As an Elder Law attorney in Omaha, Nebraska, one of my primary functions is to help families plan for how they are going to pay for long-term care. In many of the planning sessions, at some point, we will need to contemplate Medicaid long-term care assistance. I know there is a lot of confusion and misinformation regarding Medicaid, so wanted to provide high-level overview of the Medicaid eligibility criteria.
Many people think of Medicaid as the health insurance program for the poor – which it is. But Medicaid has a separate function and that is to provide medical assistance for long-term care. There are basically 3 criteria to qualify for Medicaid. Now, please recognize that this is just an overview and each tier is complex with many nuances and exceptions that are beyond the scope of my overview.
The First criteria that must be met is your “status”, which means you must be at least 65 years old and a US citizen. Please note that you can qualify if you are younger than 65 and/or not a US citizen, but that’s a different topic beyond the scope of this overview.
Further, to qualify in Nebraska you must also be a resident of the state of Nebraska. Residency is generally defined as living in the state of Nebraska with the intent to make it your home. There is no specified period of residency prior to application, but it can become an issue if a person comes to Nebraska and then immediately enters a long-term care facility.
An applicant’s countable resources are the second eligibility criteria. To qualify, the applicant cannot exceed a certain level of wealth or assets. Since the rules contemplate countable resources this naturally means there are assets that are not counted and these assets are called excludable resources. The countable resource number is subject to change, so for purposes of this overview, assume a single or individual applicant is generally limited to about $4,000 of countable resources. Married couples where both apply for Medicaid at the same time, are limited to $6,000 and for married couples where only one spouse is going to be institutionalized, there are rules that will allow the non-institutionalized spouse
(commonly referred to as the community spouse) keep a portion of the couples assets which is typically referred to as the spousal impoverishment rules.
Basically the thought is we don’t want to impoverish the community spouse just to qualify the institutionalized spouse. Since there are rules that limit the amount of resources an applicant can have to qualify naturally there are rules limiting the ability to give assets away. This is known as the deprivation of resources or the 60 month look back rule.
Finally, the third qualification criteria is a limitation on the amount of income the applicant can receive. Basically, if your income exceeds the cost of the care to be provided then obviously you don’t qualify because you can pay for the care yourself. The “income” rules are a little different than the “countable resources” in the sense that all assets of a married couple (regardless of how they are titled) are contemplated in the countable resources analysis; where generally income paid to the non-institutionalized spouse is not included in income analysis.
I hope you found this overview on Medicaid eligibility informative. Please keep in mind that the rules surrounding Medicaid are complex and continuously changing, but a qualified Elder Law Attorney take advantage of planning opportunities which will benefit you and your family.
So, whether you are early in the planning process or find yourself in crisis mode, give my office a call today to set up a convenient time to meet and discuss your potential long term care situation or complete the “contact us” form at the right of the screen if you have a quick question you want to ask me.
Finally, if you would like to get a better idea of what you can expect on your initial consultation, check out the video on the right side of the screen titled “Long Term Care: The Initial Consultation” or if you would like to gather more information, check out the other long-term care topics.