Understanding the Medicaid Look-Back Period and Penalty Period

If you need help with paying for healthcare costs and have low-income and limited resources, you might qualify for Medicaid. Medicaid is a federal and state program that offers medical and health coverage for people with low incomes and limited assets who otherwise cannot afford paying for health care. In order to be eligible you must meet strict financial eligibility requirements both during the application process and after you have qualified.

medicaid look back penalty period

Financial Eligibility Requirements for Long-Term Care Medicaid 

Many low-income seniors find that their countable assets and/or income exceed the Medicaid restrictions in their state. They must carefully reduce or "spend down" extra funds on things like medical expenditures, house improvements, a prepaid funeral plan, and so on in order to meet the financial requirements. Gifting—giving away money or assets for less than market value—is not permitted as part of a Medicaid spend-down strategy.

The Centers for Medicare and Medicaid Services (CMS) devised a system for analyzing all applicants' financial histories to prevent seniors from simply giving away all of their assets to family and friends and then depending on Medicaid to pay for their long-term care. The following sections review the ins and outs of the Medicaid look-back period, as well as what happens when a senior decides to transfer assets.

The Medicaid Look-Back Period

Medicaid only looks at applicants' previous financial information for a limited period of time. This is known as the Medicaid Look-Back Period. Each state's Medicaid program has slightly different eligibility standards, but most states look at all of a person's financial transactions five years back (60 months) from the date of their qualifying application for long-term care Medicaid benefits. (This timeframe is only 30 months in California.)

There is no difference between the number of gifts an applicant made and to whom the gifts were given during the Medicaid Look-Back Period—barring a few exceptions, which will be discussed later on. If a senior's money or assets changed hands for less than FMV in the five years leading up to their application date, they will incur a penalty period during which they are ineligible for Medicaid.

The Medicaid Penalty Period

If a senior files for Medicaid and is found to be otherwise eligible, but has gifted assets within the five-year look-back period, they will be prohibited from receiving benefits for a specified amount of months. This is known as the Medicaid Penalty Period and there is no limit to how long a penalty period can be. 

For example, if you write a check to a family member for $14,000 and apply for Medicaid long-term care within five years of the date on the check, then Medicaid will delay covering the cost of your care because you could have used that money to pay for it yourself. The penalty period begins running on the date a senior applies for Medicaid coverage, not the date on which they gifted the money.

The length of the penalty period is determined by the total amount of assets gifted by the applicant and their state's specific "penalty divisor," which is the average monthly cost of a long-term care facility in that state. (The divisors may be the averaged daily expenses in some jurisdictions, and several states even employ divisors that are particular to nursing home costs in individual counties.) These figures are published annually by each state’s Medicaid program.

Who Pays During Medicaid Penalty Periods?

When a senior requires care but has spent down all of their assets (inadvertently) and is no longer covered, one might wonder who pays for their care. If a senior has gifted countable assets during the look-back period and needs nursing home care, they will have to pay for it out of pocket until the look-back period is over and the senior can apply for Medicaid without difficulty, or until the penalty period expires and they are eligible for coverage.

Exemptions and Exceptions to Medicaid Gifting Rules 

Medicaid penalties do not apply to all gifts.

One exemption you may receive is a “child caregiver exemption” for transferring assets to a child who has taken care of you for at least two full years. For example, if your daughter's care allowed you to put off moving into a nursing home, then transferring your home into her name for less than fair market value would not be penalized. Even if a senior applies for Medicaid within five years after the transfer, the "child caregiver exemption" still applies.

Another exception to the rule is a gift (or the creation and funding of a trust) for a kid who is blind or disabled under the Social Security Administration's standards. No penalty will be imposed on such a gift, regardless of its size.

Finally, gifts between spouses are never subject to any penalties. There is no need to impose a penalty on such transactions because both spouses' entire assets are counted when one spouse applies for long-term care Medicaid.

Successfully applying for Medicaid is a complicated and difficult process, and is rarely something you do on your own. Mistakes can have long-term financial consequences for a family. If you or someone you know plans to apply for long-term care Medicaid, please contact the best elder lawyer who can guide you through the application process at the Law Office of Inna Fershteyn at (718) 333-1233. 

3 Important Elder Law Updates in 2021

When it comes to certain aspects of Elder Law, such as Medicaid or Long Term Care Planning and Asset Protection, laws are constantly changing. For that reason, it’s important to stay updated on any recent elder laws, as they may impact you. Read about 3 important elder law updates in 2021 that could impact you.

3 Important Elder Law Updates in 2021

3 Important Elder Law Updates in 2021: 

  1. Medicaid Lookback Period: Lookback periods vary from state to state. In New York, the law requires a 5 year lookback period on Medicaid Nursing Home Benefits. This means that transfers that were done during this period are reviewed by Medicaid and a penalty is measured if the asset transfer (or “gifts”) in that period was for less than the full consideration. The transfer rate in New York is $13,037, so you should consider this if you are planning on applying for Medicaid or if you already have Medicaid and are making asset transfers. The Governor has also redesigned the program to implement a 30-month look-back period on any uncompensated transfers for home care or community Medicaid that was supposed to go into effect on April 1, 2021, but has been pushed back to July 1, 2021. Once in effect, those who plan to apply for Medicaid and who already have Medicaid after July 1, 2021, must disclose all transfers going back to October 1, 2020. There are exemptions to this update though. If the transfer is or was made to a spouse or a disabled or blind child, Medicaid does not impose a penalty. Additionally, real estate transfers to a spouse, disabled or blind child, a family caretaker that resides in the home and cares for the loved one for at least 2 years, and a sibling with an equity interest in the estate that resides at the elderly’s home for at least 1 year have been expanded to be exempt from receiving a penalty under the new Elder Laws in New York. When considering applying for Medicaid Nursing Home benefits you should take into account that your transfers prior to and after you apply for coverage matter in regards to your eligibility. 
  2. Stimulus Check doesn’t impact Medicaid Eligibility: When assessing your eligibility for Medicaid, the COVID-19 pandemic may cross your mind and specifically the stimulus checks that were given out by the federal government. The three rounds of stimulus payments that were issued from March 2020-April 2021 have been considered to be exempt from Medicaid, SSI, and other need-based benefits. This means that the payments received from the stimulus checks do not count as countable income, and will not compromise your eligibility for any of the benefits named above. This new update gives those who plan to apply for Medicaid or who have Medicaid peace of mind that these payments will not affect their eligibility for their healthcare plan and their loved ones will continue to receive benefits without any issues. 
  3. The New Power of Attorney Form: A Power of Attorney (POA) is an important document you should have especially if you are a senior. This document allows you to appoint an individual to make decisions for you when you are unable to do so yourself. The Healthcare Power of Attorney deals with any and all medical decisions that will be made on your behalf by a representative of your choosing in the case that you become incapacitated. This form that was put into effect in 2010 in New York, was known to be complicated and long. Governor Cuomo has recently issued a new form of this Power of Attorney that is simpler and shorter. This new form will go into effect in June 2021 and will not impact those who already signed a power of attorney. This new POA document is different from the one currently in effect. The difference in the new Power of Attorney form is that it’s shorter in length and is simpler in the language that it uses, making it easier for people to understand. An individual who is physically incapable of signing, but is mentally in the right state of mind can appoint a trusted individual to sign the Power of Attorney on their behalf. Banks and Financial institutions that refuse to accept this new version of the Power of Attorney can face penalties and could be subject to legal fees. This new law is great for those who are looking to make decisions on behalf of their loved ones and provide them with the best care possible. If your concerned that your Healthcare Power of Attorney is not up to date, speak with an Elder Law Attorney.

What is Elder Law?

Elder Law is an area of law that relates to issues relevant to older people and their family members and loved ones. Elder law attorneys act as advocates for their elderly clients and can handle a variety of legal matters that affect elderly or disabled people. Some of these issues are related to long-term care planning, guardianship, retirement, estate planning, and Medicaid Planning, along with other important matters. Additionally, an experienced New York City Elder Care Attorney will be able to handle the sensitive and emotional needs of an elderly person, and therefore address complicated situations that concern their clients.

How Can an Elder Law Attorney Help? 

An Elder Law attorney is informed of all current updates to the laws on Medicaid eligibility and other aspects of Elder Law. Unfortunately, Medicaid laws constantly change as well as the requirements of your state so it makes the process of finding the best plan for your loved one even harder. An Elder Law attorney will help simplify this process for you and advise you of all updates to the law creating less problems on this journey of Medicaid planning. Hiring an Elder Law attorney will ensure that you're planning for your loved one’s care in a way that corresponds with the laws imposed by the state in which you reside, while also satisfying their wishes.

For further important updates on the Elder Laws in 2021 please contact the Law Office of Inna Fershteyn at 718-333-2394 to obtain aid in receiving medical coverage to cover the cost of nursing home care and help with any of your Elder law needs.

How Can An Elder Law Attorney Help Me Get Approved for Medicaid?

There are many ways an elder care attorney can help you get approved for Medicaid. Medicaid is a joint federal and state program that covers medical payments, such as hospital care, physician services, and long-term care in nursing homes for individuals with financial need. Individuals of low socio-economic class are unable to cover the costs of medical care out of pocket and therefore rely on Medicaid for aid. Applying for Medicaid is a very difficult and lengthy process, as the questions being asked within the application have great depth and implications for your future. The foundation system responsible for asking the questions that define your eligibility for Medicaid purposely selects specific diction and word choice which may make it challenging for elderly individuals to effectively answer the questions. Answering these questions incorrectly or inaccurately could place your potential coverage in jeopardy, meaning you may not qualify for the aid you need to cover your medical costs. Considering that these questions are the main defining factor when it comes to obtaining Medicaid coverage, family members should seek guidance from an experienced Elder Law Attorney to guide them through this imperative process. The attorney is highly experienced and familiar with New York state’s rules when it comes to long-term care planning and receiving government benefits.The Elder Care Attorney will use her experience in the field to devise the most effective plan in assisting the family by selecting strategies that align with the family’s personal and financial circumstances.

An Elder Law Attorney Could Help you get Approved for Medicaid

Differences Between Medicaid and Medicare:

Medicaid and Medicare are often confused, as both provide medical coverage to individual applicants. However, there is a grand difference between both programs based on the qualifications and the services provided. Medicaid is directly managed by the state and federal government, which correlates with an individual's income to calculate their estimated extent of need. Medicaid covers low-income individual’s medical care regardless of their age. Medicare, on the contrary, typically applies to individuals over the age of 65, and in some cases covers the costs of medical bills for individuals with disabilities at any age. Medicare patients pay part of the costs through deductibles for hospital coverage and small monthly premiums for non-hospital coverage. Expenses that are not covered by Medicare will have to be paid out of pocket or with the help of a private long-term care insurance policy. 

Benefits of Medicaid Coverage:

New York Medicaid benefits pertain to regular examinations, immunizations, and doctor visits. Coverage also extends to medical supplies and equipment, lab exams, X-rays, dental, and vision. Medicaid is beneficial in regards to covering nursing home service payments, hospital stays, emergencies, and prescriptions. Medicaid coverage is extremely helpful for individuals who cannot afford to pay the costs of their medical healthcare independently. This is a great stress reliever and minimizes the pressure on loved ones who worry about paying for their own care or their family members’ care. New York state Medicaid covers essential dental services that are medically necessary, such as extractions to prevent disease. Medicaid will provide a reimbursement for eye examinations every two years and glasses when medically necessary. Medicaid may also cover the cost of contact lenses with prior authorization. Medicaid guarantees that medical professionals will select the most cost effective options when prescribing a patient’s medication, which in most cases is simply the generic brand. Medicaid may also provide reimbursements for over the counter products. New York Medicaid also provides emergency and non-emergency transportation services to beneficiaries. 

Medicaid Eligibility Requirements:

Medicaid eligibility depends on your household size and your earned income. An individual with assets and income that exceed the designated Medicaid requirements will not be eligible for coverage. This means that individuals entering nursing homes will be considered private pay residents and must continue to spend down until they become eligible for Medicaid coverage. There is a five year lookback period involved regarding any gift given to heirs,which may result in a Medicaid penalty or completely prevent you from meeting the qualifications of Medicaid coverage. This is established to prevent Medicaid applicants from transferring their large assets to their children and then claiming they have a financial need for coverage. The lookback period is exactly 60 months, which is five years from your application date. The applicant’s home is not considered as assets, but the estate pay be billed for services provided after the individual passes away. Vehicles, household contents, prepaid burial funds, and an IRA or 401(k) plan are all excluded from the asset calculation process that determines if you are eligible for Medicaid coverage. If the applicant is married, then both spouses’ income will be considered in the effort to grant coverage, even if only one spouse is in need of Medicaid. A spouse that will continue to reside in the home when the other spouse enters nursing home care will be able to keep half of the assets with some additional income for support services, as long as this amount meets the maximum quota.

Elder Law Attorney Assistance in Applying for Medicaid:

An experienced and esteemed Elder Law Attorney can assist you in the process of applying for Medicaid coverage in a variety of methods. One such method is guaranteed avoidance of potential penalties that you may have been unaware of had you decided to file for Medicaid without the help of a lawyer. There are numerous questions that seek to identify if the applicant has made any disqualifying transfers that would result in a penalty. The most common question that correlates to the Medicaid penalty prospect is the prompt asking if the applicant has made any gifts or transfers for less than fair market value within the last 5 years. If you hire an Elder Care Attorney, the lawyer will ensure that you do not have any penalties that would prevent you from obtaining the Medicaid benefits you deserve. The attorney will be well aware of any of the exceptions that will prevent you from earning a penalty and will therefore assist you in the process of qualifying for Medicaid. Hiring an Elder Care Attorney enhances the probability that your application is approved, therefore increasing your chances of obtaining Medicaid coverage. Additionally, another benefit to hiring an Elder Care Attorney to assist in filing for Medicaid coverage is the establishment of effective spend down plans. In order to qualify for Medicaid many married couples must participate in the Spend-Down process, which pertains to the prospects of saving assets when only one spouse needs Medicaid. The purpose of this process is to ensure that the individual in need of long-term care receives the aid they need, while also guaranteeing that their spouse has the financial means of remaining in their home and covering the cost of all their living expenses. An Elder Care Attorney may assist in creating a personal care agreement that enables the senior to provide monetary compensation towards their family caregiver, while also participating in the Spend-Down process. Additionally, the attorney can aid in renaming bank accounts and real estate titles in the effort to enhance the applicant’s eligibility for Medicaid. The attorney will use her experience in the field to answer any inquiries you may have regarding the application process and determining whether you and your loved ones qualify for coverage. 

For further Medicaid eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2395 to effectively complete the Medicaid Application.

Top 5 Strategies for Protecting Your Assets From Medicaid

Medicaid is a means-tested program that conditionally accepts applicants based on their income and current assets. According to Medicaid regulations, individuals must have less than $2,000 to qualify for coverage. Applying for Medicaid is quite a complex process, as the questions being asked within the application have great depth and implications for your future. The foundational system responsible for asking the questions that define your eligibility for Medicaid purposely selects specific diction and word choice which may make it challenging for elderly individuals to effectively answer the questions. Considering that these questions are the main defining factor when it comes to obtaining Medicaid coverage, family members should seek guidance from an experienced Elder Law Attorney to guide them through this imperative process. The attorney is quite familiar with your state’s rules when it comes to long-term care planning and receiving government benefits. An Elder Care Attorney will use her experience in the field to devise the most effective plan in assisting the family by selecting strategies that align with the family’s personal and financial circumstances. Below are the top 5 strategies suggested by an Elder Law Attorney regarding ways of protecting your assets from Medicaid.

Best Strategies for Protecting your Assets from Medicaid

1. Income Trusts

Income Trusts serve the purpose of protecting your assets and keeping your monetary income safe. This trust aids in maintaining the income limit set for all Medicaid applicants. Income Trusts are beneficial towards those applicants that exceed the qualifying amount. These trusts give the applicant an opportunity to designate a sub quantity of their income to a specific trust in order to refrain from exceeding the standard acceptable quantity. The Qualified Income Trusts are irrevocable meaning they cannot be changed or revoked. They serve as holding areas for the applicant’s excess income and protect this income from being taken by Medicaid. In states that allow applicants to spend down their excess income, these trusts are less effective, yet can still be utilized based on the applicant’s preference. In order to qualify for Medicaid many married couples must participate in the Spend-Down process, which pertains to the prospects of saving assets when only one spouse needs Medicaid. The purpose of this process is to ensure that the individual in need of long-term care receives the aid they need, while also guaranteeing that their spouse has the financial means of remaining in their home and covering the cost of all their living expenses. An Elder Care Attorney can assist you in establishing an Income Trust and answering any of your questions regarding the trust. 

2. Asset Protection Trust 

An Asset Protection Trust is a great way to preserve your assets when applying for Medicaid, as it allows you to maintain your wealth while still receiving coverage. This is helpful because a Medicaid applicant is only eligible for convergence if they meet the specified quantity of assets held within their account. Many individuals fall into the assumption that the best way to remove the additional assets that prevent them from getting Medicaid coverage is to transfer the assets to family members. This approach, however, is extremely flawed and risky because it often results in a Medicaid penalty. Incurring a penalty prevents you from receiving coverage for a specified period of time. A trust allows you to disperse these assets to the family members you had in mind at the time of creating a trust. The beneficiaries will not be subject to the payment of capital gains tax based on the increase in quantitative value your assets have accrued over time. It is important to note that transfers to a trust are still subject to the Medicaid Lookback period,which tends to include the last five years of your assets. This strategy is extremely effective when it comes to protecting your assets fromMedicaid, while still receiving the coverage you are in need of. An Elder Care Attorney can guide you through the process of creating an Asset Protection Trust based on your personalized extent of assets. 

3. Caregiver Agreement

A caregiver agreement is beneficial to individuals who require additional services that will not be included within the typical Medicaid coverage. This option is great for individuals who would prefer to be cared for by a family member or a trusted close friend. You would not only be cared for by an individual you already know and have a close relationship with, but you would also be benefitting the caregiver for their service. The caregiver will be paid for their duty in caring for you and you will receive the best care possible. In most cases the caregiver would be paid for their services in advance under a contract that defines the services provided and the hours being worked. In the case that the patient passes away all of the unearned funds must be paid to Medicaid in correlation to the amount that Medicaid paid for the patient’s care. A Caregiver Agreement can be the best option for numerous individuals who do not wish to leave home and go into the care of a nursing home, as they would still be able to maintain their full Medicaid coverage. An Elder Care Attorney can help you make the decision in selecting a caregiver you trust to take care of you. 

4. Medicaid Compliant Annuities and Promissory Notes

In many cases, individuals require urgent long-term care services, however they have recently conducted a transfer of assets or are still in possession of the assets that limit the income cap they require to qualify for Medicaid coverage. As of now, there is no possible method of removing these assets in time to qualify for coverage because any movement of the assets will result in a Medicaid penalty. The only options left to qualify for coverage under such short notice and with exceeding assets present would be to write an annuity or promissory note. This would serve as an insurance product that would payout the income. First, you would make an investment into the annuity. Then, the insurance provider would return your income by using a constant stream of income approach. The annuity has specific qualifications to ensure that Medicaid will approve of the strategy. The annuity must be fixed with all monthly payments being the same, while also being irrevocable. The annuity is unassignable meaning it cannot be transferred or sold to another individual. The payments on the annuity must be immediate in order to qualify for coverage. An Elder Care Attorney can further explain this strategy in describing the best course of action in selecting an annuity with qualifications that would make it possible for you to still qualify for Medicaid. 

5. Spousal Transfers and Spousal Refusal

According to current Medicaid laws, transfers may occur between spouses without being subject to the five year look-back period. The assets who are under the name of the spouse in need of care should be transferred to the name of the spouse who doesn't require care. The spouse who is not in need of care is typically referred to as the community spouse. With the presence of spousal refusal, the community spouse may refuse to provide necessary support to the spouse in need of care. If this is the case, then the spouse who is in need of care will immediately be provided Medicaid services to ensure that they are provided with all the care necessary. Medicaid may then require the community spouse to make contributions even though that spouse initially refused to provide the necessary support. The community spouse will still receive a benefit because the reimbursements to Medicaid will be at specified discounted rates. Spousal refusal is present in New York, however it may not be present in other states. Seeking legal advice from an Elder Care Attorney puts you and your loved ones in a good position to protect your assets from Medicaid. 

Reasoning Behind Asset Protection:

Asset protection from Medicaid is extremely important in the long run in regards to receiving long term coverage. Without taking the proper steps now to protect your assets, you may be unable to receive long term coverage, such as nursing home care. Long term care insurance provides coverage for nursing home care and at home coverage for individuals ages 65 and older with chronic conditions. There is nothing worse than running out of money when you need it most, so by taking the necessary steps to protect your assets today, you will avoid this problem when it becomes time to consider long term care. An Elder Care Attorney will guide you through the process of following all of the strategies above to save and protect your assets from Medicaid.

For further Medicaid eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2394 to effectively protect your assets from Medicaid.

How to maintain Medicaid Eligibility when your spouse dies in NYC?

The process of aging is a difficult concept, especially for individuals who lack knowledge of their medical coverage system and management of their financial assets. Prior to reaching old age, individuals should consider applying for Medicaid and creating an Elder Care Plan. Applying for Medicaid is quite a complex process, as the questions being asked within the application have great depth and implications for your future. The foundation system responsible for asking the questions that define your eligibility for Medicaid purposely selects specific diction and word choice which may make it challenging for elderly individuals to effectively answer the questions. Considering that these questions are the main defining factor when it comes to obtaining Medicaid coverage, family members should seek guidance from an experienced Elder Law Attorney to guide them through this imperative process. The attorney is quite familiar with your state’s rules when it comes to long-term care planning and receiving government benefits.The Elder Care Attorney will use her experience in the field to devise the most effective plan in assisting the family by selecting strategies that align with the family’s personal and financial circumstances.Additionally, the esteemed attorney will ensure that you maintain your Medicaid Eligibility even when your spouse dies in NYC.

Maintaining Medicaid Eligibility when your spouse dies in NYC?

What if the nursing home spouse outlives the community spouse?

In the case that the spouse enrolled in nursing home care passes away prior to the community spouse, then the living spouse is subject to an exception of 50% of the total countable assets of both of the spouses.The total countable assets may only reach the value of $119,220 in order to remain qualified for Medicaid coverage. However, this exemption does not work if the roles are reversed. This means that if the community spouse passes away prior to the spouse in the nursing home, then the nursing home spouse may not use the 50% exemption.This is due to the fact that the individual inhabiting the nursing home will no longer receive Medicaid coverage and therefore will not obtain the care they require. The maximum quantity of assets an individual on Medicaid may hold is $2,000, thus any value above this would result in a Medicaid penalty. In most cases the surviving spouse will receive the remaining assets based upon the content of the will. To avoid dealing with this complex situation you should hire an Elder Care Attorney to begin Medicaid Planning for married couples.

Medicaid Planning for Married Couples

Upon receiving inheritance the surviving spouse should convert this money into a non-countable form. These forms may include Medicaid-qualified annuity, a new car, new household furniture, etc. An Elder Care Attorney will provide guidance on which non-countable form would be most effective for your specific family circumstances in order to avoid incurring a Medicaid penalty. This penalty will result in a disqualification period that may leave you without coverage, which is certainly not worth the risk. Prior to the death of the community spouse, the couple should change their accounts in order to prevent them from being in joint names. Without taking this step, there may be numerous financial consequences that will jeopardize your Medicaid coverage. In the case that the house or the home was under joint names and the community spouse passes away, then the spouse receiving nursing home care will exceed the $2,000 maximum assets allowed. Therefore, the house should be solely in the name of the community spouse instead of under joint names. 

The passing of a Medicaid recipient’s spouse could harm the current Medicaid recipient by making him ineligible for coverage. If the community spouse dies and leaves the estate to the nursing home Medicaid recipient, then the individual will have too many assets to qualify for coverage. Even in the case that the individual chooses not to claim his share of the estate, Medicaid will still assess the situation, which may result in a Medicaid penalty. In this case, a trust could be an effective option to protect the spouse’s medical coverage. The surviving spouse is typically titled to either half or a third of the assets titled under the name of the deceased spouse. The money must be removed and properly disposed of to ensure that the Medicaid recipient continues to be eligible for coverage. 

For further Medicaid eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2394 to effectively maintain Medicaid Eligibility when your spouse passes away. 

Medicaid versus Medicare: Who covers nursing home costs?

There comes a point in time when you may begin to consider placing your loved one into a nursing home to ensure that they receive the best care possible. When making such a decision it is important to be well informed and aware of all of the aspects that attribute towards nursing home care. One such attribute pertains to the cost of care and how it will be covered. Usually the cost will either be covered using Medicare or Medicaid. However, there are specific qualifications that outline which coverage plan may be utilized based on your personal situation. Additionally, it is important that you are able to differentiate between the types of care offered, such as skilled care and custodial care. In order to best be informed of all the details concerning enrolling your loved one in the care of a nursing home, you should contact an Elder Care Attorney to guide you in your decision making process. With proper counsel you will be sure to place your loved one in the hands of the best nursing home possible, while still being able to cover all of the costs such care will require.

Medicaid vs Medicare Nursing Home Coverage

Qualifications for Medicare Coverage of Nursing Homes

There are specific statements that discuss if an individual qualifies for Medicare coverage when it comes to nursing home care. The first statement pertains to the period of time the individual stayed at the hospital out of medical necessity. In order to qualify for Medicare coverage an individual must have spent at least three consecutive days in inpatient care for a medical necessity. After being discharged from the hospital the individual must then be admitted to a nursing home within the 30 day period that begins the moment the patient is discharged. The individual must be in need of skilled nursing or rehab care on a daily basis for the specific condition they endured while hospitalized in inpatient care. Lastly, in order to receive Medicare coverage for nursing home care, an individual must have a letter from a physician ordering and proving the necessity of this care. If the individual falls within the category that aligns with all of these statements, then they may be eligible for receiving Medicare coverage when it comes to nursing home care. 

Skilled Care vs Custodial Care

The greatest difference between skilled care and custodial care pertains to the manner in which the care is provided and who is responsible for providing such care. Skilled care refers to care that is specifically administered by a professional who is responsible for ensuring that the individual does not further deteriorate from the condition they are currently in. This care is administered when direct medical care becomes a necessity as a result of a short-term medical condition that they will recover from. On the contrary, custodial care can be performed within the home setting, meaning the one administering this care does not have to be a medical professional. This type of care provides aid for activities related to daily living. These activities usually pertain to eating, bathing, and similar skills. In most cases, patients that receive custodial care have a chronic condition, meaning they are not expected to improve in the manner that those who receive skilled care are. If custodial care is the only type of care necessary, then it is possible that Medicare will not cover the costs. However, Medicaid will cover the costs of custodial care, so you will be able to provide your loved ones with the care they require to continue thriving.

Medicaid Rules for Skilled Nursing Payments

Receiving Medicaid coverage can be quite complex, as there is a very specific list of qualifications necessary to obtain coverage. Medicaid is based on “needs only” policies, meaning there are strict regulations pertaining to the amounts of assets you are allowed to hold.  Medicaid is income based, while Medicare does not depend on your assets or income. An esteemed Elder Care attorney will assist you in qualifying for the type of coverage you need, as the attorney has much experience in the field and knows the specific rules of state pertaining to the amount of money an individual can have while still qualifying for Medicaid coverage. A Medicaid applicant over the age of 65 can possess up to $2,000 in NY in order to qualify for coverage. Asset limits for married couples vary in relation to whether both spouses require Medicaid coverage or only one spouse. One automobile regardless of the quantitative value is referred to as a “non-countable” asset as long as the car is used to transport the Medicaid applicant or other members of the family. The attorney will assist you in preparing for the five year Medicaid lookback period and will provide guidance on the Medicaid spend-down process. 

Is Dual-Eligibility a Possibility?

Dual-Eligibility refers to an individual who is qualified to receive both Medicaid and Medicare coverage. In this case, Medicaid will cover all of the costs that Medicare did not cover. Usually, individuals qualify for Medicare based on their age and qualify for Medicaid based on the income bracket they fall into. Additionally, Medicare beneficiaries below the age of 65 who live on Social Security Disability Insurance may be eligible to receive Medicaid benefits. The benefits of being dual-eligible is that you may receive greater medical coverage and lower out-of-pocket costs. For medical issues Medicare is the primary payer, Medicaid will serve as the secondary payer to cover any Medicaid costs leftover. Medicaid assists in covering the cost of the Medicare premiums, deductibles, and copays. An Elder Care Attorney can assist you in becoming dual-eligible and receiving the benefits that result from this eligibility. 

For further Medicaid eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2394 to obtain aid in receiving medical coverage to cover the cost of nursing home care.

Top 5 Strategies for Protecting Your Assets From A Nursing Home

Coming to terms with the prospects of your loved ones aging is not a simple and enjoyable task, especially when you are the one responsible for making the most efficient medical and financial decisions for them. Not only are you tasked with these complex decisions, but you are also responsible for finding the best ways to protect your loved one’s assets from a nursing home. In order to make this process simpler and give you more time to spend time with loved ones, rather than worrying about legalities, an Elder Care Attorney can assist in the procedure. Around 73 percent of individuals over the age of 65 will need long-term care, thus is it quite logical to make decisions concerning this care prior to the individual reaching the specified age. Participating in the long-term care planning process early will give you the opportunity to consider which facility will best cater to your loved one’s individual needs. This will also give you the opportunity to plan your desired payment method for all of the medical and care expenses. There are various procedural strategies that can be followed to guarantee that your assets are being protected from a nursing home.

Best Strategies for Protecting your Assets from Nursing Homes

Strategy #1: Asset Protection Trusts

An Asset Protection Trust is a great way to preserve your assets when applying for Medicaid, as it allows you to maintain your wealth while still receiving coverage. This is helpful because a Medicaid applicant is only eligible for convergence if they meet the specified quantity of assets held within their account. Many individuals fall into the assumption that the best way to remove the additional assets that prevent them from getting Medicaid coverage is to transfer the assets to family members. This approach, however, is extremely flawed and risky because it often results in a Medicaid penalty. Incurring a penalty prevents you from receiving coverage for a specified period of time. A trust allows you to disperse these assets to the family members you had in mind at the time of creating a trust. The beneficiaries will not be subject to the payment if capital gains tax based on the increase in quantitative value your assets have accrued over time. It is important to note that transfers to a trust are still subject to the Medicaid Lookback period,which tends to include the last five years of your assets. This strategy is extremely effective when it comes to protecting your assets from a nursing home, while still receiving the coverage you are in need of. 

Strategy #2: Income Trusts

Similarly to the Asset Protection Trusts, Income Trusts serve the purpose of protecting your assets and keeping your monetary income safe. This trust aids in maintaining the income limit set for all Medicaid applicants. Qualified Income Trusts and Pooled Income Trusts are beneficial towards those applicants that exceed the qualifying amount. These trusts give the applicant an opportunity to designate a sub quantity of their income to a specific trust in order to refrain from exceeding the standard acceptable quantity. The Qualified Income Trusts are irrevocable meaning they cannot be changed or removed. They serve as holding areas for the applicant’s excess income and protect this income from being taken by nursing homes. In states that allow applicants to spend down their excess income, these trusts are less effective, yet can still be utilized based on the applicant’s preference. In order to qualify for Medicaid many married couples must participate in the Spend-Down process, which pertains to the prospects of saving assets when only one spouse needs Medicaid. The purpose of this process is to ensure that the individual in need of long-term care receives the aid they need, while also guaranteeing that their spouse has the financial means of remaining in their home and covering the cost of all their living expenses.Pooled income trusts also happen to be irrevocable, however they specifically aid disabled applicants. The excess income is pooled together and is then cared for by a non-profit organization. This organization takes on the role as the trustee, meaning they are responsible for disbursing the funds. 

Strategy #3: Medicaid Compliant Annuities and Promissory Notes

Oftentimes individuals require urgent long-term care services, however they have recently conducted a transfer of assets or are still in possession of the assets that limit the income cap they require to qualify for Medicaid coverage. There is no way to remove these assets in time to qualify for coverage because any movement of the assets will result in a Medicaid penalty. 

The only options left to qualify for coverage under such short notice and with exceeding assets present would be to write an annuity or promissory note. This would serve as an insurance product that would payout the income. First, you would make an investment into the annuity. Then, the insurance provider would return your income by using a constant stream of income approach. The annuity has specific qualifications to ensure that Medicaid will approve of the strategy. The annuity must be fixed with all monthly payments being the same, while also being irrevocable. The annuity is unassignable meaning it cannot be transferred or sold to another individual. The payments on the annuity must be immediate in order to qualify for coverage. 

Strategy #4: A Caregiver Agreement 

A care agreement is beneficial to individuals who require additional services that will not be included within the mMedicaid coverage in a nursing home. This option is great for individuals who would prefer to be cared for by a family member or a trusted close friend. You would not only be cared for by an individual you already know and have a close relationship with, but you would also be benefitting the caregiver for their service. The caregiver will be paid for their duty in caring for you and you will receive the best care possible. In most cases the caregiver would be paid for their services in advance under a contract that defines the services provided and the hours being worked. In the case that the patient passes away all of the unearned funds must be paid to Medicaid in correlation to the amount that Medicaid paid for the patient’s care. A Caregiver Agreement can be the best option for numerous individuals who do not wish to leave home and go into the care of a nursing home.  

Strategy #5: Spousal Transfers and Spousal Refusal

According to Medicaid laws transfers may occur between spouses without being subject to the five year look-back period. The assets who are under the name of the spouse in need of care should be transferred to the name of the spouse who doesn't require care. The spouse who is not in need of care is typically referred to as the community spouse. With the presence of spousal refusal, the community spouse may refuse to provide necessary support to the spouse in need of care. If this is the case, then the spouse who is in need of care will immediately be provided Medicaid services to ensure that they are provided with all the care necessary. Medicaid may then require the community spouse to make contributions even though that spouse initially refused to provide the necessary support. The community spouse will still receive a benefit because the reimbursements to Medicaid will be at specified discounted rates. Spousal refusal is present in New York and Florida, however it may not be present in other states.

With the aid of an Elder Care Attorney, nursing homes and other senior housing options become affordable even for individuals who did not allocate money specifically for elder care. Government programs can provide assistance to elderly in financial need of aid. This government aid will come in the form of Social Security, Veteran’s Benefits, Medicaid, and various state programs. Additionally, there are insurance coverage options for those who do not qualify for government aid. These insurance options pertain to Medicare, Medicare Supplement programs,and Short-Term Care Insurance. There are potentially private assistance options, such as certain nonprofits and foundations that aid elderly in need of care. Once you have a senior housing option in mind, it is a great time to start thinking about the medical and financial power of attorney. A durable power of attorney allows an individual to make decisions for the benefit of your loved one in regards to financial and medical concerns over their well-being. This allows documentation to stay in place even if the elderlt loved one becomes incapacitated and is unable to make decisions independently. This individual is in charge of paying your bills, managing your assets and investments, and directing your medical care when you are unable to do so yourself. The medical power of attorney establishes your loved one’s plans for healthcare, such that the agent will work with medical professionals to ensure the individual is cared for in a manner in which they personally prefer. The financial power of an attorney gives an individual the ability to make financial decisions involving real estate and more. The agent can be responsible for depositing Social Security checks, managing tax returns, and other fiscal tasks. An esteemed Elder Care Attorney will assist you in completing these documents, as well as selecting the designated agent and specified senior housing. All the while, the attorney will guarantee that your assets will remain protected from the nursing home.

For further Medicaid eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2394 to effectively protect your assets from nursing homes.

Applying for Medicaid: An Elder Law Attorney Can Help

Applying for Medicaid is quite a complex process, as the questions being asked within the application have great depth and implications for your future. The foundation system responsible for asking the questions that define your eligibility for Medicaid purposely selects specific diction and word choice which may make it challenging for elderly individuals to effectively answer the questions. Considering that these questions are the main defining factor when it comes to obtaining Medicaid coverage, family members should seek guidance from an experienced Elder Law Attorney to guide them through this imperative process. The attorney is quite familiar with your state’s rules when it comes to long-term care planning and receiving government benefits.The Elder Care Attorney will use her experience in the field to devise the most effective plan in assisting the family by selecting strategies that align with the family’s personal and financial circumstances.

Enhancing Medicaid Eligibility by hiring an Elder Care Attorney

What are some of the advantages in hiring an Elder Care Attorney when Applying for Medicaid?

Advantage #1:Avoiding Penalties

There are numerous benefits in hiring an esteemed Elder Care Attorney, as the lawyer has much experience in the field and will be able to answer all of your questions concerning the Medicaid application process. Hiring an attorney guarantees that you will be able to avoid Medicaid penalties, which are very common in individuals who attempt to complete the Medicaid application without the aid of an attorney. There are numerous questions that seek to identify if the applicant has made any disqualifying transfers that would result in a penalty. The most common question that correlates to the Medicaid penalty prospect is the prompt asking if the applicant has made any gifts or transfers for less than fair market value within the last 5 years. If you hire an Elder Care Attorney, the lawyer will ensure that you do not have any penalties that would prevent you from obtaining the Medicaid benefits you deserve. The attorney will be well aware of any of the exceptions that will prevent you from earning a penalty and will therefore assist you in the process of qualifying for Medicaid. Hiring an Elder Care Attorney enhances the probability that your application is approved, therefore increasing your chances of obtaining Medicaid coverage.

Advantage #2: Effective Spend-Down Process Plans

In order to qualify for Medicaid many married couples must participate in the Spend-Down process, which pertains to the prospects of saving assets when only one spouse needs Medicaid. The purpose of this process is to ensure that the individual in need of long-term care receives the aid they need, while also guaranteeing that their spouse has the financial means of remaining in their home and covering the cost of all their living expenses. An Elder Care Attorney may assist in creating a personal care agreement that enables the senior to provide monetary compensation towards their family caregiver, while also participating in the Spend-Down process. Additionally, the attorney can aid in renaming bank accounts and real estate titles in the effort to enhance the applicant’s eligibility for Medicaid. In order to receive Medicaid long-term care benefits the spouse inhabiting the nursing home may have up to $2,000 while the community spouse may have up to $128,640 according to 2020 data.Therefore, hiring an esteemed Elder Care Attorney can assist you in the Medicaid Planning process associated with qualifying for Medicaid coverage.

What is the Medicaid Lookback Period and how does it impact my Eligibility for coverage?

A Medicaid Lookback is imperative in relation to Financial Eligibility for Medicaid. This means that if a lookback is required for a specific service, then the medicaid applicant is required to present all financial records pertaining to the applicant and their spouse during the lookback period. The typical lookback period for nursing homes is estimated to be around 5 years. The Human Resource Administration (HRA) is responsible for reviewing the lookback documents and checking the transfer of assets, especially in identifying transfers for less than the fair market value by the applicant or spouse during this period. Based on current NY State laws, nursing homes are required to do a lookback to admit applicants for care. The lookback will  be required for people who are in the Medicaid Buy-In for Working People with Disabilities. Applicants who have an income that is below the income bracket of $895 as a single individual or $1304 for a couple will not be required to partake in the lookback process. It is important that you avoid giving away or selling assets below the fair market price, as this could jeopardize your eligibility for Medicaid coverage. The Elder Care Attorney must be fully aware of all the transactions made during this 5 year period to ensure that you avoid any penalties that would delay the rate at which you would qualify for coverage.

What procedure will the Elder Care Attorney follow when assisting me in the Medicaid eligibility process?

When consulting an Elder Care Attorney for the purpose of Medicaid Planning, the attorney will begin by asking you about your assets and income. In order to effectively decide when is the best moment to apply for Medicaid coverage, the attorney must be aware of your personal financial situation. The attorney will ask you how your home, bank accounts, and other assets are titled. You will be asked to state all of the transfers you have made within the last 5 years in the effort to create a plan that avoids the often lengthy Spend-Down process. Although hiring an Elder Care attorney can be quite costly, it is certainly worth the price. The attorney will provide guidance in the process of filling out all of the paperwork, as well as outline the next steps when filling out the Medicaid eligibility application. It is imperative that you do not wait until Medicaid coverage becomes an urgent matter, for it will be extremely challenging to obtain financial aid in such a short time period. This process is quite lengthy and requires planning to guarantee the best outcome, thus it is encouraged that you initiate the Medicaid Planning process as soon as possible and select an attorney you trust.

For further Medicaid eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2394 to effectively complete the Medicaid Application.