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Paying for Nursing Home Care

Paying for a Nursing HomeWhen the subject of nursing homes is being discussed, the topic of paying for nursing home care soon follows and thereafter inevitably, Medicaid. As the single largest payer for nursing home care, discussing Medicaid is a logical turn. What often goes unsaid though is the complexity of the Medicaid qualification process and what options exist to help families through this endeavor.

Surprisingly there are many different sources that claim to provide assistance in helping individuals to qualify for Medicaid. Less surprising is that many of these sources also stand to gain from helping the applicant qualify. This is not to say that these sources are without value; they can and do provide useful information and are of real assistance. What is required is for the applicant to understand Medicaid eligibility and to understand the motivations of their potential sources of Medicaid planning assistance. While this article touches on these subjects, a more detailed examination of 2013 Medicaid eligibility and a comparison table of Medicaid planning assistance options are available.

Medicaid eligibility is determined differently by each state but largely it is the applicant’s income and financial resources that are the determining factors. In 2013, a rule of thumb is that single applicants must have less than $2,130 / month in income and less than $2,000 in countable financial resources. Both monthly income and countable financial resources are open to a degree of interpretation and both of those numbers can vary up or down depending on one’s state of residence and the type of Medicaid for which they are applying.

We’ve identified eight types of industry professionals that offer expertise in Medicaid planning, which we have categorized into three groups. The simplest group to understand are those who undertake Medicaid planning as a fee-based service. This group includes Elderlaw Attorneys, Eldercare Financial Planners, Geriatric Care Managers and others who simply specialize in Medicaid planning. These professionals charge a fee, sometimes a flat fee, sometimes on a sliding scale and other times dependent on the services provided. Though costly, these professionals assuredly do not have a conflict of interest and, barring any disreputable individuals, can be counted on to have their clients’ best interests in mind.

The second group of professionals are public employees. In this category we include Case Managers, SHIPs Counselors and Long Term Care Ombudsmen. While this group invariably has the Medicaid candidate’s interest in mind, they are conflicted in that as state employees they cannot advise their clients on what to do when they do not automatically qualify for Medicaid. For many individuals who are on the cusp of qualifying, it can be frustrating and challenging to obtain objective Medicaid information from this group. A second factor which also can lead to frustration with this group is the fact that they are typically subject to very heavy workloads and their availability may be limited.

The third group we refer to as commission-based Medicaid planners and is comprised of Insurance Agents, Annuity Salespersons and individuals selling funeral trusts or other products that help applicants to qualify financially for Medicaid. These individuals, though not without value, do have a conflict of interest and anyone working with them should be aware of this fact. The financial products they sell are intended to lower one’s income or assets to a Medicaid compliant level. They do not charge for their counsel but make commissions off the products they sell. Given the complexity of Medicaid eligibility sometimes these individuals do not fully understand the applicant’s situation and sell them a product which does not in fact make them Medicaid eligible.

For individuals considering applying for Medicaid, the website MedicaidPlanningAssistance.org offers a free service in which Medicaid planning professionals review a candidate’s vital information and provide a preliminary assessment of the likelihood that the applicant will qualify and what steps need to be taken to ensure the best possibility of acceptance into the Medicaid program.

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