Vendor Medicaid (Medicaid for Long-Term Care) has unique Medicaid eligibility requirements). Knowing the Medicaid requirements and the planning steps to prepare for eligibility is vitally important in order to be ready to receive care and to receive assistance to pay for this care,
Planning in advance for nursing home care, and planning for Medicaid assistance to pay for this long-term care, is the only way to ensure that the maximum amount of assets is preserved from spend down on care. Medicare does not pay for skilled nursing care. The only remaining options for payment for long-term are private pay or Medicaid assistance to pay for nursing home costs.
First, the basics: the Medicaid exempt countable asset limit for a nursing home level of care in an institutional setting in Missouri is ($6,000). Countable assets include real estate (outside of the home), bank accounts, certificates of deposit, investments, etc. There is no income limit; any income (less a personal needs allowance) is paid to the nursing home, hence the reason for no income limit. Non countable assets include the principal residence, one automobile, personal property, and a burial plan.
If a single applicant is above the resource limit and sees long-term care on the horizon, planning can assist with preservation of assets. If the perceived span of time available is more than five year look back period and hence outside of the look back period, then perhaps an irrevocable trust can be established for asset protection, preserving all of the assets transferred with no penalty period.
If the span of time available before care is needed is less than 5 years, then the ability to make asset transfers is more limited. If this is the case, base level asset preservation strategies should be employed, such as debt payment, mortgage reduction, and purchase of a burial plan. Additionally, the benefits of a Medicaid compliant annuity at the time of care should be investigated. Contacting QMC or perhaps a local elder law attorney to learn the benefits of a Medicaid compliant annuity as part of a person’s estate planning would be worth the time.
For married couples, planning for care would involve learning the basics of a Division of Asset filing at the time that the applicant spouse enters a long-term care facility. The non-applicant spouse (the “Community Spouse”) would be allowed to keep a significant portion of the couple’s assets (free of estate recovery), called the Community Spouse Resource Allowance, if the Division of Assets is filed properly on a timely basis.
Additionally, for married couples, the basics of the monthly income rules should be reviewed. The Community Spouse is allowed to keep a minimum amount to ensure that he or she is able to live even though the other spouse is receiving a nursing facility level of care. The Minimum Monthly Maintenance Needs Allowance ensures that the Community Spouse has enough to live on on a monthly basis, in order to avoid spousal impoverishment.
The bottom line is that advanced planning for skilled nursing care always allows for maximum asset protection. Knowing all of the available options, all of the assets that must be spent, the methods of converting countable assets into non countable assets can help keep thousands of dollars with the family avoiding the exhausting assets on home and community based services, home health care, adult day care and other medical services.
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