Through our own professional and personal experiences, we understand the difficult questions we face regarding our finances, health, and needs of our family after we are gone. Confronting these issues is an essential and important part of providing peace of mind for you and your family. Here at Medina Law Group, P.A. we offer a variety of services that can help you plan for the future.

Despite these differences, eligibility is generally based upon the amount of assets a person has, along with the income that the person receives. Eligibility is determined at state Medicaid offices and, in the case of married individuals, the assets and income of both spouses are considered in the determination process.

It is important to distinguish between Medicare and Medicaid. Medicare is an insurance program providing payment for medical needs for persons 65 and over and for certain people with disabilities. All persons 65 and over, regardless of financial resources or income, are eligible for Medicare. However, Medicare and Medicare supplemental insurance provide very limited coverage with regard to the cost of long-term care in nursing homes. These non-covered services must be paid privately by the individual, unless the individual has coverage under a long-term care insurance policy. Medicaid, on the other hand, pays for medical needs for those of any age that have been determined to be eligible. In fact, a person with limited income and resources who has Medicare coverage may also qualify for Medicaid benefits.

What You Need to Know

Medicaid is considered to be one of the most complex laws of the United States and, further complicating matters, each state has a different version of Medicaid. Many elder law attorneys have carefully studied the Medicaid statutes and regulations and are able to assist clients.

Medicaid is often of importance to middle-income Americans because Medicare does not cover the costs of long-term care for illnesses such as Alzheimer’s disease or paralysis caused by a stroke. Most people who need such care for extended periods of time will eventually deplete their assets and become unable to pay the costs of their care.

At such a time, Medicaid is available to pay the difference between their income and the actual costs of care provided in a nursing home, including room and board, physicians’ care, hospital care, and all other reasonable necessary medical expenses. Medicaid covers the costs of such care in nursing homes, adult care homes, hospices, and, in appropriate cases, in the individual’s own home.

If faced with the possibility of long-term care expenses, there are certain rules that you should be aware of:

• In determining eligibility for Medicaid payment for long-term care expenses, the eligibility team will review the individual’s actual need for care, their available resources (including life insurance and retirement plans), and income received from any source. In some states, if monthly income exceeds a certain amount, then the individual is ineligible for Medicaid, even though the individual’s long–term care expenses exceed his or her income.
• In determining eligibility, a person will be disqualified from Medicaid for gifts made within the previous few years.
• In determining eligibility for one spouse, the assets and income for both spouses are considered, regardless of premarital agreements, community property laws, or the nature of the ownership of the asset.
• Assets of married couples, however, receive special treatment so that the spouse who remains living at home will not be unduly impoverished. Such a community spouse is permitted to keep one-half of all of the available assets (up to a federally-established maximum) and is allowed to keep a minimal amount of income of the couple in order to provide for support expenses at home.
• There are certain resources that are considered non-countable for eligibility purposes. These include the family residence, household contents, a vehicle, a prepaid burial fund and other necessary items.

It is important to be aware of the state-specific eligibility provisions and exemptions so that assets will not be unnecessarily spent down before applying for Medicaid. Finally, it is important to know that there are appeals processes built into the Medicaid system. If you are unhappy with your eligibility determinations, care decisions, or placements made under Medicaid, there is a process for an administrative hearing and even court proceedings to enforce your rights.

Medina Law Group, P.A. has the knowledge and experience to guide you through the complex Medicaid process. If you would like more information, please contact us to schedule an appointment.

The appointment of a guardian under this situation is imperative, as it may be the only means of protecting the individual from themselves or from others who may look to financially exploit or abuse them. Unfortunately, the guardianship court process can be very cumbersome, lengthy, and expensive, and often brings all the stress of litigation. This stress can be greatly increased if family members disagree over who should serve as guardian. Due to our experience, dedication, and compassion, we at Medina Law Group, P.A. have successfully guided many families through the guardianship process, ensuring that the idea of personal respect for the incapacitated individual, the guardian, and their family members is upheld throughout the process. If you would like more information, please contact us to schedule an appointment.