Medicaid Benefits | Overview for Qualifying for Medicaid
Medicaid Benefits | The purpose of the Medicaid program is to provide financial assistance and managed health care to those who are disabled or age 65 or older, and they have income and assets that fall below certain marks. Because Medicaid is funded by the federal government but administered by state governments, determining whether you qualify varies by state. Qualifying for Medicaid has many moving parts, including your medical needs, your assets and your income.
Generally speaking, a person must prove they have a medical need (such as the assistance of another person with the activities of daily living); have less than $2,000 in assets (your primary residence, a vehicle and minor necessities do not count in this calculation); and a monthly income less than 133% of the federal poverty level (in Florida, that’s $2,313).
While many people see these numbers and assume they don’t qualify because they have too much in income or assets, skilled elder law attorneys can explain the strategies for meeting these qualifications. Let’s take an overall view of each requirement area:
Again, remember that each state has its own set of requirements, so it’s important to seek reliable information on your state’s rules. But basically, you want to show that you are impaired (blind, dementia or Alzheimer’s, for example), need ongoing skilled nursing care, or require assistance from another person to eat, dress, bathe, and/or go to the bathroom. So it is possible to qualify for Medicaid without the need for skilled nursing care, but you do need the help of family member or caregiver to assist you living in your own home. Your state will define the “level of care” criteria that you must meet.
Assets: For the purposes of Medicaid eligibility, your primary residence, its furnishings, your personal items, a vehicle and an irrevocable burial trust does not count against you. What is counted: cash, all bank accounts, bonds, stocks, investment portfolios and real estate (such as a rental property) to name a few. While the asset limit for a single person is $2,000, the limit climbs to $126,420 if you have a non-applying spouse. Once again, if you believe you are “over-assets,” it pays to check with an accredited elder law attorney, who can show you ways to protect these overage assets and still qualify.
It is also important to note that there is a “look-back” period of 60 months. That means Medicaid will review your financial history to see if assets were sold or given away for less than fair market value. If any such transfers are found, there will be a penalty period before you can become eligible. An elder law attorney can explain the details of this part of the process as well.
Income: Medicaid limits income to $2,313 per month for a single applicant in Florida. It counts income from any source: Social Security, disability income, pensions, job wages, alimony, IRA disbursements and withdrawals, and bank and stock dividends, etc. The good news: If you are married, but only you are applying, the income of your spouse is not counted. There is also a “spousal allowance.” This means the applying spouse can transfer a set amount of money each month to the spouse (currently $2,058) to provide for housing and utility costs.
In short, the Medicaid process is an evolving and complicated process. Don’t go it alone. Seek the assistance of an elder law attorney to help you navigate the hurdles and paperwork.