You know that Medicaid can pay for long-term care, and that it’s basically the long-term care insurance policy for the middle class. But the question remains: Can it pay for your care? Are you eligible?
Eligibility for Medicaid can be complex. It depends on the sub-program, age, where you reside, the level of care you need, assets, income, and a host of other things. Remember that Medicaid is not a single program, but many. It’s too confusing to talk about all of them at once.
This post is about eligibility for the Medicaid program that applies to most of my clients—the one that pays for long-term care in a nursing home for the elderly, blind, or disabled (what I’ll refer to as EBD Medicaid).
When it comes to EBD Medicaid in Wisconsin, I like to break eligibility down into two categories:
- Nonfinancial Eligibility
- Financial Eligibility
This is the basic stuff. You must be in the demographic group that benefits from EBD Medicaid. Most clients already meet these requirements just because of where they live and who they are.
- You must be a citizen of the United States (or, in some cases, a resident).
- You must be a Wisconsin resident.
- You must be elderly (65 or older), blind, or disabled.
Other Medicaid programs cover residents who need help but are not elderly, blind, or disabled.
You must also have a medical need for long-term care. Exactly what counts as needing long-term care can get complicated, but this usually gets assessed before entering a nursing home or other medical institution.
Medicaid is a means-tested benefit, which means it is only available to people with income and assets below a certain level.
- Your income must be less than your medical expenses (likely if a nursing home is billing you $8,500 per month).
- If you are single, you must have $2,000 of assets or less.
- If you are married, you must have less than $50,000 to $123,600 (depending on your situation).
There are many exceptions and nuances to these rules, though. For instance, you usually don’t have to count the value of your house or your spouse’s retirement account. But beware of divestment—giving money away can cause ineligibility.
Financial circumstances are the largest obstacle to eligibility for long-term care Medicaid. Many people in a nursing home simply pay the bill each month, waiting until their savings are depleted.
There are often better ways to use those savings. I help clients use their money for good, plan ahead, and become eligible for Medicaid sooner without running afoul of hidden rules and regulations. Financial eligibility for Medicaid is something you can—and should—be proactive about.
But It Depends
The lawyer answer: it depends. Everything depends on your situation. Especially with Medicaid, for every general rule there are a thousand exceptions, alternatives, and conditions to keep in mind. When you have a huge government program, that’s unavoidable. It’s just part of the bureaucracy.
That’s why people need an expert. You need someone who knows the rules; someone who knows how to ask the right questions; someone who can give you options and help you make the right decision for you; someone trusted who is on your side.