What You Need to Know about Assisted Living Planning and Medicaid

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What You Need to Know about Assisted Living Planning and Medicaid

Assisted Living Planning and MedicaidWith an aging population, we at Meurer Law Offices in Denver have more clients who inquire about assisted living planning and Medicaid. The rules surrounding long-term care and Medicaid can be quite complicated. Here is a general overview you are looking into long-term care for someone who will need Medicaid.

What is Long-Term Care?

Both assisted living services and nursing homes are considered to be types of long-term care. Long-term care includes both personal services and medical services, particularly for people with illness(es) or disabilities. For example, a nursing home resident may pay for medical services as well as pay for help with bathing and dressing. Medicaid rules differ from other services when it comes to long-term care, so it is important to understand when nursing home planning.

State Requirements

Federal laws mandate that states provide specific services to those who are on Medicaid. For example, states are required to pay for nursing facilities for Medicaid recipients as well as home health care for those Medicaid recipients that would qualify for assisted living or a nursing home. States can use Medicaid funding voluntarily to provide additional long-term care services such as adult-foster homes, help with medication management, rehabilitation, and housekeeping.

Long-Term Care Facilities are Not Required to Accept Medicaid

When taking on assisted living planning and Medicaid, it is important to understand that not all nursing homes or assisted living facilities are required to accept Medicaid. You should inquire with the facility you are considering to determine whether it accepts Medicaid. Facilities that accept Medicaid are licensed by the state and must meet federal standards, as well as be subjected to regular inspections.


Medicaid is not only supplied to the elderly in need, but it can also be used for children and young adults whose circumstances qualify them for it. Regardless of age, Medicaid will only pay for a long-term care facility if such a facility has been proved to be medically necessary for the person involved. All states require that your doctor certify that the patient needs to be in a long-term care facility in order for Medicaid to cover such services.

Financial Eligibility

When it comes to assisted living planning and Medicaid, remember that each state has been allowed to determine maximum asset and income requirements. Many states have chosen to use the asset and income guidelines that are used for the Supplemental Security Income (SSI) program, while other states have set their own requirements. If you find yourself with too many assets, talk to us about a Medicaid Spend Down which may help you qualify.

Limits on Income

In many states, you can have up to 300% of the SSI income limit and qualify for Medicaid for your nursing-home needs only. It is important to understand that the type of care that you need may change the income guideline used. For example, some states have in-home care services and the income limit for those services is lower than it is for nursing home services. Your local Medicaid office can help you determine which income limit will be used for the services you require.

Limitations on Resources

The states that use the SSI standards have a $2,000 limit on assets for one person (of the assets that are considered to be countable). If both persons in a married couple are receiving care, the limit on assets is $3,000.

Now, not all assets are included automatically. For example, the patient’s home is not always included. It is important to refer to your state’s Medicaid agency. If your assets put you above your state’s limits, you may need to spend your resources down. Some states do not allow this, so it will be important to check. Many people enter long-term care as private pay patients, which means they pay for their care out of their own pockets until they become eligible for Medicaid for long-term care.

Other states offer a form of insurance to assist with payments in conjunction with Medicaid. By contacting the Meurer Law Offices, we can look at all of your options.

Asset Transfers

If you plan to make any asset transfers when addressing assisted living planning and Medicaid, remember that Medicaid requires that you get fair market value for any assets within the last 5 years from the time of application.

If, for example, you gave your vacation home to your children last year and applied for Medicaid this year, you may be subject to a waiting period penalty. The penalty period divides the value of the asset by the average monthly cost of long-term care. The penalty will not be imposed until you apply and qualify for Medicaid. This means it is possible to pay out of pocket to spend down, apply for Medicaid and then be subject to the penalty if you transferred an asset for less than fair value in the last 5 years.

Impoverishment Protection for Spouses

If one spouse needs long-term care but the other does not, the healthy spouse can keep some income and assets. Each state has determined its own “spousal protection” rules. Such rules range from allowing a spouse to keep as little as $24,180 to as much as $120,900. The rules for a spouse keeping income can be complicated, so you may want to consult with a lawyer, such the Meurer Law Offices in Denver which specializes in assisted living planning and Medicaid.

Medicaid Estate Claims

If you receive long-term care via Medicaid and are over 55, or if you are younger than 55 but were permanently institutionalized, your state Medicaid program will be eligible to have a claim against your estate for the amount spent on your care. The state will wait to attempt recovery until after the death of your spouse and only if your dependent children are not minors or disabled. Some states can also recover the cost of other expenses.

If you want to plan your future and have concerns about assisted living planning and Medicaid, come see us at the Meurer Law Offices in Denver. We can help you with all of our state’s laws, explain the complexities of nursing home planning, as well as prepare your estate so that you, your spouse and all of your assets are protected.


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