Medicaid is a program that provides health insurance coverage to low-income and disabled persons. Medicaid is paid for jointly by the Federal and State governments. It also pays for nursing home care for people who qualify. Medicaid has become the largest payer of the nursing home bills of middle class Americans.
In most states, including Illinois, Medicaid pays very few of the costs of in-home care. New York stands out as an exception. New York pays for home care to all Medicaid recipients. Home care can cost less than care in a nursing home. A few other states (Wisconsin, Oregon, Hawaii, and Massachusetts) are attempting to show that Medicaid can save money and provide good care to patients without requiring them to leave their homes. Some people receiving Medicaid benefits in Florida have sued the state government saying that their rights have been violated. These changes may, some day, have an effect on the Medicaid program in Illinois.
Each state runs the program for its citizens. Because of this, the rules are a little different in every state. The basic system is the same across country. Be sure to consult an elder attorney in your state before applying for benefits.
Asset Limit
In order to be eligible for Medicaid benefits a nursing home resident may have no more than $2,000 in “countable” assets.
When the person in a nursing home has a spouse living at home the spouse is called a “community spouse”. The community spouse is allowed to keep the couple’s joint assets up to $109,560 in “countable” assets. This amount is adjusted for inflation each year.
There are some “non-countable” assets which do not count against the Medicaid limit:
*Personal items like clothing, certain pieces of jewelry, and furniture
*A motor vehicle, worth up to $4,500 (no limit to the value for a stay at home spouse).
*The applicant’s home (subject to certain limits).
*A prepaid funeral
*A life insurance policy with a face value of $1,500.
*Prepaid funeral plans and a small amount of life insurance
Penalty for Transfers
There is a penalty for transferring assets. Lawmakers want you to pay your nursing home bills and have Medicaid pick up the tab when you have very little left. In years past a person could enter a nursing home on today, give their money away the next day, and apply for Medicaid by the weekend. Congress put a penalty in place so people who transfer assets can not receive benefits for a period of time after the gift. The penalties have been made tougher with the new rules, called the Deficit Reduction Act (DRA).
The penalty period is calculated by dividing the amount given away by the cost of care.
As an example, the cost of care in Illinois is around $6,000 per month. If a transfer of $6,000 was made then the penalty would be 1 month during which Medicaid would not pay any nursing home bills ($6,000 ÷ $6,000 = 1). If $60,000 was transferred then the penalty would be 10 months ($60,000 ÷ $6,000 = 10). If $600,000 were transferred then the penalty period would be 100 months or 8 years and 4 months ($600,000 ÷ $6,000 = 100).
Some Transfers Do Not Earn A Penalty
Transfers to the applicant’s spouse (for the benefit of that spouse).
Transfers can be made to a blind or disabled child
Transfers can be made to a trust for the “sole benefit of” a disabled person under age 65.
There are special rules for the transfer of a home. The Medicaid applicant may transfer his or her home to certain people without a penalty:
*The applicant’s husband or wife
*A minor child of the applicant (under age 21)
*A blind or disabled child or the applicant
*To a trust for the “sole benefit of” a disabled person who is under 65 years old
*To the brother or sister of the applicant who has lived in the home for a year before the applicant went into a nursing home (if they already owned part of the home)
*To a child of the applicant who has lived in the home for two years before the applicant entered a nursing home and who took care of the applicant so that they could stay out of the nursing home longer.
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