Play Medicaid-opoly
Qualifying for Medicaid, regardless of need, has become like playing numbers in the lottery. The rules are increasingly complex. What is especially disturbing is the amount of misinformation obtained even from people who might work within the medical delivery system. As one result a person who needs care and whose assets are low enough to qualify for Medicaid might be denied because innocent mistakes were made along the way, or a person who qualifies now might not know to apply.
As one man stated to me recently “I get a different answer from everyone I ask.”
Since many readers have followed this column for years, I thought it would be interesting to test their knowledge with a game of my making which I’ll call Medicaid-opoly. Readers should answer the questions themselves and then present the questions to attorneys, financial advisors, and case managers. I will provide the answers in a later column.
Qualification Questions –Answer True or False.
- Medicaid is only available to persons 65 years old and older.
- Medicaid benefits can be received in the home under certain circumstances.
- All states in the U.S. have the same Medicaid rules because Medicaid is a federal program.
- If a recipient is receiving benefits under Medicaid in Pennsylvania and moves to another state, she does not have to reapply for benefits because benefits follow her to the other state.
- All persons receiving SSI (Supplemental Security Income) in Pennsylvania also receive Medicaid.
- Only government operated nursing homes accept Medicaid as payment for care.
Spousal Questions. Multiple Choice.
- If a husband in Pennsylvania needs to move to a nursing home, his wife who remains at home: (a) needs to sell the home immediately; (b) can keep their home during her lifetime but, if her husband goes on Medicaid, her estate must give the home to the State; (c) can keep their home during her lifetime and there is no claim against her estate even if her husband goes on Medicaid unless she dies before he dies.
- When a spouse who is receiving care in a Medicaid certified facility applies for Medicaid, his spouse at home might keep: (a) all of their assets and all of their income; (b) half of their assets but all of their income; (c) all of their exempt assets, about half of their non-exempt and available assets up to a maximum and no lower than a minimum, all of her income, and sometimes, depending on circumstances, some or even all of his income.
Gifting Questions – Answer “Yes,” “No,” or “It Depends”
- If a father gives $12,000 to his daughter and another $12,000 to his daughter’s spouse in 2008 and then suffers a stroke in 2009 causing him to need nursing care, will he be able to qualify for Medicaid in 2010 assuming that he has paid for his care up to that time, his assets are low enough, and he otherwise would qualify for Medicaid?
- If a mother, after her husband’s death, adds her daughter’s name to the title of her house, is this counted as gifting such that she could be prevented from receiving Medicaid if she applies for benefits three years later?
- The most important change that resulted from the Deficit Reduction Act effective February 8, 2006 is that it changed the lookback period to five years. Answer “yes” or “no.”
Extra Credit – Essay Questions
- Describe in one or two paragraphs what a Family Agreement is. Explain how it can be adapted for families who have a member who needs long term care and how it could relate to Medicaid.
- Name circumstances under which it would be best for an individual to obtain long term care insurance. Include the optimum age and asset range and any limiting factors. Do the same for a reverse mortgage.
- Describe what the government would consider to be an “undue hardship” under the Medicaid laws.
- Where an elderly person who has been victimized financially applies for Medicaid benefits while she is receiving nursing home care, can she qualify or would the funds taken from her be considered “uncompensated transfers” making her ineligible? Explain.
- Where a family member or friend receives “gifts” that would make the giftor ineligible for Medicaid for a period of time, is there a procedure for returning the gift? Is there concern as to how and when she returns it? Explain.
- Can any amount be given in Pennsylvania without concern? What is the amount and how can it be given?
Good luck.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.