Medicaid Planning
WORK WITH A MEDICAID ATTORNEY IN NORTH MIAMI BEACH, FL
What is Medicaid?
Medicaid is a government funded program that pays for Long Term Care. It is not Medicare, in that Medicare does not pay for Long Term Care. Medicare would pay for the first 21 days of Long Term Care, and then the co-pay donut hole kicks in for the next 80 days. After 100 days, Medicare does not pay anything for Long Term Care.
Medicaid pays for all medical costs, alleviating the dreaded Donut Hole, as well as all of the costs for a Nursing Home or Rehabilitation Center, the Level of Care in an Assisted Living Facility, up to 40 hours for a Home Health Aide, or the costs for an Adult Day Care Center.
What is Long Term Care?
Long Term Care is a variety of services which help people meet both medical and non medical needs of people with a chronic illness or disability who are unable to care for themselves over a long periods. This usually occurs with seniors who often are the most vulnerable and needing Long Term Care.
How to pay for Long Term Care
There are three basic types of Long Term Care services: Nursing Home, Assisted Living Facility, or Home Based (In-Community). The costs vary between the types of services, and even between different providers within each type. Generally, a Nursing Home in South Florida would cost between $7000 to $12000 per month, an Assisted Living Facility between $1800 and $5500 per month, and Home Health Aide approximately $20 per hour.
There are three ways to pay for Long Term Care. The first is private pay. This means that the patient has enough resources and pays for the services on their own. The average stay in a Nursing Home is 2.5 years, so this avenue could be very expensive. The second method is Long Term Care Insurance. Some people have Long Term Care Insurance that they took out when they were younger. The third method is Medicaid. The government pays for the care for as long as the individual continues to need the care.
Qualifications for Medicaid
There are two key financial requirements for Medicaid. The first is income and the second is assets. An individual has to have less than $2199 of monthly income. If the income does exceed the limit, we simply create a special type of trust to alleviate the disqualification for income. The second is that the individual can not have more than $2000 of assets. Again, if the assets exceed the requirement, then we create a Medicaid strategy to make the individual Medicaid eligible.
I say to my clients that we do the strategy in order to preserve the assets for the family. Would it not be better to have the government pay for the Long Term Care and preserve the assets for the kids or grandkids? This is proper Medicaid Planning.
Doesn't a Medicaid patient at a facility get treated like a second-class citizen?
This is a common question that we get from our clients. Actually, it is against the law to treat a Medicaid patient differently than a private pay patient. Furthermore, the staff does not know which patient is private pay and which is Medicaid when the staff administers to the needs of the patient.
How am I different from other Medicaid Attorneys?
Applying for Medicaid has two distinct but equally important aspects. The first is the creation of the strategy itself so that the individual is Medicaid Eligible (recall the two financial requirements). The second is the application process itself. The application process can take up to two years for approval, if not done by a specialist. Most attorneys simply give the strategies to the families and tell them to apply through the Aging Disability Resource Center (a non profit organization), or have them apply themselves on line. Some attorneys actually have a paralegal in their office who has been trained in a limited capacity to apply for Medicaid.
I have taken this very disjointed approach and have turned it on its head. I personally sit on the Executive Board of the Miami Alliance for Aging, the non-profit organization responsible for Medicaid Applications in Monroe and Miami Dade. The typical approval time is about 2 years for Medicaid. My clients average half that time, because of my expertise in this area.
Secondly, when you call us, I answer the phones directly. This is very unique in the law field. Typically a client will have to go through a receptionist and or a paralegal before being able to speak with the attorney directly. I believe that I owe it to my clients to be accessible for their needs.
Medicaid vs. Medicare
While they are often confused with each other, it is important to understand a critical difference between the two. Medicare is short term care that is broken down into four main "parts":
- Part A: Hospital/Hospice Insurance
- Part B: General medical insurance
- Part C: Medicare Advantage. This is an HMO. Medicare Part C is elected instead of Part A & B and typically provides more services, including prescriptions. Usually covers the 20% not covered subject to co-pays/deductibles.
- Part D: Prescription Drugs. Pays initial deductible and when certain thresholds arereached there is the dreaded "donut hole."
What is Long Term Care?
Long Term Care (LTC) is medical care in Nursing Homes, Rehabilitation Centers, Assisted Living Facilities, and care at home (or In-Community Care).
Doesn't Medicare cover Long Term Care?
Unfortunately, Medicare was designed to provide healthcare coverage, much like your healthcare insurance carrier, such as Blue Cross Blue Shield. Medicare will pay for your hospital visits, prescription drugs (with a donut hole), doctors visits, and such. Medicare will NOT pay for an Assisted Living Facility, Nursing Home, Rehabilitation Center, In-Community assistance. That is left to either self pay, LTC insurance, or Medicaid.
I know that this can be confusing, but Medicare will pay up to 21 days in a Rehabilitation Center, and then the patient is responsible for approximately $150 per day of the costs up to 100 days. This is really not a solution though, given the expensive daily cost.
What does Medicaid Cover?
Medicaid will cover ALL of the costs of a Rehabilitation Center or Nursing Home, for as long as the patient needs those services.
Medicaid will also pay for the Level of Care in an Assisted Living Facility, up to $1200, as well as up to 40 hours per week for a home health aide.
Of course, Medicaid would also pay for all medical care, including prescription drug costs, thus eliminating the dreaded Donut Hole.
