What is Medicaid?
Placing a loved one in a care facility is a difficult decision which often must be made quickly, and preparing financially just adds to the stress. Katten & Benson can help you navigate through the regulations and requirements so that you may concentrate on caring for your family member – and yourself.
Medicaid application and qualification is a lengthy process, and can influence or change many aspects of a person’s life. Therefore, at Katten & Benson, you will always meet with one of our attorneys, and an attorney will oversee the qualification process. We believe it is important to have an attorney fully engaged in the qualification process, as many legal issues can come up during qualification. Our attorneys can also provide you with many of the legal documents you may need, such as a Miller Trust, Lady Bird Deed, Mineral Deed, and Warranty Deed and Partition Agreements. Not sure what these are? Please call our office – we would be happy to explain how they may benefit you.
How are Medicaid and Medicare different?
Medicaid is a federally funded, state administered program which helps pay for long term care costs. Nursing home care is expensive, and many times the only long term option to pay for care is to apply for Medicaid. Medicare, on the other hand, is federally funded, federally administered health insurance for those over 65. Medicare does have a limited long term care benefit: for those on regular Medicare, the benefit is 20 days, and possibly up to 100 days (with a daily copay) if a person qualifies. If you have a Medicare Advantage Plan, your benefits may differ. However, most people will need a longer stay at a nursing home, and may need to qualify for Medicaid.
What are the Medicaid qualifications?
There are three main requirements to qualify for Medicaid:
- A person must demonstrate medical necessity – that is, a doctor or the facility must certify this person needs 24-hour skilled nursing care.
- The qualifying individual’s income must be under $2,163.00 (gross) per month.
- The qualifying individual’s countable resources must be under $2,000.00. Exempt assets, which do not count towards this limit, are a home, one vehicle, a prepaid burial policy, and certain very small life insurance policies. All other resources count towards the $2,000.00 limit.
At Katten & Benson, we assist our clients by identifying the method for qualification best suited to the client’s needs. We then submit the paperwork and associated documentation, and we monitor the case until certification is received from the Texas Health and Human Services Commission.
I’m married, and my spouse needs to go to a nursing home. Do the rules change for a married couple?
Yes. Spouses who remain at home, called the community spouse, are allowed to keep all of his or her income, and possibly some of the incapacitated spouse’s income, as well as many of the couple’s assets. Spousal qualification is more complicated than qualifying a single person. We suggest that you make an appointment to determine if you or your spouse qualify for Medicaid.
I’ve heard the State will take my house. Is this true?
No. While the State of Texas does have a Medicaid Estate Recovery Program, this program only goes into effect after a person has qualified for Medicaid benefits and passes away. Under current regulations, surviving spouses are exempt from recovery attempts. Additionally, there may be ways to avoid estate recovery all together. Please call our office for an appointment to learn how the Medicaid Estate Recovery Program works and discuss these options.
Do you offer free consultations?
No. We find that many of our clients gain valuable information even if we are not able to assist them past the first consultation. However, if you come in for a consultation and decide to hire us to do additional work, we will credit your consultation fee toward the total fee quote. We charge $300.00 for a Medicaid consultation.