financial requirement, the asset limit, is a different story.
Meet Martin, 82, and Jane, 79. Martin has been living at home with Jane, who has been acting as his primary caregiver. However, Martin’s health has been on the decline for several months, and Jane can no longer give him the proper care he needs.
While Martin may be medically eligible for Medicaid, Jane is worried about his financial eligibility. They have $125,000 in combined savings, which is well above Medicaid’s eligibility asset limit in their state, which is $2,000. Plus, their home is valued at $200,000, and they have a small rental property worth $75,000.
Since Medicaid considers married couple’s assets to be jointly owned, Jane and Martin are left wondering: How can they possibly meet Medicaid’s asset limit and get the care Martin needs?
Meet Regina, she’s 80-years-old and has been living in the same house for 50 years. Her husband died 10 years ago and she has been self-reliant for most of that time, but her health has recently taken a slight turn for the worse. She is becoming more forgetful and her diabetes has begun causing issues with her mobility and her ability to complete daily tasks, like showering and getting dressed.
Regina’s daughter, Cathy, has been caring for her mother after work. Regina’s recent health issues have made Cathy nervous about leaving her alone for extended periods of time during the day, but Cathy can’t afford to quit her job or hire an in-home caregiver for her mother.
Regina’s income puts her over the state’s income limit for Medicaid, but it isn’t enough to hire a caregiver. Plus, she has $25,000 in savings and she owns her home, which puts her over the asset limit for Medicaid as well.
Add it all up and Cathy isn’t sure what to do.
Our team of Certified Medicaid Planners™ will help you navigate the difficult landscape of Medicaid for long-term care.
