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Medicaid Nursing Home Crisis Planning

The high cost of long term care has made planning critically important for most middle class seniors and their families.  A majority of seniors require long term care at some point during their lives. Sadly, many are unprepared for the financial burdens it will places on their families' resources.  We help families and seniors avoid the devastating financial effects of long term care.

Long-Term Care Insurance
While some fortunate seniors are able to afford private pay care, the cost of long-term care can consume available resources of middle class families in a matter of years, which is particularly troubling for individuals with a non-institutionalized spouse or other dependents.  Those who have planned ahead by purchasing long-term care insurance have a degree of certainty and peace of mind, knowing that they have a resource to fund care.  Unfortunately, many seniors can’t afford the premiums for long term care insurance or cannot qualify for long term care insurance because of age or medical condition.  Moreover, many policies have high deductibles or provide for only a short period of care in facility, and many do not protect against the erosion of policy benefits due to inflation.

Medicare and Long Term Nursing Home Care
Contrary to the belief of many seniors, Medicare does not pay for long term care.  Medicare may pay for skilled nursing home costs for up to 100 days following a hospital stay of at least 3 days, but it does not cover skilled nursing home costs beyond 100 days, and does not cover custodial nursing home care or non-skilled home health care.

Medicaid Eligibility For Nursing Home Care
The other option to pay for care is Medicaid.  A joint federal-state program, Medicaid provides medical assistance to low-income individuals, including those who are 65 or older, disabled or blind.  Medicaid is designed as the option of last resort for people who have no other way to finance their long term care.  It is the largest payer of nursing home bills in America.

Although Medicaid eligibility rules vary from state to state, federal minimum standards and guidelines must be observed.  The most significant barrier to Medicaid coverage for many seniors is the resource limit of $2000.  Although some assets such as a home and one car may be exempt, many seniors facing nursing home costs are told that they must "spend down" their life savings below $2000 before they can qualify for Medicaid nursing home coverage.

In recent years, Medicaid eligibility rules have become more complex and restrictive.  The latest significant change was the Deficit Reduction Act of 2005.  These changes have resulted in included changes in look-back periods, income caps, transfer penalties and waiting periods.  Seniors who attempt to position themselves for Medicaid eligibility  without advice from counsel can be penalized by Medicaid for so-called "uncompensated transfers."  If they are concealed from Medicaid, such transfers may even result in criminal prosecution.

The Law Office of Richard Poole has the expertise to steer seniors through the maze of Medicaid eligibility requirements using every tool legally and ethically available to preserve assets for their spouse and family.  With proper planning, even seniors facing crisis because of an immediate need for nursing home care can preserve some or all of their assets.   Each individual's situation must be carefully analyzed to formulate an appropriate plan.  We use a Long Term Care Questionnaire to guide our clients in gathering the information needed for planning, and use that information to draft a Medicaid Asset Protection Letter which analyzes their situation and presents planning options .  Contact us today if you or a loved one needs to start this critically important process.


The Law Office of Richard Poole assists clients in the Wilmington, North Carolina area, including New Hanover County, Brunswick County and Pender County, Topsail, Hampstead, Figure Eight, Ogden, Wrightsville Beach, Carolina Beach, Kure Beach and Leland.



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1213 Culbreth Drive, Wilmington, NC 28405
| Phone: 910-509-7253

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