3 Keys To Nursing Home Medicaid Eligibility

Nursing Home Medicaid has a bunch of eligibility factors you have to prove before you can win your case. Here we are going to look at three of the biggest ones which usually trip people up when they don’t have an experienced lawyer.

  1. Income Eligibility
  2. Asset Eligibility
  3. Penalties

Within a few months we went from panic on how to proceed to breathing a huge sigh of relief. My mother is getting great care she can afford and it would not of happened without Richard Shea.

Dale R. Client

Are You Under The Income Limit?

In order for an applicant to create nursing home Medicaid eligibility with their income, they must not receive more than $2,724 in income each month. If your loved one is over this limit the HHSC will deny their application. There is a way around this income limitation however, the Miller Trust.

The Miller Trust is used only for applicants that are over the Medicaid income eligibility limit. It is not an asset protection tool, it is an income eligibility solution.

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From our first contact, Mr. Shea treated me as if I were a family member and he quickly coordinated my mother’s care

Teresa F.

Are You Under The Asset Limit?

In order for your loved one to win their case on the issue of resources, they must not have more than $2,000 in counted resources. It is important to keep in mind that this limit only applies to “counted resources.” There are many assets that are exempt from Medicaid while others that many people think are exempt are in fact counted. A popular example is cash value life insurance that is intended to pay for funeral expenses or many kinds of retirement accounts.

Married Couples and Asset Limits

When a married couple with one spouse applying for Medicaid enters the picture, special rules apply to their asset limits. In this case, the applicant has an asset limit of $2,000, however the healthy spouse at home may have a slightly different asset limit. The rule of thumb for the healthy spouse’s asset limit is 50% of the combined asset value, which has a minimum and maximum set by law. The floor on this value is currently $29,724 in 2023 and a maximum of $148,620.

This does not mean you can keep $150,620 ($148,620 + $2,000). For example, if you have $75,000 in counted resources, under the default rules you will only be able to keep approximately $37,500. The rest will go to the nursing home.

For that reason, if you have assets above these limits then you need to recognize this early on and be proactive on how best to handle the excess; whether that be spending them down or arranging some form of proven protection plan. Understanding these complex rules is essential if you want to make sure you are taking full advantage of your rights.

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I cannot say enough good things about how Rich Shea helped me with the process of getting my father to qualify for Medicaid. I’ve hired a couple of other lawyers before and never received the response I received from Mr. Shea

Lori M.  Client

Do You Have Any Gift or Transfer Penalties?

A penalty is imposed for every transfer of assets by an applicant or his or her spouse in the last five years.

If your loved one has a penalizing transfer or event in the last five years (even those gifts the IRS does not tax each year) then they will not have nursing home medicaid eligibility until the penalty period expires. If this applies in your case, doing nothing about it until the money runs out is one of the worst things you can do.

Speak to me today about how we can minimize the damage from previous gifts and transfers.

Medicaid Eligibility Doesn’t Just Happen

We Make it Happen

  • If your parent or spouse is over the income limit, I can fix that.
  • If your parent or spouse is over the asset limit, I can protect their assets and get them under the limit.
  • If your parent or spouse has made gifts and may have a Medicaid penalty, I can minimize the damage and get them Medicaid as soon as possible.
  • If you need help getting through the application, I can walk you through the entire process.