Medicaid available for home care

By Sanfrod R. Altman, Esq.

Question:
My parents, whose health is beginning to fail, are becoming increasingly concerned about the prospect of needing long term care. We help them as much as we can and would certainly rather keep them home than in a nursing home. Is there any help available for home care?

Answer:

This is one of the questions most often asked by my clients. Understandably, the goal is to stay at home as long as possible. However, home care costs can run as high as nursing home fees. For example, I have one client who had been paying $2,000 per week for round-the-clock home health aides. To complicate matters, although all states are now mandated to have a plan in place for care in the community rather than in an institution, there simply are not enough qualified individuals to provide such care (and, not surprisingly, the State plan is not yet in place).

However, the good news is that there may be help available. If you qualify, Medicaid will pay for a certain amount of home care. The better news is that the helpers that they pay are not required to be from a home care agency, but can even be family members or friends who are providing the care.

Medicaid eligibility is based upon need - both your income and assets are taken into account. In the case of a married couple where only one spouse is applying, the standards are the same as if that spouse were going to be in a nursing home. This is referred to as “Spousal Medicaid.” While the exact amount of allowable income and assets changes each year, suffice it to say that the non-applying spouse is permitted to retain a great deal more in assets and to receive a much higher income than the spouse applying for Medicaid. Transfers from one to the other may be done without Medicaid penalty so that there is much more flexibility and planning possibilities when dealing with a married couple. Individual (non-married) applicants for Medicaid do not have the option of spousal transfers, but their allowable income, while still low - currently under $700.00 per month - is significantly higher than the $50.00 per month allowed for nursing home applicants.
Whether you are single or married, having too high an income does not necessarily exclude you from Medicaid. If otherwise eligible, you will be asked to spend down your excess income on medically related items (home care, medicines, doctors, etc.) before Medicaid will pick up the tab. Excess assets may also be reduced by gifting since there is no penalty or waiting period for gifts when applying for Medicaid for home care. Nonetheless, any such gifting must be undertaken with extreme caution because, in the event nursing home admission is then required, the gifts may cause you to lose your Medicaid benefits.

How much home care will Medicaid provide? Unfortunately, we never know the answer to this until your application is approved and they send someone to your home to assess your needs. The range that my clients have received has been from a few hours a day to round-the-clock (very rare). The less free help you have available and the worse your condition, the more they will give you. In addition, and well worth mentioning, is that there are some services and programs which are only available if you are on Medicaid.
Planning for home care Medicaid and the application process may both be quite complex and may require guidance from a professional. However, if you are looking to remain in your home, Medicaid may well be the means to reaching your goal.

Sanford R. Altman is an Elder Law Attorney with a firm in Orange, Dutchess and Sullivan Counties, a member attorney of the AARP Legal Services Network and frequently writes on Elder Law issues for local publications. He may be reached at the following number (845) 778-2121 or sra@jacobowitz.com. Please note that while this column is intended to give general legal information, everyone’s circumstances differ. This column is not a substitute for obtaining legal advice directly from an attorney which will address your particular circumstances.