Eligibility
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.