Medicaid Long Term Care Benefit FAQs

What is long term care Medicaid?

Long term care (LTC) Medicaid is a joint federal and state program for individuals who need nursing home-level care and meet other eligibility requirements.  The care can be received in a nursing home, at home through community-based care services, or through PACE (Program for All-inclusive Care for the Elderly).  Assisted living facilities provide a lower level of care; they are not licensed to provide nursing-home level care.

What are the eligibility criteria for Medicaid LTC?

The individual must be categorially, medically, and financially qualified to begin receiving Medicaid LTC benefits.

Categorial qualification means that the individual is

  • a U.S. citizen (or meets a limited category of non-citizens),
  • a resident of the state where the application will be filed, and
  • a member of a “covered group,” such as “aged” (65+ years old), “blind” (per a set definition), or “disabled” (per the Social Security Administration’s definition).

Medical qualification is evaluated based on the number and extent of assistance needed in activities of daily living (transferring, toileting, walking, eating, bathing).  The level of assistance with medication management is also considered.

Financial qualification is the most complex.  The LTC Medicaid applicant cannot have more than $2,000 in “countable” resources to qualify for, and then to keep, LTC Medicaid.  Not all resources “count.”  The well spouse of a LTC Medicaid applicant is entitled to keep a formula-based portion of the couple’s assets.  In addition, the applicant’s income is evaluated.

To reach the appropriate resource allowance, the single applicant (or applicant and spouse, if married) may need to “spend down” to eligibility levels.  If LTC Medicaid is received in the community, an income spend down may also apply.

Is there an age requirement for Medicaid LTC benefits?

No.  If the individual needs nursing-home level of care, then an individual of any age (assuming the other qualification requirements are satisfied) can qualify for LTC Medicaid.  Individuals who are younger than 65 years old must qualify based on a disability or blindness.

Can I just give all my assets to my family and qualify for LTC Medicaid?

Not usually.  The LTC Medicaid program penalizes most “uncompensated transfers” (think gifts made to another plus other transactions such as selling your home for less than tax-assessed value) made within the 60-month period immediate before the application is filed.  The length of the penalty period depends on the total dollar value of the uncompensated transfers.

Individuals who make transfers more than 60 months before they apply for Medicaid (or to certain individuals favored under Medicaid rules) will not be penalized.  However, any control the individual retains over the assets will generally make the asset or income produced by it available or countable.

Does Medicaid “take the house” or “take the assets?”

No, Medicaid does not take the house or the assets.  If the applicant (applicant and spouse, if married) does not meet the resource limits, then the individual will have to “spend down” to qualify, whether by paying for care, purchasing goods or services, converting countable assets to non-countable assets, or through other strategic planning options.  With proper legal guidance, the applicant may be able to make some gifts in such a way that does not jeopardize the applicant’s ability to have his care needs met.

Once a LTC Medicaid recipient dies, Virginia’s Medicaid program can request repayment from the recipient’s estate.   Often the recipient has little to no estate and no repayment occurs.  If the Medicaid recipient is the beneficiary of a special needs trust that was funded by the recipient’s own assets, then the trust itself must contain language requiring repayment to Medicaid or else the trust assets would prevent the beneficiary from receiving Medicaid in the first place.

If you have questions about your or a loved one’s ability to qualify for LTC Medicaid services, please contact Promise Law at (757) 690-2470 or click here to schedule a consultation.