Many courts have commented that federal Medicaid laws are the
most complicated laws that have ever been promulgated by Congress
with the exception of the Internal Revenue Code. In addition,
Oklahoma has many special laws, rules, regulations and
interpretations that increase the confusion.
Achieving Medicaid eligibility can challenge even attorneys who
practice in this area every day. But for those willing to persevere
and obtain the proper guidance of a knowledgeable elder law
attorney, the rewards can be great.
In Oklahoma there are over 50 different Medicaid programs including
a long-term care assistance program for the financially needy. If
certain eligibility criteria are met, then Medicaid virtually
absorbs the entire cost of nursing home care, except where the
resident’s income must first be paid to the nursing home.
Eligibility - Medical Necessity
To obtain nursing home Medicaid benefits, a person must be at least
65 years of age, or blind or disabled, and have the medical
necessity to be in a nursing home. Usually this is not a problem
because people seldom go to live in a nursing home unless they have
to. For Medicaid, a nurse employed by the state will do an
evaluation to determine the medical need.
For someone medically qualified for nursing home care but who is
still at home, Oklahoma also has The Advantage Waiver Program which
provides some in home help and pays for some prescriptions.
Eligibility - Financial Requirements
There are two basic financial requirements:
Not too much assets, and
Not too much income.
Asset Test: The nursing home resident must have less than $2,000 of
countable assets. Some assets are exempt. The exemption may be
temporary or permanent.
Examples of countable assets are cash in the bank, cash on hand or
cash held by others, stocks, annuities, bonds, land, minerals,
rental property, notes receivable, and vehicles (with exceptions).
Countable assets must be spent down to $2,000. Minerals are a
special problem.
“My children’s names are on my checking and savings accounts and my
certificate of deposit. Does that make them exempt or partially
exempt?” Generally not. Those are your assets and countable even
though the children have access to the money.
Additionally, people finding themselves in a situation where a
family member is going into the nursing home are sometimes led to
believe that the purchase of an annuity is the best or even the only
way out. This is rarely the case. In fact, the use of annuities in
Medicaid estate planning is useful in only a very small percentage
of cases. Usually, the case can be handled in other ways that are
more advantageous to the Medicaid applicant and family.
An annuity, when purchased, leaves the person locked into what is
usually a low-yielding investment, with the remainder possibly going
to Medicaid to the extent that Medicaid benefits were advanced on
behalf of the Medicaid beneficiary.
Even if “spending down” is part of the plan to obtain Medicaid, a
knowledgeable attorney is able to counsel clients in a manner that
is advantageous to the Medicaid applicant and to the family.
“I put my assets in a Trust a few years ago. Does that protect the
assets?” Rarely, if the Trust assets or income can be used for your
benefit, then they are available to pay the Nursing Home.
States are getting more aggressive in pursuing estate recovery
relating to benefits paid for a Medicaid recipient. The assets of a
person who has received Medicaid benefits are at risk of being
"taken" by the state to repay the amount of the state's expenditure
for Medicaid services provided. This can take place either during
the person's lifetime or after death. Potentially, property or money
which has previously been gifted, or which passes by joint tenancy,
life estate, beneficiary designation or in trust may also be at
risk. Thorough consideration of Medicaid estate recovery should be
in part of good Medicaid planning.
Medicaid laws, rules and interpretations are constantly changing.
Before you rely upon any Medicaid information or advice, you should
make sure your advisor knows all the facts of your particular
situation and the most current Medicaid laws, rules and
interpretations.
Avoid depleting your life's savings unnecessarily. Seek advice from
a qualified Elder Law Attorney as soon as Nursing Home care appears
inevitable. The sooner the better.
|
