Medicaid Long-Term Care
Overview of Medicaid Long-Term Care (LTC)
It’s a crisis. Your senior loved one can no longer safely remain at home alone. Maybe you just can’t provide direct care, so your loved one needs the day-to-day attention a nursing home can provide. But nursing care is expensive—ranging anywhere between $7,000-$12,000 per month on average. How can any ordinary family handle such extreme costs when neither the senior’s income nor other assets match the expense?
Depending on your loved one’s situation, the answer may lie in making a plan that includes Virginia Medicaid Long-Term Care (LTC). When working with an experienced attorney to navigate this system, families can manage to preserve a legacy without going broke to qualify.
Medicaid LTC
Virginia Medicaid LTC is a joint federal-state insurance program that helps eligible Virginians pay for long-term care. Though people often want to stay at home because it is more familiar and gives a sense of independence, a loved one with significant physical or cognitive decline probably needs care in a nursing facility.
Nursing facilities are specifically designed to provide around-the-clock supervision or custodial care. These facilities assist people with basic needs, including feeding, bathing, and using the toilet. While few people can honestly say they hope to end their days in such a facility, the fact is that nursing homes provide seniors with socialization, regular meals, and forms of critical care that families often cannot for various valid reasons.
Qualifying for Medicaid
It’s important to note that Medicaid is not a handout. Medicaid Long-Term Care applicants must meet strict requirements to qualify for assistance.
Virginia Medicaid LTC is available to the blind and disabled (as defined under Social Security rules), but most of the time it is used by the third category—the “aged”—which is defined as those 65 and older. In addition to meeting one of these categories, an applicant must be financially and medically eligible.
To be financially eligible, a person must own $2,000 or less in “countable resources.” When the loved one in need of care has a spouse who will remain in the primary residence, the home is not included in the countable resources, nor are a portion of the collective assets.
Moreover, your loved one must meet a certain level of physical or cognitive incapacity to qualify—needing just a bit of help won’t get them in. Unless someone is already in custodial care, a pre-admission screening is required, in which Social Services personnel determine whether the person who would receive services is truly in need of nursing home level care.
Nonetheless, the strict financial eligibility criteria can lead to a “Medicaid crisis.” If someone meets the Medicaid medical requirements for nursing home care coverage but has more than $2,000 in countable resources, they are “too rich” to qualify for assistance. This puts them in the untenable position of potentially being unable to either pay for nursing home care or receive Medicaid LTC assistance. What’s worse, Virginia’s Long-Term Care Medicaid has a 5-year “look-back” period. Below-market sales of assets or gifts made in the 60 months before applying for Medicaid LTC can result in a penalty. In other words, despite being otherwise eligible for Medicaid LTC benefits, the senior will not receive them during the penalty.
But there’s good news. When working with an experienced attorney, families can qualify for Medicaid LTC while preserving resources for the well spouse or future generations.
How Promise Law Can Help
If you have a loved one in a care crisis, please call us. We offer a free consultation to help you. You start with our paralegal who will guide you in gathering the information necessary to determine whether your loved one qualifies. If they don’t, we can create a strategy to qualify for Medicaid LTC and counsel you through the steps to implement the strategy. We also frequently bring in the expertise of a geriatric care manager to assist in this process.
If you’re reading this because you think Medicaid LTC is a possibility down the road, please view Promise Law’s free Medicaid workshop. The workshop is available “on-demand” and provides an explanation of the essential rules to understanding Virginia Medicaid Long-Term Care.