2008-05-23 / Columnists

Spotlight On Elderlaw

Financing Long Term Care: Medicaid Home Care Benefits
Commentary By Nancy J. Brady, RN, Esq. And Linda Faith Marshak, Esq.

As life expectancy increases, we are seeing more and more individuals who require some form of long term care in order to remain at home as long as possible, rather than be admitted to a facility. In addition to the stresses of a loss of independence, most people worry about how to pay for the care they require.

There are several ways to pay for care at home: out-of-pocket using savings and retirement assets; through Medicare, although Medicare will only pay for limited services for a short period of time; or with long term care insurance, if the individual was fortunate enough to be able to afford it, and sensible enough to purchase the policy when healthy enough to keep premiums down. Last but not least, Medical Assistance is still available in New York State for those individuals who are eligible.

The program is available to individuals who are elderly, blind, or disabled, and who meet financial and medical eligibility requirements. This article will provide a brief snapshot of the Medical Assistance home care services program as it currently exists in New York.

Financial eligibility requirements

In order to be eligible for Medical Assistance for home care (also known as Medicaid), there are strict income and resource limits which must be met. An individual applying for benefits can have no more than $4,350 worth of assets.

Assets include all bank accounts, annuities, life insurance, and real property. A person who has transferred assets out of his name may be financially eligible for Medical Assistance, but there are income limitations as well. Individuals can keep up to $700.00 of monthly income (plus an additional $20 per month for persons over age 65).

In addition to the allowed income, the Medicaid recipient can pay for secondary health insurance. Any monthly income amount left over has to either be paid to the agency providing home attendant service, or, deposited into a qualifying trust to pay expenses (aside from medical expenses) on behalf of the Medicaid recipient. Clients have told us of social workers and nurses who have told them they can transfer assets without an attorney's advice, and apply for Medicaid. BEWARE!!

Before transferring any assets individuals should consult with an experienced elderlaw attorney to ensure that the transfers are done properly to avoid any tax consequences or placing any assets at risk. The cost of a consultation with an attorney is a small price to pay to get sound legal advice regarding one's lifetime savings!!

Medical eligibility requirements home care Medicaid benefits will provide up to 24 hours per day of home attendant services, if the individual qualifies. Home attendant services may be available in certain circumstances (if the individual qualifies) for split shift services, or two aides per day, twelve hours each, for continuous around the clock care. Part of the application includes a medical form which needs to be signed by a physician. Great care must be taken in the completion of the form, to accurately reflect the applicant's needs, to ensure that the individual will receive the services he or she needs. Very often, when more than a few hours per day of care is required, the individual or their representative must argue the case at a "fair hearing" before those services are put in place.

Through a special program, Medicaid recipients can even hire their own aides, provided the aide has a valid social security number, and the aide can even be a member of the Medicaid applicant's family, with the exception of certain close relatives. Home attendants can be expected to provide light cleaning, cooking, shopping, laundry and personal care services for the Medicaid recipient. They will help the individual perform daily care routines, help with walking if necessary, help with meals, and to use the toilet throughout the day and night if the individual requires that assistance.

The home care worker can accompany the individual outside the home to appointments. The aide is not expected to provide these services for anyone else in the household but the Medicaid recipient. Medical assistance benefits also include prescription drug coverage, supplies and transportation. Services that could otherwise cost thousands of dollars per month can be provided to individuals through the Medical Assistance Program.

The Medicaid application process is detailed and complex. An inaccurate application can result in extreme delays. Particularly when there are assets to protect, your best choice is to hire an elderlaw attorney experienced in the application and fair hearing process. This is not the time to cut corners. What you spend in legal fees is very little compared to the cost of services you may receive through the Medical Assistance Program. As mentioned earlier, improperly transferring assets without legal advice can have costly tax consequences, or otherwise place assets at risk.

In closing, if you, your spouse, parent, or other loved one requires services, you should consider applying for Medical Assistance as soon as possible. There are proposals being considered to reduce Medicaid benefits, so get into the program before changes are made. If you would like to learn more, please attend one of our seminars (call the office for the seminar dates) or call for a consultation. See our display ad in this publication).

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