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I have written in past blog posts about Medicaid’s 5 year look back and the need to be familiar with the transactions that Medicaid will be reviewing.  We still, however, receive many calls where a quick spend down to Medicaid is necessary. In the case of a married couple where only one spouse is applying for benefits, the spend down is especially important to the healthy spouse.  Determining the amount that spouse can keep under the community spouse resource allowance (CSRA) is one part of the process.  Countable assets are divided in half and the healthy spouse can keep 1/2 of the assets but only up to a certain maximum amount ($154,140 in 2024). In addition to countable assets, the healthy spouse can keep exempt assets such as a home (if either spouse is living in it) and one car.  There is no limit to the value of these assets which leads to opportunities to maximize what the healthy spouse can keep, an important consideration since we never know how long that spouse may live or what his/her needs may be. The potential of a Medicaid penalty, however, is another important piece to the equation.  A significant penalty which is effectively tacked on to an expected Medicaid start

In this week’s post I will review the updated numbers for 2024 for the VA program that provides a benefit to wartime veterans and their spouses.  Known as the VA Aid and Attendance program, this benefit provides a special pension to eligible applicants who need long term care. The maximum pension amount is tied to the same cost of living adjustment as Social Security, which for 2024 is 3.2%. For a single veteran with no dependents the maximum pension one can receive goes up to $2300 per month.  For a married veteran the maximum for 2024 will be $2727.  For a widowed spouse who needs care the 2024 maximum will be $1478 per month. The Aid and Attendance program is a needs based benefit.  This means that to be eligible one must meet a financial test.  Different than Medicaid, the VA uses a net worth test.  It calculates the applicant’s (in the case of a married couple both spouse’s) annual income and adds that to the countable assets.  This is known as the net worth.  For 2024 the net worth must be no more than $155,356 to qualify for this benefit. Existing VA A&A recipients should have received a letter from the VA informing them of the new amount they will

Last month in this blog I updated you on some of the new Social Security and Medicare numbers for 2024.  The recently announced cost of living adjustment (COLA) of 3.2% has resulted in a much smaller benefit increase than the past 2 years. Many other federal programs are tied to the Social Security COLA.  These include Medicaid and the VA Aid and Attendance programs.  This week we will review the 2024 Medicaid numbers.   Medicaid’s programs that cover long term care have a strict income cap or limit.  For 2024 that number is $2829 per month.  Anyone with more than $2829 per month of gross income (before taxes and Medicare and health insurance premiums are deducted) must use a Qualified Income Trust in order to qualify for Medicaid. Medicaid recipients must also have less than $2000 of countable assets.  A home is an exempt asset up to a certain limit as long as the applicant is living in it.  In 2024  the limit is $1,071,000 of equity.  Anything above that amount is countable.  For a married couple where at least one of the spouses is living in the home there remains no limit.  In other words, the home is exempt in that case no matter the value. In the case of a married couple where only

In my blog post last week, I explained that John was unsuccessful in his attempts to obtain Medicaid benefits for his mom.  He then ended up being sued by the facility for the amount of unpaid bills which were not covered by Medicaid.  But why did his repeated attempts fail? From my conversation with John it became readily apparent that he didn’t entirely understand the Medicaid process - how detailed and complex it is.  The first application he filed was denied.  I asked him the reason but he couldn’t recall.  It was clear, however that the level of detail overwhelmed him.   John said he basically kept refiling the application at least 3 more times but he didn’t address the specific reasons for each denial.  It sounded as if he was almost taking a stab in the dark, hoping to hit on the solution.  That never works and so I completely understood why he failed each time. What made the problem worse is that with each passing month, John said no one approached him about the unpaid bill so he assumed everything was fine - until he received the summons and complaint. Finally, John asked me if he could appeal any of the denials.  Unfortunately, I told him that there is a strict

In my blog post last week I told you about John’s call to our office.  John had made several unsuccessful attempts to obtain Medicaid for his mom who was in a nursing facility.  He called because he had been sued by the nursing home where his mom had been residing.  The facility was looking for payment of nursing home fees totaling $100,000 with attorneys fees and costs of the lawsuit added on to that. He said that during the time he was attempting to obtain Medicaid benefits, the facility never asked for payment.  He wanted to know my opinion as to whether he could be held responsible.  After reviewing the admissions agreement that he signed, I told him that he could  possible be on the hook. Although John admitted to me that he never read the admissions agreement, he signed it as resident representative on behalf of his mother.  The agreement contained  several pages of language concerning filing a Medicaid application as well as what is expected of the resident representative.  The agreement also stated that the facility “encourages the Resident representative to utilize the assistance of the Facility’s Medicaid representative”.  This is typically a company that the facility uses to process applications. Other language in the agreement gave the facility the right

We received a call some weeks ago from a caller named John, whose mother was in a nursing facility.  He had attempted several times to qualify her for Medicaid.  Each attempt was unsuccessful.  After the last unsuccessful attempt he took his mother home to “regroup”.  John called our office when he received a summons and complaint filed on behalf of the facility seeking payment of unpaid bills totaling approximately $100,000.  I explained that we don’t handle these types of lawsuits.  Rather, we file Medicaid applications on behalf of our clients. John then asked me whether, in my opinion, he could be held responsible for the unpaid bills.  He told me that the facility had told him what to provide to Medicaid and never said anything about the unpaid bills while he was working thru the application process for Medicaid. He also asked me whether I could handle an appeal  of the most recent denial of benefits and get Medicaid to cover his mother’s care  dating back to when she applied. Next week I’ll share with you what I told him.