Medicaid is a government program that pays for medical services for those who qualify, including nursing home care. To qualify for coverage you must meet medical eligibility and financial eligibility requirements.
Medical Eligibility
The Washington State Department of Social and Health Services (DSHS) will make a determination on the Long-Term Care needs of the applicant. An applicant is considered to need Long-Term Care when he or she requires substantial assistance with two or more of the following activities of daily living: eating, bathing, using the toilet, ambulation, transfer, positioning, and medication management.
If an applicant has a significant cognitive impairment, then he or she can qualify for Medicaid Long-Term Care if substantial assistance is needed with only one of the above listed activities of daily living.
Financial Eligibility
Financial eligibility for Medicaid involves income and resource (asset) tests. Your monthly income must be less than the private pay rate in the nursing facility plus your monthly medical expenses. Due to the high cost of care in a nursing home setting this requirement rarely disqualifies a person from benefits eligibility.
Resource eligibility is based on the total amount of resources you own. It is determined on the first day of the month that the Medicaid application is filed.  A single recipient cannot have more than $2,000 in non-exempt resources. Resource eligibility for married recipients is more complex, particularly when the recipient’s spouse will remain living at home. In these cases, eligibility is based on the total amount of resources that both spouses own. As a general rule, married couples cannot have more than $56,726 in non-exempt resources (community spousal resource allowance of $54,726 plus $2,000 for the Medicaid applicant spouse).
Some resources do not count toward the determination of resource eligibility. These are known as exempt resources. These exempt resources include your home (with certain limitations), your personal property, a vehicle, a burial plot or urn space, and life insurance policy valued at $1,500 or less.
If you have more than the allowable amount of non-exempt assets, there are ways to protect those assets while still obtaining Medicaid Long-Term Care benefits. A solid plan utilizing our Smart Spend-DownTM procedures can help you avoid unnecessarily depleting your assets. Let us help you explore the Medicaid Asset Preservation StrategyTM that is appropriate for you.
Whether you need to move into a nursing home or are already living in one, Elder Law Group PLLC can help you obtain the benefits you need. We will give you legal advice on the best options available to meet your objectives and protect the assets you have accrued over a lifetime.
Elder Law Group PLLC has been recognized as one of the fasted growing law firms in the U.S. as an Annual Law Firm 500 Award honoree. Contact us or call (509) 468-0551 (Spokane office), or (509) 579-0206 (Tri-Cities office), for personal, compassionate, and competent guidance on Long-Term Care planning, Asset Protection Estate Planning TM, or other legal needs of seniors, the disabled, or vulnerable adults and their families.