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 completing daily tasks, like showering and getting dressed. She’s also started experiencing incontinence in the nighttime.
Medicaid defines the Activities of Daily Living as mobility, bathing, dressing, eating and toileting. In the state where Regina lives, requiring help with three of the five Activities of Daily Living constitutes needing a Nursing Facility Level of Care (NFLOC), and needing that level of care is the medical requirement for long-term care coverage through most Medicaid programs. Since Regina needs help with her mobility, bathing and dressing, she meets that requirement.
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 and she can’t afford to hire an in-home caregiver for her mother.
Regina’s income is $3,000/month, which puts her over the state’s income limit for Medicaid eligibility, but it isn’t enough to hire an in-home caregiver. Regina also has $25,000 in savings for emergencies and she owns the house she lives in, which is worth $150,000. These assets put her well over the state’s asset limit for Medicaid eligibility.
Add it all up and Cathy isn’t sure what to do. She knows her mother needs more care, but she can’t afford it and she doesn’t want her mother to have to sell her home and use up all of her savings to pay for the care, either. It seems like Regina should qualify for some help, but she is over those Medicaid financial eligibility limits, so Cathy decides to call Eldercare Resource Planning for help.
$25,000
Worth of Assets Preserved
Thanks to Eldercare Resource Planning
• Qualify Regina for Medicaid’s long-term care coverage.
• Establish an in-home caregiver for Regina.
• Ensure Cathy has enough income to live comfortably.
After her initial consultation with Eldercare Resource Planning, Cathy knows she will need our integrated team of Certified Medicaid Planners (CMPs), financial consultants and legal advisers to get the kind of help she needs. We know we can help Regina and Cathy achieve all of the goals listed above because we’ve done the same thing for many clients in similar situations. Plus, we can make sure Regina’s Medicaid application is completed and submitted correctly, saving Cathy the stress of that step and ensuring that her mother won’t be denied because of a typo or technicality. Even a minor mistake could lead to an application being denied denial or a penalty period of ineligibility, which would leave Helen and Amy paying those pricey nursing home bills out of pocket.
First, the Certified Medicaid Planner (CMP) working with Cathy and Regina confirms that there is a Medicaid program in their state that will cover the kind of in-home care they are hoping to find. The program is one of Medicaid’s Home and Community Based Services (HCBS) Waivers.
Regina meets the medical requirement for the HCBS Waiver, but as we’ve already mentioned, she doesn’t meet either of the financial requirements – the income limit or the asset limit. However, the CMP has a plan to solve both of those problems using a pair of tools that we will discuss next.
There are many ways to qualify for Medicaid if you are over the income limit, but for Regina the best way is to use a Qualified Income Trust. These trusts are allowed in her state and they work quite simply: Regina just deposits her excess income in the trust on a monthly basis to maintain her eligibility. A Qualified Income Trust must follow certain guidelines when it’s created, and our CMP can make sure Regina and Cathy follow all of those guidelines.
There are also many ways to qualify for Medicaid if you are over the asset limit. For Regina, the best way will involve using a Personal Care Agreement. These legal documents allow Medicaid applicants to pre-pay for future care without violating the Look-Back Period, a Medicaid rule that prevents applicants from simply giving away their assets to become eligible. But by using a Personal Care Agreement with the help of a CMP, Regina can pre-pay Cathy (for the care she would already be giving) with her $25,000 in savings and solve multiple issues. First, spending the money reduces Regina’s assets and makes her asset eligible for Medicaid. It also ensures Regina will have the amount of care she needs and that Cathy will have the income she needs.
Since Regina will be able to remain living in her home, our CMP assured Cathy that its $150,000 value will not count toward Regina’s asset limit for eligibility.
After establishing the Qualified Income Trust and the Personal Care Agreement, our CMP helps Cathy and Regina complete and submit Regina’s Medicaid application. This includes gathering all the financial documents required by the state, which is usually a time-consuming chore, but is much easier with a CMP on your side.
After Regina’s application is accepted, our CMP goes over the benefits package to make sure that Regina will, in fact, receive the kind of in-home care and financial support she is entitled to. The CMP notices the state has not allotted Regina the full complement of in-home care benefits, but that is quickly rectified after a quick follow-up. Other than that, everything looks good.
In the end, Eldercare Resource Planning:
• Helped Regina qualify for Medicaid long-term care coverage
• Enabled Regina to live at home and share her savings with her daughter.
• Helped Cathy get paid for the care she was already giving her mother.
• Lessened the burden on Cathy and eased her worries about her mother.
Our team of Certified Medicaid Planners™ will help you navigate the difficult landscape of Medicaid for long-term care.
