Elder Law
Sturgis Estate Planning - Elder Law

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Michael A. Hettinger

Kalamazoo: 324-2000   Battle Creek: 968-5000

Three Rivers: 273-7800  Sturgis: 659-6161

Coldwater: (517)278-6800  Dowagiac: 782-2500

Fax: 344-3601 Statewide: 800-294-5055

Medicaid Planning for Nursing Home Care
(Based on requirements for the year 2012)

To be eligible for Medicaid in the nursing home or through MI Choice Waiver, a person must be sufficiently ill to qualify for nursing home–level care and must be either in his or her home or in a Medicaid-certified nursing home.

To be eligible for Medicaid benefits, an applicant must meet asset eligibility requirements. An unmarried person must have countable assets of less than $2,000. Countable assets are assets that are not excluded. For a married person to qualify, the couple’s combined countable assets musts be less than $2,000 plus a protected spousal amount. The protected spousal amount is the amount that the community spouse (non–nursing home resident spouse) may keep and utilize for his or her own needs. This protected spousal amount is calculated via a formula that looks at the countable assets of the couple as of a specific “snapshot date”. The snapshot date is generally the first date that the applicant has been in the hospital or nursing home for the beginning of a 30-day period, commonly the last night the ill spouse slept at home. When an individual seeking Medicaid benefits has assets that exceed the allowable amount, the person’s efforts to meet the asset requirements are referred to as a “spenddown.”

Divestment is a transfer of property for less than fair market value during a set period of time before applying for benefits. The period of time that is reviewed for such transfers is called the look-back period. Divestment by the applicant may result in a penalty period that will delay the date that an applicant may qualify for Medicaid.

In addition to asset eligibility requirements, applicants must meet income eligibility requirements. To be eligible for Medicaid in a nursing home, the applicant must have income less than what it would cost to privately pay for nursing home care. This is rarely an issue because nursing home care costs between $4,500 and $7,000 per month. To be eligible for Medicaid through the MI Choice Waiver program, the individual must have income below $2,094 in 2012.

When a single person becomes eligible for Medicaid in a nursing home, most of his or her income is paid to the nursing home as his or her patient pay amount. When a married person becomes eligible for Medicaid in a nursing home, the calculation of the patient pay amount may allow some income to be diverted to the community spouse. There is no patient pay amount for an individual receiving assistance through the MI Choice Wavier program.

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