By Attorney Elizabeth Durnell
A few weeks ago, Judy and Gary came into the office to discuss how to pay the nursing home bill they are anticipating for Judy’s father, George. George has been slowing down and can no longer be cared for at home. George’ doctor is recommending they place him in a nursing home. George’s estate is close to $300,000, and he worked a lifetime to build it. He wants it to go to his family, not the State of Ohio.
Here’s the problem: Judy and Gary understand that an individual must have less than $1500 in assets to have their benefits paid. Judy and Gary are worried that they must spend down all of George’s money for his care before Medicaid will begin to pay the bill, or they must keep George at home until all of his money is spent.
This is a common misconception in nursing home planning: you have to spend all your money before Medicaid will pay.
The main focus of my work at Cooper Elder Law involves nursing home planning. I often meet with the families of clients who will need to make gifts in order to qualify for Medicaid benefits and share the same worries as Judy and Gary.
The good news is, there is hope for these families. When a person makes a gift during the “look-back period,” which is the five years before a person is admitted to a nursing home, the person is placed on a Restricted Medicaid Coverage Period. During the Restricted Period, Medicaid will not pay for the person’s room and board at the nursing home. So, for George, this does not mean that he can’t live in a nursing home, it only means that he must pay privately for his care until the Restricted Period is over.
The Restricted Medicaid Period does not mean that you must pay for all expenses out of your pocket. Medicaid may cover services such as emergency room visits, ambulance services, hospital stays, surgery and anesthesia, if medically necessary. Medicaid may also pay for medical equipment such as wheelchairs, hospital beds, orthotics and prosthetics, diabetic supplies, canes, walkers and crutches, lifts, colostomy supplies and oxygen supplies. Finally, although there are some limitations, the following services are available as well: doctors visits, lab testing and x-rays, occupational therapy, speech therapy, physical therapy and hearing services. Prescription drug coverage may also be provided by Medicare Part D.
If you or a loved one develops a condition that may mean a nursing home is in your future, you should consult with an elder law attorney who can help you understand the rules that apply to Medicaid. This is not a good choice for do-it-yourself. You need to understand the complex rules that Medicaid has developed in order to protect the work of a lifetime.
