Medicaid Eligibility

The Medicaid application process can be complicated and overwhelming. At Ayres Presser Elder Law, we help you understand and navigate the complexities of Medicaid to ensure access to essential long-term care services.

What is Medicaid?

Medicaid, also known as Medical Assistance, is a jointly funded federal and state program that provides health coverage to eligible individuals with limited income and resources. A specific component of Medicaid in Pennsylvania pays for the care costs of people requiring extended skilled nursing care in nursing homes. Medicaid may also pay for certain home-based long-term care services under the Home and Community Based Services (HCBS or Waiver) Program. HCBS allows eligible individuals to receive care in their homes or community settings as an alternative to nursing home placement.

Who is Eligible for Medicaid?

Medicaid eligibility in Pennsylvania considers various factors such as income, assets, age, disability, and level of care needed. To qualify, individuals must meet the financial eligibility requirements, which involve income limits and asset thresholds. Typically, Medicaid recipients may only have $2,400 or $8,000 in total assets, depending on their gross monthly income. If they are married and have a spouse living in the community, their spouse may also keep one-half (1/2) of the total assets (up to a set maximum). Certain assets, such as the spouse’s retirement accounts, and income may be exempt or disregarded in the eligibility determination process. Individuals must also need skilled nursing care. Skilled nursing care refers to specialized medical care and services by trained professionals such as registered nurses, licensed practical nurses, therapists, and other skilled medical personnel. It encompasses round-the-clock care and may include physical and occupational therapy, post-surgical recovery, medication administration, wound care, and assistance with basic daily activities such as walking, bathing, dressing, toileting, and eating meals.

What is the Medicaid Application Process?

Applying for Medicaid benefits for nursing home or HCBS involves submitting a comprehensive application that is filed with the Department of Human Services (DHS). The application process evaluates an individual’s financial situation and medical needs. If the Medicaid applicant is married, the first step in the financial application process is completing a Resource Assessment. The Resource Assessment reports all assets of both the Medicaid applicant and their spouse to determine the spouse’s protected share and the amount of money that needs to be spent down to be eligible for Medicaid. Once the assets are spent down, a Medicaid application is filed which reports all remaining assets of the Medicaid applicant and their spouse. The Medicaid application is reviewed by the local county assistance office. Professional assistance from an elder law attorney, as well as guidance from financial professionals such as certified financial planners and accountants, can be invaluable in navigating this complex application process.

How Ayres Presser Elder Law Can Help

Our firm is dedicated to assisting our clients in securing Medicaid benefits to pay for nursing home care. We offer comprehensive legal support, including:

1. Asset Protection Strategies: Creating plans to preserve assets within Medicaid guidelines, including Medicaid compliant annuities to protect funds for a community spouse.
2. Asset Planning: Working with financial professionals to provide guidance on restructuring assets to meet Medicaid eligibility requirements.
3. Application Assistance: Assisting with the Medicaid application process to ensure accuracy and completeness, including gathering necessary asset information and working with the nursing home and county assistance office.
4. Appeals and Advocacy: Representing clients in Medicaid denial appeals and advocating for their rights.

It is a misconception that you will lose your hard-earned assets and home if you or your spouse requires nursing care. Our team knows the rules and strategies for protecting your assets, which is possible in many cases. It is essential that you contact us immediately if you are facing this situation so that we can offer tailored solutions and immediate support.