An Elder Care Lawyer Can Help You Get Medicaid Home Care

The over-65 crowd is growing dramatically. Millions of Baby Boomers are transitioning into older adulthood and are living longer than previous generations. According to recent U.S. Census Bureau data, the U.S. population over the age of 65 is expected to balloon from about 56.1 million in 2020 to about 82.1 million in 2050.

This growing population segment is looking for ways to live their lives as completely as possible. Through lifestyle choices, such as eating healthfully, exercising regularly, and socializing in their communities, older adults can improve the quality of their lives.

Another way seniors are creating healthier lives is by living in their homes longer and opting to receive care at home. For many, this option reduces the stress of moving into a nursing home or assisted living facility. Aging in place also helps one retain a greater sense of independence.

Many seniors want to receive home care not only because of the benefits but also because of the frustrations they say they are experiencing with the current health care system in the United States. According to a recent study by The John A. Hartford Foundation, four out of five older adults say the U.S. health care system is not prepared for the changing needs of America’s growing senior population.

The option to receive health care at home is a growing need. Home health care is not without its costs, though.

For seniors who are struggling financially, Medicaid can provide financial assistance for home care services. However, since the federal government and the individual states run Medicaid jointly, benefits coverage is different in each state.

Qualifying for Medicaid is not only state-specific but also can be a complicated process. With the help of an elder care lawyer, seniors can navigate the Medicaid application process and more easily realize the benefits that will help them live more comfortable, independent lives.

Medicaid Eligibility Requirements for Home Care

Medicaid covers various long-term care services, including home health care, caregiver support, and personal care services for such activities as dressing, bathing, and meal preparation. However, qualifying for Medicaid home care involves meeting stringent financial and functional eligibility criteria, which vary from state to state.

Income and Asset Limits

Medicaid has strict income and asset thresholds that determine whether an applicant qualifies for assistance. The limits depend on the state in which the applicant lives, but they generally require individuals to have limited income and assets. Check your state’s Medicaid income and asset limits. Individuals with too much in savings, investments, or other assets might be denied Medicaid coverage.

Functional Needs Assessment

Besides financial eligibility, Medicaid requires applicants to demonstrate a functional need for home care services. A comprehensive assessment is often conducted to evaluate the applicant’s ability to perform daily activities.

How Elder Care Lawyers Help Seniors

Navigating Medicaid’s complex requirements can be overwhelming for seniors and their families. Elder care lawyers specialize in helping older adults manage legal, financial, and health care issues, including qualifying for Medicaid. Here’s how they can help:

Medicaid Planning and Asset Protection

Elder care lawyers can play a crucial role in Medicaid planning. This may involve legally structuring an elder’s finances to ensure they meet Medicaid’s strict asset limits using strategies such as:

Spending down: This refers to using excess assets to pay for medical care, home improvements, or other approved expenses, reducing the senior’s assets to Medicaid-qualifying levels.
Creating a trust: An elder care lawyer can help a senior transfer assets into certain types of trusts. For example, a Medicaid Asset Protection Trust (MAPT) or a Miller Trust can remove those assets from one’s personal estate so that they don’t count toward Medicaid’s asset limits.
Gifting strategies: Medicaid has a lookback period (usually five years) that penalizes asset transfers or gifts made below fair market value. An elder care lawyer can help structure gifts and transfers in a way that minimizes penalties.

To make the most of Medicaid planning, be sure to work with an elder care attorney before you actually need long-term care.

Navigating the Medicaid Application Process

The Medicaid application process is complicated and often requires submitting extensive documentation, including proof of income, assets, and medical needs. Elder care lawyers help:

Collect and organize necessary documentation: They can help ensure that all paperwork is in order before submission, reducing the risk of delays or denials.
Avoid mistakes: Errors in the application process, such as misreporting assets or failing to disclose relevant financial information, can lead to delays or even disqualification. Attorneys specializing in elder law can help clients avoid these pitfalls.
Appeal denials: If a Medicaid application is denied, elder care lawyers can represent seniors in the appeals process, helping them address any issues raised by Medicaid.

Protecting Spouses Through Medicaid’s Spousal Impoverishment Protections

For married seniors, qualifying for Medicaid can be especially challenging since one spouse may need Medicaid while the other does not. Elder care lawyers can assist in navigating spousal impoverishment protections. These standards, which vary by state, allow the healthy spouse to retain a certain amount of assets and income while the other spouse qualifies for Medicaid. With the help of an elder care lawyer, the healthy spouse can therefore remain financially secure.

Originally, spousal impoverishment rules applied only to married couples where the Medicaid spouse received care in a nursing home. Lawmakers have temporarily extended these protections to the spouses of patients receiving home health care through Medicaid waivers. Under current law, spouses of Medicaid patients receiving home health care will have these protections only through September 2027. Unless lawmakers extend this deadline, some states may no longer offer the same impoverishment protection for these spouses.

Paying a Family Caregiver

The majority of older adults who receive care in their homes rely at least partly on family members or friends for their care. Often the family members and friends provide this care for free. This can strain the finances of some caregivers if they have to take time off from work or leave the workforce entirely.

The good news is that Medicaid in most states will pay a family member to provide home care to an aging relative. The requirements  to qualify for this Medicaid benefit vary by state. An elder care lawyer can help you navigate the process of getting compensation for a caregiver.

Long-Term Care Planning

Medicaid home care can be a solution for immediate needs, but elder care lawyers also help seniors plan for future long-term care needs. This may include:

Developing a comprehensive estate plan that aligns with Medicaid eligibility while ensuring that the senior’s assets are distributed according to their wishes.
Establishing a guardianship or conservatorship if a senior is no longer able to make decisions for themselves. This ensures that a trusted individual manages their financial and medical affairs.

Veterans’ Benefits and Medicaid

Seniors who are veterans may be eligible for additional benefits. For instance, Aid and Attendance through the Department of Veterans Affairs can supplement Medicaid home care services. Elder care lawyers with experience in both veterans’ benefits and Medicaid can help coordinate these programs to maximize care.

Learn More About Medicaid

Qualifying for Medicaid home care is essential for low-income seniors who wish to receive care at home rather than in a nursing home. Elder care attorneys can provide critical support by helping seniors navigate Medicaid’s often complex financial and functional requirements. They can help seniors protect their assets and ensure that they receive the care they need while maintaining their financial well-being.

For families facing the challenge of securing care for aging loved ones, the guidance of an elder care lawyer can be invaluable, providing peace of mind and a clearer path forward. Connect with us for a consultation. We can also be reached by phone at 513-672-6119 or by email at oksmith@cmrs-law.com. Our office is in Cincinnati, OH, with clients throughout the Greater Cincinnati area, Northern Kentucky, and the surrounding counties. We look forward to working with you.

For additional reading on home care, Medicaid, and related topics, check out the following articles:

Using a Trust in Medicaid Planning
Report: Planning for America’s Aging Population
Beware of Medicaid Income Limits When Receiving an Inheritance
Protect Your House When You Want to Qualify for Medicaid