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Medicaid Planning FAQ

What is Medicare?

Medicare is a federal health insurance program available to anyone who has contributed to the Medicare system. Medicare Part A covers hospital care and limited care in a skilled nursing facility. Medicare only pays for nursing home care for up to 100 days when the nursing home stay is for rehabilitation purposes following at least a three day hospitalization. Medicare pays 100% for the first 20 days and only a portion of the cost for the next 80 days. Medicare Part B covers "outpatient" care such as office visits, ambulance transportation and tests.

What is Medicaid?

Medicaid is a joint federal and state need-based program that helps pay for long-term nursing home care indefinitely. Individuals will qualify for Medicaid when they have less than $8,000.00 or $2,400.00 in countable resources, depending on their gross monthly income. Countable recourses include bank accounts, annuities, pensions, IRAs, vehicles, life insurance cash values and any other assets that are titled jointly with a spouse, jointly with other individuals, and/or in a spouse's individual name. The principal residence, household contents, a spouse's IRA, one vehicle and prepaid funerals are not considered countable assets.

For married Medicaid applicants, the applicant's countable resources are determined after setting a portion of the total assets aside for the community spouse. The community spouse is entitled to one half of the countable assets, subject to a minimum and maximum amount established by the state each year. For married Medicaid applicants, the community spouse is entitled to receive his/her monthly Social Security and pension income, if any, subject to a minimum amount established by the state each year.

Once an individual qualifies, Medicaid will pick up the monthly cost of nursing home care that exceeds the individual's monthly income. The individual is entitled to receive a monthly personal care stipend to pay for personal care items not paid for by Medicaid.

What is the WAIVER Program?

WAIVER is a need-based program that provides services at no cost to individuals who are nursing home care eligible but prefer to stay in the home and receive home health care. Among the services to be offered are: home delivered meals, medical supplies & equipment, caregiver respite services, adult day care, home environment modifications, registered nurses, home health aides, homemaker services, physical therapy, speech therapy, occupational therapy, emergency response systems, companion services, transportation and mental health counseling. WAIVER's financial eligibility requirements parallel the Medicaid requirements.

Medicaid/WAIVER Planning

Careful planning will help maximize the assets that are retained by the community spouse, ensure that the community spouse can continue to maintain a comfortable lifestyle and/or allow individuals to pass some of their assets on to the next generation.

Technically, all of the applicant's countable resources should be used to pay for care. However, through the use of asset protection planning we may be able to gift a portion of the countable assets, convert countable assets into exempt assets (i.e. prepaid funerals, home or car improvements/ repairs, household contents), or spend some of the assets on routine expenses (real estate taxes, health insurance etc.). Any gift made within five (5) years of the Medicaid application will create an automatic period of Medicaid ineligibility.

Medicaid/WAIVER Planning includes counseling and advice on the assets that should be retained and which assets, if any, should be gifted, spent, and/or converted. As part of our planning we counsel clients through the eligibility process (completion of the Resource Assessment Form, submission of the Application, and representation at the eligibility Hearing). We also help them collect the mountains of paperwork required by the Pennsylvania Department of Human Services. Most importantly, we plan so that the applicant's care is adequately funded during any period in which he or she is ineligible for Medicaid benefits.

Why Choose Owlett & Lewis, P.C. to Handle Your Medicaid Planning?

Our attorneys have years of experience in dealing with Medicaid planning and other Elder Law issues.

Our attorneys have the knowledge and experience to make the proper gifts in the proper amounts at the proper times.

Our attorneys have attended and hosted seminars dealing exclusively with Medicaid Planning and Elder Law issues. They have hands-on, practical experience in applying the concepts learned at these Medicaid Planning and Elder Law seminars. We keep ourselves up to date on the continuing changes in this area of the law.

It is never too early or too late for Medicaid Planning!!


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Owlett & Lewis, P.C.
One Charles Street
Wellsboro, Pennsylvania 16901
Phone: (570) 723-1000