There is a high probability that every family will be affected by nursing homes in some way. Based on this, along with the potential for financial ruin, the concept of planning for nursing facility care must be a priority to every family.
In order to receive Medicaid benefits, many believe that a simple "transferring of assets" will cause a nursing home resident to become eligible. This is simply not true. Transferring assets is not permissible. The government will not allow you to simply give assets away in order to reduce one's asset level so that he or she can become eligible for Medicaid benefits. There are very strict rules prohibiting Medicaid benefits. There are very strict rules prohibiting the transfer of assets in oder to become eligible for Medicaid. As well, asset transfers could be a criminal act.
THESE RULES CURRENTLY APPLY IN THE STATE OF LOUISIANA. ALL INFORMATION CONTAINED WITHIN THIS SECTION IS SUBJECT TO CHANGE.
II. Medicaid a. All (total) Medicaid -- in this case, the resident has NO income. b. Medicaid/Private Liability -- in this case, the resident may have Social Security, Retirement, or dividend income. Medicaid will then pay the difference in the rate set by the State of Louisiana and the private liability paid by the resident. After being certified for Medicaid, the resident becomes "QMB Qualified." This means that the resident is a "Qualified Medicare Beneficiary." Medicaid will then begin to pay the resident's Medicare premium and the resident's Medicare deductible.
c. Medicaid/Sposual Impoverishment
The spouse entering the nursing facility must first meet Medicaid eligibility before he or she can give his or her spouse any income.
In order to receive any type of Medicaid benefits, there must not have been any transfer of property or money for the past 36 months. This includes transferring money or property to children, or other family members, rather than using it for medical or necessary expenses for the resident during the 36 month period of time immediately prior to admission of the resident to the nursing home.
It should be noted that funds or property transferred by anyone acting as "power of attorney" on behalf of the nursing home resident shall be treated the same as if the nursing home resident made the transfer of funds or property himself or herself.
A nursing home resident can have a burial policy. The funeral home of choice must be made the "irrecovable owner" of the policy to keep the policy from being a "countable asset" under Medicaid.
The reason that property in the form of a "HOME" is "exempt" from being a "countable asset" is because the "home" is being held for the patient's return, or the spouse is living in it.
The reason that property in the form of an "AUTOMOBILE" is "exempt" from being a "countable asset" is due to the presumption that the resident or spouse living at home must have reliable transportation.
III. Medicare
The Medicare program is administered by HCFA (Health Care Financing Administration) and the Department of Health and Human Services (DHHS).
Medicare Part A premiums are paid through employment taxes during the course of a person's work history. Medicare Part B premiums are financed through a voluntary premium of $43.80 (1998 premium) There is a "benefit period" under Medicare Part A that applies to SKILLED NURSING FACILITIES. The benefit period is up to a maximum of 100 days "per spell of illness." In a "Skilled Nursing Facility," Medicare Part A pays based on:
Medicare Part A will pay 100% of services during days 1 through 20.
Medicare Part A will pay 80% for days 20 through 100. The remainder must be paid privately at a rate of $95.00 per day or through co-insurance such as Blue Cross/Blue Shield or AARP.
Medicaid pays for room and board, physicians' visits, Medicaid-approved medications, and daily nursing care. These residents receive $30.00 per month from SSI (Social Security Insurance). As well, the State of Louisiana provides an $8.00 month supplement check. This money is to be used for monthly personal needs such as diapers, clothing, burial insurance, etc.
The sum of the TOTAL monthly income less $38.00 per month (for monthly personal needs such as diapers, clothing, burial insurance, etc.) less hospital supplement policies (examples of these are Blue Cross/Blue Shield, AARP, etc.) will be paid to the nursing facility. This is called private liability. The resident owes the private liability each month.
If a resident enters a nursing home, a spouse at home may keep up to $2,019.00 of monthly income and $80,760.00 in resources, excluding the home and the newest automobile owned by the husband and wife.
Medicare is a FEDERAL insurance program for:
a. Age 65 and older
b. Disabled for 2 years or more
c. End stage renal dialysis (ESRD)
a. Part A covers the following:
More about Medicare Part A:
1. In-Patient "Skilled" care in a nursing facility
b. Part B covers the following:
2. In-Patient Hospital Care
3. Home Health and Hospice Care
1. Physicians' services
2. Out-Patient Hospital Services
3. Home Health Services
4. Physical, Speech, and Occupational Therapies
5. Some Supplies
IV. Long Term Care Insurance
a. Qualifications of the resident based on the NEED for skilled services.
b. A hospital stay of at least three (3) midnights which precedes admission to the skilled nursing facility by no more than 30 days.
Today many individuals are choosing to purchase long term care policies which cover all or a portion of a stay in a long term care facility. It is advisable to purchase a policy such as this, particularly if an individual has a significant amount of assets which could be "countable" under Medicaid.
V.A. Benefits (at some nursing facilities)
Some nursing facilities accept payment from the Veteran's Administration for qualified beneficiaries. See Garden Park Nursing Home.
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