Medicaid & Long-Term Care Planning
Law Office of Natalie J. Miller advocates the rights of seniors for Medicaid. In addition to planning for the possibility of long-term illness, we advise clients and their families after such illness occurs. The rules of Medicaid eligibility change almost daily, becoming increasingly complex. There are pitfalls for the unwary, but there are also opportunities for the astute planner. We can help guide clients through this maze. We help prepare the complex Medicaid application and guide our client through the often lengthy approval process.
State and federal officials often deny Medicaid benefits to which applicants are entitled. We represent clients in the confusing administrative process to secure the benefits the system is supposed to provide.
Medicaid rules and regulations are very complex and change on an unpredictable and rather frequent basis. Asset preservation strategies must be carefully planned and implemented because certain asset transfers may cause ineligibility during a penalty period and trigger a tax to be due. It is very helpful to have a skilled attorney guide you through the process of obtaining benefits for someone in care without the need to spend every last dime. Attorneys at Law Office of Natalie J. Miller advise families how to change the status of assets, to acquire or fund assets that have exempt status, and to make appropriate transfers to create the best benefit for the client.
An applicant for Medicaid (program for nursing home coverage) or Special Assistance (program for assisted living coverage) must pass the following three-part test to qualify for benefits:
- Income: There is an income limit for Special Assistance that is usually revised at least yearly. The maximum allowable income for skilled nursing benefits is tied to the reimbursement rate at the facility in which the individual resides. It is important to note that once an application is approved for benefits, the person's entire net monthly income (less $30.00 for personal expenses) must be paid to the nursing home to cover a part of the bill for the resident's care (called a patient's monthly liability or PML). The benefits cover the rest for skilled nursing care..
- Medical Need: The individual must need the level of medical care provided. Medical need is determined by a physician and is indicated on what is called an FL-2 form. For Special Assistance, the individual must need the assisted living level of care; whereas the individual must require skilled or intermediate nursing care to qualify for nursing home care under Medicaid.
- Resources: To qualify for either program, an individual applicant must not own more than $2,000 worth of countable assets. Resources or assets are characterized as countable or non-countable.
Examples of Non-Countable or Exempt Assets
- Household goods and furnishings.
- One motor vehicle, regardless of value, used for medical transport.
- The home, as long as the person in care declares in writing the intent to return home.
- Irrevocable pre-need funeral contracts.
- Certain annuities.
- Term life insurance policies.
Examples of Countable or Non-Exempt Assets
- Stocks, Bonds, Mutual Funds, CDs, Savings Bonds, IRAs, 401Ks, 403Bs,
- investment accounts
- Trusts, depending on the terms
- Additional automobiles, boats, recreational vehicles, etc.
Treatment of married couples' assets differs between the Special Assistance and Medicaid, i.e., skilled nursing, programs. The Special Assistance program excludes any asset titled in the community spouse's name alone from the $2,000 limit, whereas, Medicaid looks at all assets owned by one or both of the spouses. However, if applying for Medicaid, the couple can use the Community Spouse Resource Allowance (CSRA) to avoid impoverishment of the spouse living in the community.
Our office uses creative tools and legal techniques to assist the elderly in achieving their goals and objectives. For example, under the Omnibus Budget Reconciliation Act of 1993, the State of North Carolina could seize your assets and sell them after your death to recoup the cost of the Medicaid benefits you received while alive. This is commonly called Estate Recovery. Property that was exempt during the Medicaid recipient's lifetime may be used to reimburse the state for the benefits paid. We can recommend the proper estate and tax plan to limit the risk to your property should you become incapacitated. We also can assist you in applying for Medicaid or appealing a negative decision.
| Consumer Guide to NC |
Medicare Savings Programs
Guide to Medicare Savings Programs provided by the NC Dept.of Health and Human Services, includes some information on Medicaid and other NC programs
|Consumers Guide to North Carolina |
Medicaid Programs for the
Aged, Blind, and Disabled
Guide to Medicaid Programs for the aged, blind and disabled provided by the NC Dept. of Health and Human Services, includes does an overview of the programs, of the eligibility requirements, and of the covered services.
Please contact us or submit your case for review on
our Case Review Page to discuss your Medicaid planning needs.
Please fill out the form below to contact us, or call 704-662-3557!