- Elder Law
- Family Law
Medicaid, unlike Medicare, is a means tested program. The law pertaining to Medicaid is found in Title XIX of the Social Security Act, 42 U.S.C. 1396, dating back to 1965. To qualify for Medicaid, the applicant must be a United States citizen or a lawfully admitted, qualified permanent resident, and a resident of the State of Texas. Medicaid provides medical care for low-income individuals who are aged, blind, or disabled. Funding for Medicaid comes from both the federal government and the State of Texas. Examples of Medicaid benefits include: inpatient hospital care; inpatient nursing home care for persons 65 and older; home health care; medical services; dental services; and, hospice.
When medical necessity demands an individual have full time care, the nursing home is a feasible option for the individual and her family. Medical necessity is a strict standard, and it is not merely a situation where the individual requires assistance performing activities of daily living, such as bathing, grooming, dressing or eating. Many individuals work their entire lives and save for retirement, but if they require nursing home care for a serious medical condition such as advanced Alzheimer’s Disease, savings deplete quickly. In fact, many individuals exhaust their savings after as few as 26 weeks in a nursing home.
In Elder Law practice, nursing home care if the primary objecting in Medicaid planning. The application process is rigorous in order to preserve resources for those in need. Applicants must make full disclosure of all resources. There is a look-back period wherein caseworkers scrutinize an applicant’s financial transactions. The present look-back period is five years. For example, if an applicant transfers an asset for less than fair market value to someone other than his/her spouse and applies for Medicaid within 60 months of that transaction, there may be a penalty period in which the applicant is ineligible for Medicaid benefits.
There are different eligibility standards for single persons and married couples, and assets are divided into countable and non-countable categories. Each January the amount of resources both individuals and married couples may have to qualify for Medicaid are revised.
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