Medicaid

Medicaid is a federal and state-funded healthcare program that provides medical assistance to low-income families and individuals. Many people are not aware of this program due to limited knowledge about healthcare programs. However, it is essential to understand eligibility for Medicaid to know if one is qualified to receive its benefits.

1. Income Requirements

One of the primary eligibility requirements for Medicaid is income. Medicaid's income limits vary by state, and some have higher income limits than others. The income limits are usually determined by the Federal Poverty Level (FPL). The FPL is set at 100% of the poverty level, which varies per household size. For example, in 2021, the FPL income for a household of one was $12,880. In most states, an individual's income must be below 138% of the FPL to qualify for Medicaid.

2. Residency Requirements

To be eligible for Medicaid, an individual should be a U.S. citizen or a qualified immigrant. In addition, the person must be a resident of the state where they are applying for Medicaid. A person may be required to provide proof of residency, such as a utility bill, rent receipt, or lease agreement.

3. Age, Disability, and Pregnant Women

Medicaid covers various groups of people, including children, pregnant women, and people with disabilities. Children under the age of 19 may be eligible for Medicaid regardless of their family's income. Pregnant women may qualify for Medicaid if their income falls below the state's income limit. People with disabilities may receive Medicaid benefits if they meet the income and asset criteria.

4. Asset Limits

In addition to income limits, Medicaid also sets asset limits based on the applicant's household size. The asset limit can include assets such as bank accounts, property, and vehicles. Asset limits vary by state, and some states may not have any asset limits at all. Additionally, some assets may be exempt from the calculation, such as the family's primary home.

5. Medicaid Expansion

The Affordable Care Act (ACA) expanded Medicaid eligibility to adults who are not disabled and do not have children. The expansion increased the income limit to 138% of the FPL. However, not all states have implemented the expansion, and the income limits may vary between states.

Dallas-Fort Worth Adult Medicaid Attorneys

Qualifying for Medicaid can be a complex process, but understanding the eligibility requirements and how to apply can help you get the healthcare coverage you need. If you need assistance with the Medicaid qualification process or have any questions, Crain & Wooley can help. Our team of experienced attorneys can guide you through the process and ensure that you receive the benefits you're entitled to. Contact us today at (972) 945-1610 to learn more.

Long-term care and nursing home costs can quickly become overwhelming. If you are planning long-term for your loved one, Medicaid may be able to help you ensure your loved one gets the care they deserve.

However, you may find yourself asking, does Medicaid cover nursing home expenses? Read more to find out.

If you need guidance with your elder care plan, contact our Dallas-Fort Worth elder care lawyers today at (972) 945-1610 to schedule a consultation!

What Is Medicaid?

Medicaid is a government program that helps families in various ways including assistance with long-term care services. As of July 2019, more than 65 million people were enrolled in the program. This program also provides many services that are not covered through Medicare or even private health insurance.

Many people have heard horror stories related to Medicaid and long-term care costs. Since nursing homes are expensive, some families have lost all assets (including their home) when paying for nursing home care, even with Medicaid. However, Crain & Wooley can help individuals plan in such a way as to protect up-to 100% of their assets while having peace of mind that their long-term care expenses are taken care of. Proactive estate planning is key. Having a plan in place before your loved one needs long-term care is critical to planning success. Our team at Crain & Wooley can help you.

Want to know the difference between Medicaid and Medicare? Get the information you need in our blog post.

Does Medicaid Cover Nursing Home Costs?

Unlike commercial health insurance and Medicare, Medicaid covers long-term care for both nursing home care and community-based services. One in every three Americans 65 or older will need nursing home care, and two in three nursing home residents receive care through Medicaid. Medicaid offers coverage for many nursing homes and communities that enable seniors and people with disabilities to live independently.

Medicaid also provides other elder care services, such as personal and attendant aid that help seniors stay independent. Many of the services provided by Medicaid aren’t available through other insurance programs and are far too expensive for most seniors and their families to pay out of pocket.

How Do I Know What Is Right for My Loved One?

You need an experienced elder law attorney on your side. At Crain & Wooley, our team has helped families throughout Texas prepare for elder care costs. We can walk you through the process, explain your options, and help you get peace of mind knowing your loved one is covered.

Contact our Dallas-Fort Worth elder care attorneys today at (972) 945-1610 to schedule a case review!

Before we begin discussing Medicaid, let’s take a moment to differentiate between two commonly misunderstood, government-supported healthcare programs.

• Medicaid is a federally-funded and state-administered health insurance program for individuals of limited means. State administration signifies that qualification requirements and benefits vary state-to-state.
• Medicare is a federally-funded health insurance program providing coverage for those 65 years old and older or those who are severely disabled regardless of income. Medicare’s qualifications and benefits are regulated by the federal government and do not vary state-to-state.

While there may be some overlap in the populations served by Medicaid and Medicare, there is a large variance in qualification for service as it relates to the economic status of the recipient. Now that we have outlined the basic differences between Medicaid and Medicare, let’s explore Medicaid and its impact on long-term healthcare planning.

The typical American lives to be 79 years old, and rarely has the necessary financial resources to fund nursing home care from the date of admission until he or she passes away. It is reported that the average cost of nursing home care in the state of Texas is more than $5,900 per month. As you can see, it would take a tremendous amount of money each year (more than $70,000!) to provide yourself or your loved one with nursing home care for an extended period. Let’s investigate two specific situations to further identify the best course of action when confronted with the need for medical services.

• Help! My mother/father/elderly relative needs emergency Medicaid.
• Help! I (we) need to plan for my/our financial and medical future.

Emergency Medicaid

Help! My mother/father/elderly relative needs emergency Medicaid. When facing an emergency medical need, including nursing home care and in-patient treatment, many of us do not know how to navigate the complex world of Medicaid applications. An attorney knowledgeable in Medicaid eligibility is a great source of assistance to decipher Medicaid complexities including how to proceed in cases of unanticipated nursing home care.

A few of the issues that our attorneys address in this process are as follows:

• Crafting your monthly income to fit in below the income cap, which is currently $2,250/individual.
• Structuring a plan to keep your total available resources below the resource limit which is currently $2,000.
• Addressing real estate to avoid Medicaid recovery claims after your death.
• Closely walking you through the complications of the Medicaid application process.

Planning for the Future

Help! I (we) need to plan for my/our financial and medical future. None of us like to dwell on the topic of our mortality, but it is better to proactively plan rather than reactively scramble to make decisions during a time of crisis. For example, did you know that a step in qualifying for Medicaid services involves a five-year look back into financial activities? This financial review takes into consideration both current and historic assets when determining eligibility. Being over the income cap is one of the most common causes for Medicaid denial. A timely transfer of assets sets the stage for a smooth transition when planning for future needs. But the question remains, how does one transfer assets?

Placing your assets in a special kind of trust transfers them out of your name, but can still allow you to benefit from those assets once transferred. An irrevocable trust is not for everyone and each situation is unique. Working with a qualified estate planning attorney avails you of the expertise needed to establish a long-term care plan that best meets immediate and future needs.

Key benefits of establishing a trust are:

• Asset protection from future creditors of beneficiaries
• Ability to designate who will receive the net distributable income generated in the trust
• Ability to make assets in the trust noncountable in terms of eligibility for means-based governmental benefits, such as Medicaid and Supplemental Security Income (SSI)
• Ability to specify certain terms and incentives for beneficiaries’ use of trust assets
• Ability to determine who will receive any trust assets after the deaths of the initial beneficiaries
• Ability to create special conditions for asset distribution and many more benefits

None of these benefits are automatically included in a trust. Each potential benefit requires the inclusion of specific language in the design and drafting of the trust. Thoughtful planning and careful drafting are necessary to take advantage of benefits. Partnering with a qualified estate planning attorney is an investment into your (and your heirs') future.

Our firm is here to help you explore many avenues of planning for your future. Each situation is unique, and we take the time to work with you to discover what is best for your circumstance. Estate planning is not a one-size-fits all activity. Partnering with our firm places you and your needs as a top priority when either applying for emergency Medicaid or crafting trust documents that position you to remain in control of your assets even upon needing Medicaid services.