7 Things to Know about Medicaid & VA Benefits

When a loved one needs long-term care at home, in Assisted Living, or in a nursing home, figuring out what to do and how to get help can be overwhelming. Consulting with a Certified Elder Law Attorney (CELA) can help prevent costly errors, preserve assets for a spouse and/or heirs, and provide peace of mind that you’re providing your loved one with the best possible care.

Who can get help from Medicaid or the VA?

Having a long-term care plan in place well before it’s needed is best, but unfortunately, a vast majority of us never get around to planning. If a long-term care crisis arises, it’s not too late to benefit from a solid elder law plan… Almost EVERYONE can qualify for help! No one has too much or too little to benefit from Medicaid and/or VA Aid and Attendance benefits as long as they meet the standards for eligibility. This benefit for Veterans is not service-connected either, like many other VA disability benefits.

What are the Medicaid and VA Eligibility Standards?

Both are income- and resource- (asset) based benefits. 

Medicaid applicants need to be both income and financially eligible, and in need of services Medicaid can provide (like home care, Assisted Living, or Nursing Home services). If you’re in Assisted Living or a Nursing Home, the facility must also accept Medicaid in payment for care.

VA applicants need to have served during a declared War or Conflict, not dishonorably discharged, and have recurring, unreimbursed monthly medical expenses.

Is it true I have to “spend down” all my assets?

Both Medicaid and the VA have limits for the amount of resources you can own while still qualifying for the benefits. However, some assets may not be counted initially for purposes of eligibility. There are opportunities to strategically reposition those assets that exceed the asset limits Medicaid imposes. In many situations, most (if not all) of the assets of a married couple can be preserved while still obtaining benefits. For single individuals, even up to one-half of the assets can be preserved.

In other words, it is NOT necessary to spend everything down to become eligible. Resources and income can be preserved for your needs that Medicaid or the VA may not cover, for a spouse at home, or for the family after your loved one passes away. 

What is a “look back period”?

Both Medicaid and VA will require you to disclose information so they can determine if you qualify for benefits. Medicaid will review information for 5 years prior to the date of application, while the VA will look back 3 years. They will both be looking for money or other assets transferred out of the applicant’s or spouse’s name over that timeframe. If transfers for less than fair market value have already been made, both Medicaid and the VA will impose a penalty based on such transfers.

What if I’ve already given away money or assets?

If gifts have already been made, there are still solutions. A good advisor will consider past transfers and incorporate them into a comprehensive elder law plan. It’s necessary to seek legal counsel as soon as practically possible if past gifts have been made.

How will I be penalized?

Both Medicaid and the VA will decline to pay for care for a period of time based on the value of what was transferred. Neither will require the recipient of the gift to return it, nor will they “seize” the property for payment. Instead, the applicant will not receive the benefit for a determined period of time. However, a well-crafted elder law plan will ensure that your care will be paid for if a penalty is imposed while ensuring eligibility as soon as possible. 

What is Estate Recovery?

Eligibility is not the only consideration with regard to Medicaid. Estate Recovery, applicable only to Medicaid, is the process by which the State will seek to recover the funds spent on the care of a Medicaid-recipient from his or her estate or from the estate of the spouse, even if the spouse didn’t need Medicaid-paid care. A thorough elder law plan will consider Estate Recovery and will address how to minimize or avoid it. Your Medicaid Eligibility Plan should not be good only for the lifetime of the applicant. It should continue to protect your estate even after the death of the Medicaid Recipient.

If you’d like to have a conversation (no charge) to find out more about planning for Medicaid or VA Benefits, reach out to speak with our Certified Elder Law Attorney. Remember, even if you’re already in the middle of a long-term care crisis, it’s not too late! Let’s Talk!

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