As you might already know, the cost of long-term care has risen tremendously over the last few decades, and it is still rising. In Virginia, the median monthly cost of longer-term care in a nursing home is $7,452 for a semi-private room and $8,517 for a private room. Most families cannot afford to pay these prices on their own for very long, so they must rely on Medicaid if and when long-term care is needed.

Medicaid Planning

Because Medicaid is a needs-based program, it has strict asset limits for eligibility. Therefore, a single individual, who is 65 or older and needs Medicaid to pay for a nursing home, may have no more than $2000 in “countable” assets when applying for Medicaid (more if he or she is married, but still only a limited amount).

Since $2000 in “countable” assets is not a lot, many seniors believe that in order to qualify for Medicaid benefits, they must spend down or give away almost all of their assets. However, proper Medicaid planning, performed with the assistance of a qualified elder law attorney, can enable elderly individuals and couples to keep most of their assets and still qualify for Medicaid, by exchanging “countable” assets for “non-countable” assets.

Trusts Used For Medicaid Planning

Medicaid planning often involves the use of Trusts. Whether the Trust can be used to help you qualify for Medicaid will depend on the terms of the Trust and who created it.

A Trust is simply a legal document that tells a Trustee how the assets held in the Trust can be used for the Trust beneficiaries. The Trustee can be an individual, attorney, bank, or Trust company.

Here are the most common types of Trusts used for Medicaid planning:

Irrevocable Trusts

An Irrevocable Trust is one that you cannot alter or modify once it has been created and that only allows limited control and access to the Trust assets.
For the purposes of Medicaid, assets held in an Irrevocable Trust will not count against your eligibility for Medicaid, as long as the Trustee cannot distribute the assets to you or your spouse.

However, a Revocable Trust may be altered or modified by its creator and is, therefore, considered a countable asset when determining Medicaid eligibility.

Bear in mind, if you are institutionalized in a nursing home or other long-term care facility, any income generated by an Irrevocable Trust must go to the nursing home to pay for your care.

Furthermore, transferring assets into an Irrevocable Trust within the five years prior to applying for Medicaid may trigger a period of ineligibility. The actual length of time you may be ineligible for Medicaid will depend on the value of the assets you transferred to the irrevocable Trust.

Testamentary Trusts

A Testamentary Trust one that is created by a Will. This kind of Trust, which is set up by a deceased person for the benefit of his or her surviving spouse, is protected from Medicaid, as long as any distributions from the Trust to the surviving spouse are at the Trustee’s discretion and not obligatory.

A TestamentaryTrust is an excellent way for a community spouse (the spouse at home) to leave assets to a surviving spouse who is in a nursing home. These assets can then be used for certain things that Medicaid will not cover, such as medical specialists, therapy, legal fees, and the cost of transferring to a different nursing home.

Income-Only Trusts

Income-only Trusts are used for just that—income. This type of Trust is set up so that it will pay an income to you for the rest of your life. Then, when you die, the remainder of the Trust assets will be transferred to your beneficiaries.

The income distributed to you with an Income-only Trust is protected and will not be counted as an asset for Medicaid purposes. But, if you do end up needing to spend time in a nursing home, the income will go to that nursing home to pay for your stay.

Special Needs Trusts

A Special Needs Trust is a type of Trust authorized by federal law whose assets don’t count for the purposes of Medicaid qualification. A Special Needs Trust, also known as a Supplemental Needs Trust, is one designed to supplement, instead of supplanting or diminishing, a disabled loved one’s eligibility for government assistance, such as Medicaid. Assets transferred into a Special Needs Trust are not counted against the disabled individual’s eligibility for Medicaid.

Consult With An Experienced Virginia Elder Care Attorney

If you think you will need Medicaid to pay for a nursing home in the future, don’t wait too long to plan. Advance Medicaid planning will allow you to protect your assets against the high cost of long-term care in advance and to preserve those assets for future generations. Contact Speedwell Law, PLLC at (703) 495-2767 to schedule an appointment with an experienced Virginia elder law attorney.

Click here to learn more about our Medicaid services and to schedule your free consultation.

The information on this site is for general informational purposes only. The information presented in this site is not legal advice or a legal opinion. You should seek the advice of legal counsel of your choice before acting upon any of the information in this site.

This is an overview of the Virginia Medicaid program for persons who are elderly or disabled. The information applies to older Americans and people with physical, cognitive, sensory, or mental impairments.

What is Medicaid?

Medicaid is a joint federal and state-funded health insurance program that is administered by the state. It covers individuals with low incomes who also meet certain citizenship requirements.

In Virginia, the program name for persons who are over 65 or disabled is Medicaid for Persons Who are Elderly and Disabled.

Types of Virginia Medicaid Programs

The federal government establishes basic Medicaid guidelines, but states have a certain amount of flexibility with regard to the actual eligibility requirements for their Medicaid programs. In Virginia, there are a variety of different medical programs, each with its own specific purpose, distinct name, and eligibility, income and assets, and citizenship requirements.

The various Virginia Medicaid programs are as follows:

1. Full Medicaid Coverage
2. Limited Medicaid coverage (Medicaid Savings Plans)
3. Long Term Care Medicaid
4. Emergency Medicaid
5. Spend Down Medicaid

Most of these Medicaid programs provide comprehensive coverage. Those that do not, are typically specialized programs that were created to fill certain gaps.

Who is Eligible for Medicaid in Virginia?

Essentially, if you are an individual who is 65 or older, or disabled according to the Medicaid Disability Unit’s definition, you are eligible for Full Medicaid in Virginia if you have an income of $851 or less and no more than $2000 in countable assets.

If your spouse is also over 65 or disabled, and if your combined income is below $1150 per month, and your combined countable assets are below $3000, both of you can be eligible for Medicaid.

Medicaid Citizenship Requirements

Most Virginia Medicaid programs have some requirements that you are either a US citizen or a qualified immigrant. Most non-citizens, with some exceptions, are ineligible for Medicaid benefits for the first 5 years they are in the United States.

Spend Down Medicaid

If you have too much income or too many assets to qualify for Medicaid in Virginia, you may be eligible to spend down your income and/or assets to qualify for Spend Down Medicaid. In this case, you would first have to apply for Medicaid and then be informed of how much of your income and/or assets you will need to spend down to the level that would make you eligible.

You can use unpaid medical bills and medical bills that you have already paid to meet your spend-down amount. Furthermore, you can also qualify for Medicaid, by paying your spend-down amount at the beginning of each month, much like a deductible.

Emergency Medicaid

If you do not qualify for regular Medicaid because of your immigration status, you may qualify for emergency Medicaid, which will pay for emergency hospitalization only.

Long Term Care Medicaid

Medicaid will also pay for long term care for individuals needing a nursing home level of care if your income and assets are below the state’s requirements. There are very strict income and assets rules for this type of Medicaid. These rules can also vary depending on whether or not you have a spouse who does not require nursing and will remain at home, whether you are already in a nursing home, and if you are receiving community-based care.

What’s more, there are also rules that prohibit you from giving your assets away in order for you or your spouse to become eligible to have Medicaid pay for the nursing home. If you anticipate that you or your spouse may need to apply for Medicaid to pay for a nursing home, you should consult with a qualified and experienced attorney.

How to Apply for Virginia Medicaid

If you are in a hospital, the social services department at the hospital can arrange for you to undergo a screening. Otherwise, you can apply for Medicaid in Virginia by:

1. Visiting Virginia Commonhelp online;
2. Contacting your local Department of Social Services (DSS) office to request an application; or
3. Calling Cover Virginia’s Call Center at 1-855-242-8282

To find out if you or a loved one is eligible for Medicaid in Virginia, contact an experienced Virginia elder care attorney who can explain Virginia Medicaid’s eligibility requirements to you in more detail and assist you through the application process. Please feel free to contact Speedwell Law, PLLC at (703) 495-2767 or welcome@speedwelllaw.com to arrange a consultation.

Click here to learn more about our Medicaid services and to schedule your free consultation.

The information on this site is for general informational purposes only. The information presented in this site is not legal advice or a legal opinion. You should seek the advice of legal counsel of your choice before acting upon any of the information in this site.

For most American seniors, nursing home care becomes necessary at some point in time and for some length of time as they age. Unfortunately, most seniors are unable to pay the high cost of nursing home care for any extended amount of time. In Virginia, the cost of a private room in a nursing home was $270 per day in 2019. During the same year, the average stay in a nursing home was about 25 months.

How Does One Pay For Nursing Home Care?

There are generally three ways to pay for nursing home care:

1. Your money;
2. Insurance;
3. Medicare; or
4. Medicaid

Your Money

Your money is self-explanatory—you enter a nursing home, they bill you every month, and you pay it until you run out of money.

Insurance

Long term care insurance essentially comes in two varieties 1) traditional use-it-or-lose-it insurance and 2) asset-based or hybrid insurance. Unless you buy long term care insurance by your 50s, the insurance premiums are likely to be prohibitive. On the other hand, if you buy it at the right time and have the right coverage this can be a good option.

Medicare vs. Medicaid

Medicare and Medicaid are not the same things. Both or government programs enacted during the Johnson administration. However, Medicare is health insurance that all US citizens get when they turn 65, whether they are rich, poor, or in between. Medicaid, on the other hand, is a means-tested program that was designed to pay medical expenses for people at the poverty level.

Medicare is not designed to pay for nursing home care. Nevertheless, if you have Medicare and you have entered a nursing home or rehabilitation facility after a certain amount of time in a hospital, Medicare will pay for the first 20 days. After that first 20 days, Medicare may pay 80% of the cost for the next 80 days, but only if you meet certain conditions. Then after day 100, Medicare will cease to pay and you will be on your own.

Medicaid, on the other hand, was specifically designed to pay for health care for low-income children and some low-income adults, as well as, for long term care for low income and low asset adults. Medicaid will pay for long term care in the form of in-home care or care in a nursing home.

Initially, Medicaid was only intended as a safety net for the poor. Now, however, since the need for long term care threatens to bankrupt even middle-class families, the state and the federal governments have created some loopholes so that families don’t have to lose everything paying for long term care.

When Medicaid Will Pay For Nursing Home Care?

There is a prevailing myth that you have to deplete all of your assets before Medicaid will pay for nursing home care. But, this is only true if you didn’t consult with an experienced elder law attorney before needing care, or at least before spending all of your money on nursing home care. Medicaid will pay for nursing home care if and when you meet certain requirements pertaining to 1) your need for nursing home level care (medical necessity), 2) your income, and 3) your assets.

Medical Necessity

Medical necessity means that you must show that you are unable to care for yourself for a sustained period of time and that a lack of nursing home level care would result in you being a danger to yourself. For example, this can be achieved by proving that you suffer from memory loss or mobility issues, or a combination of the two.

As a result, a Medicaid applicant must undergo “pre-admission screening”. This screening evaluates what activities of daily living you need assistance with (such as eating, bathing, dressing, toileting, and using the bathroom), as well as, how much help you need with these activities. Pre-admission screening is typically performed by a nurse or a Medicaid social worker after you have applied for Medicaid and using a form called the Virginia Uniform Assessment Instrument. Whether or not it is determined that you need a nursing home level of care will depend on the number of activities you need assistance with and the combination thereof, as well as, the level of assistance you need.

Income

Income is the amount of money that a person receives every month. It can include earned and unearned income. Earned income is money received from work i.e. wages and salary. Unearned income is money from sources such as Social Security benefits, alimony, interest on saving accounts, Veterans Administration benefits, and pensions.

For a single individual to qualify for Medicaid to pay for nursing home care, your monthly income cannot be more than 300% of the SSI amount for an individual, or $2,349 per month in 2020. for a married couple with both spouses applying, the limit is $4,698. For a married couple with one spouse applying, only the income of the applicant is counted.

If your income is above these amounts, you may still qualify if you have many medical bills. Virginia’s Medically Needy Program will allow you to use your medical bills as a means of “spending down” your income to qualify for Medicaid. To learn more about the Medically Needy Program you should consult with a knowledgeable Virginia elder care attorney.

Assets

For Medicaid purposes, assets are defined as real or personal property that is owned solely or jointly by a Medicaid applicant. This includes cash, checking accounts, saving accounts, stocks, bonds, and the cash surrender value of life insurance policies owned by the applicant.

In 2020, the asset limit for a single person to qualify for Medicaid to pay for nursing home care in Virginia is $2000. For a married couple with both spouses applying, the limit is $4000. For a married couple with only one spouse applying, the asset limit is $2,000 for the applicant and $128,640 for the non-applicant spouse. This is the total of all non-exempt assets in the applicant’s name.

Nonexempt assets include things like checking and savings accounts, cash on hand, IRAs, stocks, bonds, and the cash surrender value of life insurance policies. Other assets owned by the Medicaid applicant may be exempt from being counted towards Medicaid’s asset limit. These are called exempt assets.

The most common exempt assets include:

• Your home;
• Personal effects and household goods;
• One motor vehicle; and
• Pre-paid funeral/burial plans

Virginia has a very complicated system to determine if your home will be considered an exempt asset or not. Firstly, if you reside in the home, it is exempt. But, if you own the land around your home and that land is worth more than $5000, it will be considered a countable asset if you qualified for Medicaid by satisfying the 300% Federal Poverty Level (FPL). On the other hand, if you qualified with an income less than 80% of the FPL, then both your home and all of the land around it will be considered exempt assets.

However, to qualify for Medicaid to pay for nursing home care, you cannot have more than $595,000 in equity in your home as of 2020. What’s more, your home is only exempt for the first six months that you are in the nursing home, unless 1) you intend to return to it, 2) a spouse, dependent child, disabled adult child, or disabled parent lives in the home, or 3) selling it would cause undue hardship to a co-owner. If either case is true, your home will be exempt indefinitely.

Contact an Experienced Virginia Elder Law Attorney

Medicaid rules are complicated. But, by consulting with a qualified elder law attorney regarding your eligibility for Medicaid to pay for nursing home care, you can save yourself and your family a considerable amount of money not have to deplete all of your life’s savings.

Even if you are a high net worth individual, you can still qualify for Medicaid to pay for nursing home care. You should preferably engage in Medicaid planning before you need care. It is rarely too late to preserve assets. Call us today to learn more.

To learn more about Medicaid and long-term care and how we can help you qualify, please feel free to contact Speedwell Law, PLLC at (703) 495-2767 or welcome@speedwelllaw.com to arrange a consultation.

Click here to learn more about our Medicaid services and to schedule your free consultation.

The information on this site is for general informational purposes only. The information presented in this site is not legal advice or a legal opinion. You should seek the advice of legal counsel of your choice before acting upon any of the information in this site.

If your Medicaid application was denied or you disagree with a coverage or payment decision made by the Medicaid office, and you don’t know what to do, you may be happy to learn that you have options. Anytime you have been informed of an adverse Medicaid decision you can do one of three things:

1. Request a reversal;
2. Reapply for Medicaid; and/or
3. File an appeal

The option you choose will depend on:

1. The reason for the denial;
2. The type of Medicaid benefits you are receiving;
3. The type of health care service, item, or medication in question; as well as
4. Whether or not you believe that the adverse decision was made incorrectly.

Requesting a Reversal or Reapplying For Medicaid in Virginia

Requesting a reversal is a largely informal process by which you contact the Medicaid office and request that they reconsider their decision, usually because either you or the Medicaid caseworker made an error in the application paperwork. In many cases, you can simply provide the missing information or documentation or demonstrate where the caseworker made an error and this will result in the decision being reversed.

Alternatively, you may choose to reapply for Medicaid if you applied for Medicaid at a time when you had too much income or assets to qualify and were denied. You may want to reapply after you have spent down your income and assets or implemented certain Medicaid planning strategies in order to get below the Medicaid income threshold.

Appealing a Medicaid Decision

An appeal is a formal process by which you express your disagreement with an adverse action taken against you by the government. When it comes to Medicaid benefits, this pertains to any time you are notified that your benefits have been denied, terminated, not approved, suspended, reduced, or when you file a request and do not receive an answer.

What Can Be Appealed?

Eligibility: You can appeal decisions regarding your eligibility for Medicaid. Eligibility refers to whether you qualify for Medicaid or not.

Services: You can also appeal a decision that refuses a Medicaid service you requested. In other words, you can appeal a denial for a specific service and/or how much of that service will be provided to you by Medicaid.

Every Medicaid case is different, but with adequate proof and the help of the right attorney, you can appeal many different Medicaid decisions. Including, but not limited to:

• Medicaid Eligibility;
• Notice that you are above the income limit;
• Denial of prior authorization for a wheelchair or other equipment;
• A reduction of your personal care hours;
• No response when your doctor asks you to request something that requires prior authorization;
• Denial of a medication you need; and
• Notice that you are no longer considered disabled

How Do I File an Appeal?

You can file an appeal by using a short form from the Medicaid office. Filing this form will get you a hearing before an administrative law judge also known as an ALJ.

There is a bit more to the process, but the bottom line is that the judge is an independent party who will hear the case and decide if the Medicaid office was correct in denying Medicaid benefits.

If the Medicaid office did not give you proper notice or did not process information that you provided, the judge will order your benefits to be provided or continued.

Who Can Appeal a Medicaid Decision in Virginia?

Any Medicaid clients or appellant or their legal guardian can appeal any adverse action or failure to act concerning any Medicaid benefit. It is important to appeal immediately, whether you have received official notice of the denial or not.

In general, the Medicaid office has to give you at least 10 days of advance notice before taking any Medicaid benefits away. If you file an appeal before the date your benefits are scheduled to end, you get to keep your benefits until the appeal is resolved.

Also, be sure to keep any correspondence you receive from the Medicaid office, including the envelope it came in. The postmark on the envelope can be proof that you were not given a 10-day notice.

Furthermore, if you received no notice, keep a record of how you learned about your denial or change in benefits or eligibility. This might include messages from your doctor, pharmacist or others.

Do I Need a Lawyer to Appeal A Medicaid Decision?

The short answer to this question is no. However, appealing a Medicaid decision can get complicated and there are no court-appointed lawyers for these cases.

You have a right to hire an attorney to represent you and, in many cases, you should. However, if your deadline is tight, you should simply file the appeal and then get an attorney involved. This will allow you to preserve your benefits while you seek the right attorney to help you with your case.

If your Medicaid application has been denied, contact us to arrange a free consultation with a qualified and experienced Virginia Medicaid lawyer who can provide you with more information and the assistance that you need.

To learn more about Medicaid and long-term care and how we can help you qualify, please feel free to contact Speedwell Law, PLLC at (703) 495-2767 or welcome@speedwelllaw.com to arrange a consultation.

Click here to learn more about our Medicaid services and to schedule your free consultation.

The information on this site is for general informational purposes only. The information presented in this site is not legal advice or a legal opinion. You should seek the advice of legal counsel of your choice before acting upon any of the information in this site.

You have worked hard to save for your retirement and to ensure that you have the financial security you want for you and your family. You have also tried to plan for whatever life may bring in the future. But, even the most well thought out plans may not be enough to prepare you for the high costs associated with long-term care, if and when you or a loved one needs it.

Most people are shocked to find out how much it’s going to cost them when they or a loved one requires long-term care. In Virginia, the average cost per day for long-term care in a private room in a nursing home is approximately $300/day.

The cost of a room in an assisted living facility or for in-home care is a little less expensive, but still much more than the average family can readily afford for an extended period of time. Therefore, most individuals and families who are looking for ways to pay for long-term care turn to Medicaid for assistance.

Medicaid Resource Limits

Medicaid will cover the cost of long-term care in a nursing home or rehabilitation facility and even in your own home, if you qualify. However, to qualify, you must meet certain needs-based eligibility requirements. These requirements are generally as follows:

• Income – You must not earn more than 300% of the SSI amount for an individual, or $2,349 per month (as of January 2020).
• Assets – You must not have more than $2000 in countable assets.

If you are married and your spouse is not applying for Medicaid, there is a different set of resource limits based on Medicaid’s “anti spousal impoverishment standards”. These standards allow the non-applicant spouse to be allocated a portion of the applicant spouse’s resources so that that the non-applicant spouse can maintain his or her life at home while the applicant spouse is institutionalized.

An experienced Medicaid planning attorney can explain the anti spousal impoverishment standards to you in detail during your consultation.

Medicaid’s Look-Back Period

When you apply, Medicaid has a 60-month Look-Back Period for all gifts and transfers made for the purpose of qualifying for Medicaid to cover long-term care.

In other words, in the 60 months prior to applying for Medicaid to cover long-term care, you cannot have transferred or gifted away any substantial amount of money.

Any gifts or transfers made with the 60-month Look-Back Period will trigger a penalty period during which you will be ineligible for Medicaid coverage.

So, for example, if you gifted $10,000 to your daughter one year before you applied for long-term care assistance, Medicaid will attribute a penalty period based on this $10,000 gift. During this penalty period, you will be required to pay the cost of long-term care yourself.

After this penalty period has elapsed, Medicaid will step back in to cover the cost of your long-term care going forward. Again, an experienced attorney can explain Medicaid’s look-back period and its implications more thoroughly during your consultation with them.

Contact An Experienced Virginia Medicaid Planning Attorney Today!

To learn more about Medicaid and long-term care and how we can help you qualify, please feel free to contact Speedwell Law, PLLC at (703) 495-2767 or welcome@speedwelllaw.com to arrange a consultation. We will be happy to answer all of your questions and help you and your family navigate this challenging period in your lives.

Click here to learn more about our Medicaid services and to schedule your free consultation.

The information on this site is for general informational purposes only. The information presented in this site is not legal advice or a legal opinion. You should seek the advice of legal counsel of your choice before acting upon any of the information in this site.

One of the biggest myths about qualifying for Medicaid for long-term care is that you have to be poor. This is simply not true. However, unless you understand how to qualify, you may needlessly lose your home and drain all of your retirement savings.

On the other hand, when you understand the Virginia Medicaid eligibility rules and apply them to your circumstances, you will most likely qualify to have Medicaid pay for long term care in a Virginia nursing home, rehabilitation facility, or even in your own home.

Qualifying for Medicaid for Long Term Care in Virginia

Virginia Medicaid is a means-tested program. This means that in order to qualify, you must meet certain needs-based eligibility requirements.

To qualify for Virginia Medicaid to pay for long term care, you must meet the following standards:

• Program Requirements – You must reside in Virginia and be a US citizen or lawful resident alien. In addition, you must be age 65 or older, disabled, blind, pregnant, under age 19, or a parent living with a child under 18.
• An Income Test – Generally, an individual must earn less than $2,313 per month (as of December 2019) to qualify for Medicaid. Additionally, an individual could qualify for Medicaid as “Medically Needy” as defined by the Virginia Medicaid Manual, if an individual has income in excess of $2,313 per month (as of December 2019), but the individual does not have sufficient income to cover their uninsured medical expenses. If you are married and your spouse is not applying for Medicaid, there is a different set of standards based on a Medicaid concept called the Minimum Monthly Maintenance Needs Allowance (MMMNA). An experienced Medicaid planning attorney can explain MMMNA to you in detail during your consultation.
• Medicaid’s Asset Test – You must have less than $2,000 in what Medicaid considers countable assets. Again, if you have a non-Medicaid spouse, the rules are somewhat different due to the “anti spousal impoverishment standards” that your attorney can discuss with you during your consultation.
• The Needs Test – You must demonstrate a need for long term care, meaning that you must demonstrate a need for assistance with doing things like walking, standing, getting in and out of bed, dressing, bathing, feeding, toileting, or performing other activities of daily living.

Medicaid’s Look-Back Period

When you apply to Medicaid for assistance with paying for long-term care, Medicaid is entitled to scrutinize any transaction you made in the 5 years prior to applying. This is referred to as Medicaid’s look-back period.

If during the look-period, you transferred or gave away any assets for less than fair market value, you will be assessed a penalty period based on the value of the transaction in question. During this penalty period, you will NOT be eligible to receive long-term care assistance from Medicaid and will need to pay for any long-term care costs out of your own pocket.

Medicaid’s look-back period and the associated penalty period are meant to discourage Medicaid applicants from giving away valuable resources just to qualify for Medicaid. An experienced Medicaid planning attorney can advise you on ways you can protect assets in a Medicaid-compliant manner that does not trigger a Medicaid look-back penalty.

How Working With an Experienced Virginia Medicaid Planning Attorney Can Help

Most people are unaware that Medicaid is not just for low-income individuals. Medicaid is also for middle and upper-class individuals who have worked hard to save for retirement, only to find out that all of their planning and saving will still not be enough to afford the high costs associated with long term care, if and when they or a loved one needs it. Medicaid planning attorneys help these people to become better able to afford long-term care by qualifying for assistance through Medicaid.

An experienced Medicaid planning attorney can develop a combination of strategies to help you pay the extremely high cost of long-term care for yourself or a loved one and protect your assets from having to be spent down until there is nothing left to pass on to your heirs. This form of planning, in turn, can provide you and your family with a sense of control and much-needed peace of mind at a time of great need.

Contact an Experienced Virginia Medicaid Planning attorney

Our experienced Virginia Medicaid planning attorneys work diligently with people who don’t qualify to have Medicaid pay for long-term care because they have too much income or assets. We can provide you with legal and ethical strategies to get you eligible in accordance with Medicaid eligibility rules. For more information, please feel free to contact Speedwell Law, PLLC at (703) 495-2767 or welcome@speedwelllaw.com. We look forward to answering your questions and helping you and your family navigate this challenging time.

Click here to learn more about our Medicaid services and to schedule your free consultation.

The information on this site is for general informational purposes only. The information presented in this site is not legal advice or a legal opinion. You should seek the advice of legal counsel of your choice before acting upon any of the information in this site.

As the average life expectancy of the population continues to increase, many Americans are facing difficult situations when it comes to long-term care for their elderly or aging parents.

Imagine your Mom has recently been diagnosed with Dementia and you step up to help in whatever way you can. As the days pass, you observe the progress of the disease and recognize you need extra help caring for Mom – a lot of extra help. Maybe she suffers a fall, or is unable to manage her finances, or isn’t taking her medications according to the prescribed instructions. Mom needs round-the-clock care.

After researching the cost of long-term care facilities, you learned that the average monthly cost of care in northern Virginia is $8,517, or more than $100,000 per year.

How is Mom going to pay for that? She has limited savings. She spent her whole life paying for the family home, so you don’t want to just sell it. What can you do?

What Are the Available Options?

There are really only two options: go at it alone or hire an attorney who specializes in Medicaid planning.

How Can Medicaid Planning Help?

Every state has Medicaid programs for individuals in need of long-term care. Institutional Medicaid provides coverage for nursing homes and other long-term care facilities to qualified applicants. To qualify for Medicaid, applicants must meet certain income and asset guidelines.

Worried about whether your mother will meet the guidelines, you realize that you can execute a Power of Attorney, and you consider selling the family home and using those proceeds to fund your mother’s care until she can qualify for Medicaid.

Better yet, you consider gifting your mother’s house to yourself to avoid having the value of the house considered as an asset. What could go wrong?

The Five Year “Look-Back” Period

Unfortunately, gifting the house to yourself is considered an asset transfer under Medicaid rules. Medicaid is entitled to look back at asset transfers for five years prior to the submission of your mother’s application. The General Asset Transfer Rule states that, if the applicant (your mother) transfers assets for something less than fair market value, the applicant will be ineligible for Medicaid benefits for a period of time determined by a formula.

In essence, the value of the gift, which is the fair market value of your mother’s home, will be considered an asset if the transfer occurred within the past five years. However, Medicaid exempts particular assets, one of which includes the applicant’s primary residence.

As a result, your mother could have kept her home and still qualified for Medicaid benefits, whereas now, your mother could incur a penalty period of greater than the 5-year look-back period in addition to other possible penalties.

As this example shows, Medicaid planning is complicated, and taking the proper action could be the difference in saving hundreds of thousands of dollars. This is the type of situation where our professionals at Speedwell Law have the knowledge and experience to guide your decision-making at this important stage of your life.

What Can I Do to Protect My Assets?

The most important thing anyone can do is act promptly to protect your assets to avoid transferring assets within the five-year look-back period. One option is to transfer your assets into an irrevocable trust and appoint a trustee to manage the trust pursuant to a written agreement.

The trustee is required to act in the best interest of the beneficiaries that you designate in your trust. While an irrevocable trust requires you to give up some control over your assets, you can draft certain powers that can remove trustees, allow you to continue to reside in your home, and approve the sales or purchases of other homes if you want to move from your current residence.

Medicaid’s rules are complex, and this example is just one of the many ways in which those rules can have a major impact on your life. An irrevocable trust is one of the potential strategies that we can employ on your behalf.

As such, it is important to hire an experienced estate planning attorney to help you navigate the intricacies of Medicaid, health care, and the needs of your family and loved ones. Our experienced professionals at Speedwell Law have a fundamental understanding of Medicaid rules.

We have developed strategies to employ on your behalf to help you or your loved one qualify for Medicaid assistance. Our attorneys will manage every aspect of the process from start to finish to ensure that your loved ones get the care they need while preserving their dignity by honoring their legacy and their choices.

To learn more about how our experienced elder law attorneys can develop a strategy that suits your unique needs, call us at (703) 553-2577.

Contact Us Today To Discover How To Qualify For Medicaid

Contact our law firm at (703) 495-2767 or welcome@speedwelllaw.com to arrange a no-cost, no-obligation consultation with an experienced attorney. We’ll show you how to qualify for long-term care assistance through Virginia Medicaid, and provide you with guidance on any other Medicaid and Long-Term Care Planning issue.

Click here to learn more about our Medicaid services and to schedule your free consultation.

The information on this site is for general informational purposes only. The information presented in this site is not legal advice or a legal opinion. You should seek the advice of legal counsel of your choice before acting upon any of the information in this site.

The decision to move a spouse into a nursing home is never easy. In fact, it is a choice that many elderly couples dread having to make. Because Medicaid offers more comprehensive long-term care coverage than Medicare, and the cost of long-term care is so high, many elderly couples rely on Medicaid to pay the cost of long-term care for a spouse in need.

Qualifying for Medicaid is the first step towards receiving much-needed long-term care assistance.
But, how do you qualify?

Here are six tests that an institutionalized spouse (the spouse in need of long-term care) of a non-institutionalized spouse (also referred to as the community spouse) must pass in order to qualify to have Virginia Medicaid pay for their long-term care.

1. Citizenship

Unless the applicant is already enrolled in Medicare or receiving Social Security Disability or SSI benefits, he or she must show proof of their legal status in the United States, as well as, proof of permanent residency in Virginia. Proof of citizenship can be shown by providing a Social Security Number, driver’s license, or other documentation related to a person’s legal status.

2. Age or Disability

The applicant must be 65 years of age or older or disabled as defined by the Virginia Medicaid Manual.

3. Pre Screening

The local health department and department of social services will dispatch a pre-screening team to monitor the applicant’s ability to perform activities of daily living.

4. Monthly Income

Medicaid eligibility requirements take into account the amount of income the applicant’s household brings in every month. However, when only one spouse is applying, only the income of the institutionalized spouse will be counted. In other words, the income of the community spouse will not be considered in determining the institutionalized spouse’s eligibility for Medicaid.

For the institutionalized spouse to be eligible for long-term care assistance through Virginia Medicaid, his or her gross monthly income cannot exceed 300% of the Supplemental Security Income (SSI) amount, currently $2,313. If the gross income does exceed 300% of SSI, the applicant may be able to defer a portion of his or her income to the community spouse in order to qualify.

5. Resources: Countable and Exempt

Medicaid eligibility requirements also take into account the resources available to the applicant. Resources can be broken down into 2 categories:

A. Countable Resources – assets, such as cash, financial accounts, securities, and some real estate, that are considered available to the applicant.

B. Exempt Resources – assets, such as the applicant’s primary home (not to exceed more than $585,000 in equity), one automobile, personal belongings, irrevocable burial trust, and household furnishings, are considered unavailable and ignored for the purposes of establishing the applicant’s eligibility for Medicaid.

In general, the institutionalized spouse cannot have more than $2,000 in countable assets. However, the community spouse can maintain assets up to $126,426.

6. Transfer of Resources

The department of social services can look back up to 5 years from the date an applicant submitted a Medicaid application to determine whether an applicant has given away or sold any resources for less than fair market value. If the applicant has transferred resources for less than fair market value, the department of social services penalizes the applicant by calculating the difference between what the resource was sold for and its fair market value.

Currently, Virginia Medicaid penalizes at a rate of $6,422 per month. So, for every $6,422 you transferred for less than fair market value in the five years before you applied for Medicaid, you will be penalized for one month of Medicaid ineligibility.

Contact Us Today To Discover How To Qualify For Medicaid

Contact our law firm at (703) 495-2767 or admin@speedwelllaw.com to arrange a no-cost, no-obligation consultation with an experienced attorney. We’ll show you how to qualify for long-term care assistance through Virginia Medicaid, and provide you with guidance on any other Medicaid and Long-Term Care Planning issue.

Click here to learn more about our Medicaid services and to schedule your free consultation.

The information on this site is for general informational purposes only. The information presented in this site is not legal advice or a legal opinion. You should seek the advice of legal counsel of your choice before acting upon any of the information in this site.

I met one of my clients, Claire*, several months ago. Claire loves her father, Robert**, but one day Claire realized Robert’s health was declining and could no longer live alone. Being a loving child, Claire invited Robert to live with her. In Claire’s mind, taking care of Dad was the right thing to do.

After a few months of living together, Claire realized that she could not care for her dad on her own. Unfortunately, Robert fell several times while no one else was home and made Claire realize that Robert needed round the clock care. However, it would be impossible for Claire to care for her dad full time and support her children and family. To make matters worse, Robert had minimal assets to help pay for the care he needed.

After some research, Claire decided that Medicaid was Robert’s only feasible option because Robert could not afford to pay out of pocket to stay at a Long-Term Care Facility. Additionally, Robert’s insurance was unwilling to foot the bill. As a result, Claire went to her local Department of Social Services and filed a Medicaid Application on behalf of her dad.

When I first met Claire, I could tell that she was beyond frustrated with the Medicaid application process. She told me that she had filed five Medicaid Applications for her father and Claire was denied each and every time. Claire lamented that the case managers assigned to Robert’s case were difficult and unwilling to help her get her dad approved.

I told Claire that pursuant to the Virginia Medicaid Manual, the case managers are expressly prohibited from helping you qualify. The Department of Social Services is fearful of litigation and, as a result, takes a firm stance on not answering hypothetical questions or rendering any form of legal advice.

How is a person to qualify for Medicaid when the Department of Social Services in charge of Medicaid approval fails to help you when you are in need? Moreover, how are you supposed to qualify for Medicaid when judges have described the Medicaid laws as “one of the most completely impenetrable texts within human experience” Rehab. Association of Virginia v. Kozlowski, 42 F.3d 1444, 1450 (4th Cir. 1994). Too much is at stake for you to attempt navigating this complicated area of the law alone.

After meeting with Claire and discussing Robert’s case, I determined that there were three central issues:

1. Robert was admitted to a hospital due to a recent fall he had. The hospital was trying to discharge her because all of his Medicare days were used up. Furthermore, the hospital kept trying to pressure Claire to sign financial responsibility paperwork which would render Claire financially responsible for all of Robert’s medical bills.
2. Robert’s Social Security was being garnished by the IRS. Under no circumstances would a Medicaid eligible facility be willing to take Robert with the IRS garnishment still in place.
3. Robert’s assets were above the $2,000 minimum asset threshold set by Medicaid.

After our meeting, I devised an Action Plan which addressed each issue above in order to qualify Robert for Medicaid.

• I advocated Robert’s behalf to stay in the hospital because the discharge proposed was an unsafe discharge. Additionally, I was able to effectively navigate the Medicare appeal process to fight for Robert’s right to stay in the hospital. I also counseled Claire that she should under no circumstances sign any forms unless and until she received approval from me.
• I advocated for Robert and received a Release of Levy/Release of Property from Levy from the IRS for over $100,000 of penalties and interest that Robert owed. This release allowed us to more easily find Robert a Medicaid bed.
• I helped Robert meet the “Asset Test” by utilizing Medicaid exemptions and other Medicaid planning techniques.

After we submitted Robert’s Medicaid application, I handled all correspondence with Robert’s Medicaid case manager which gave Claire peace of mind in a very stressful period of her life. Ultimately, Claire and Robert were very happy when we received notification that Robert was finally approved for Medicaid benefits.

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Contact us today to learn more about Medicaid and Long-Term Care Planning

If you are interested in learning more about the legal services we provide in the area of Medicaid and Long-Term Care Planning, please feel free to contact Speedwell Law, PLLC at (703) 495-2767 or welcome@speedwelllaw.com. We look forward to answering your questions and helping you and your family navigate this challenging time.

*Claire’s name is used to preserve this person’s identity
**Robert’s name is used to preserve this person’s identity

The information on this site is for general informational purposes only. The information presented in this site is not legal advice or a legal opinion. You should seek the advice of legal counsel of your choice before acting upon any of the information in this site.