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Medicaid Planning Before and After a Loved One Enters a Nursing Home

Spouse in Nursing Home

In 2018, the average cost for a semi-private room in an American nursing home was $120,000.00 per year. With costs like that, it is easy to see why so many families have trouble getting their elderly loved ones into a decent facility. The federal insurance program called Medicaid can help with the expenses, but it takes time to get Medicaid in place before your loved one enters a nursing home, and it takes plenty of effort to keep Medicaid going after their stay has begun.

Planning In Advance

One of the biggest mistakes families make is thinking that Medicaid will automatically cover whatever nursing home costs the family cannot cover. Each person should talk to an elder law professional about the realities of Medicaid, and to an insurance professional about long-term care coverage. By adding long-term care coverage to a person’s insurance portfolio, it can be easier for the family to cover the rising costs of nursing home care.

Medicare Can Help In The Short-Term

Getting Medicaid approved can take time, and some families find themselves in a situation where their elderly loved one has to go from a hospital right to an assisted living facility. In many cases, Medicare will cover those costs for the first 100 days as long as the patient goes to a Medicare approved facility. Medicare can also be used to pay for 35 hours per week of in-home care if the patient is allowed to go home after hospitalization.

Medicaid’s Requirements

It is important to start the Medicaid application process as soon as you realize that your loved one will need to enter an assisted living facility. The situation can be helped if you can gain a level of guardianship by getting power of attorney for your loved one. This will make it easier to complete and file the paperwork.

Medicaid does have limitations for assets and income that can affect eligibility. But contrary to popular belief, a person does not need to be below the poverty level to qualify for Medicaid. Check with your attorney about your state’s Medicaid requirements and how you can get a Medicaid pre-approval that will allow your loved one to enter a nursing facility before the paperwork has been finalized.

The Process After Entering A Nursing Facility

A nursing facility does not require a finalized Medicaid agreement to accept your loved one. If your loved one has assets that can be liquidated to pay for the first few months of their stay, then the nursing home will allow residency while the Medicaid process is still ongoing. If it is determined that a prolonged stay in a nursing facility will completely exhaust the patient’s assets, or the ongoing assets such as a pension will not be enough to cover a long-term stay, then the family can apply for Medicaid.

If the patient owns property, then that can cause some challenges with Medicaid. It is possible to transfer ownership of property to the children to keep the property in the family, but Medicaid might require the liquidation of those assets to pay nursing facility costs.

It can take months to complete the Medicaid application process to help pay for the long-term stay of a loved one in a nursing home. The process begins before the loved one enters the nursing facility, and it will continue after the loved one has become a nursing home resident. The family should secure the services of an experienced Medicaid planning attorney and be prepared to fill out a considerable amount of paperwork for many months to come.

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