Question: What are the financial requirements for being approved for Medicaid’s Long Term Care Benefits?
Answer: Although Medicaid, also known Title 19, is a Federal benefit program, it is administered by the States, and as such it is very state-specific. This answer is only applicable to residents of Connecticut.
In Connecticut there are two different sets of requirements for Medicaid Long Term Care benefits; one for married people, and one for single people. We will first look at a married couple.
In this scenario we have one spouse who is in a long term skilled facility (convalescent home, nursing home). Except for very limited pilot programs, Medicaid does not cover Assisted Living Facilities. We will call her the Institutionalized spouse. The other spouse is called the Community spouse.
The first issue most people need to deal with is that regardless of the name on the account, between married couples, any money that is in either name, or both names is in one pot for either to use. This means that one spouse can’t give all of her/his assets to the other spouse and say that they are destitute.
That being said, for an institutional spouse to receive benefits, that individual can have no more than $1,600 in assets in their own name, no vehicles, life insurance with a cash value not to exceed $1,500, and a pre-paid irrevocable funeral contract not to exceed $5,400. They can also have a small pre-paid revocable funeral contract. In addition, generally all of the “applied income” of the institutional spouse, which would include Social Security, Railroad retirement, any pensions, royalties, etc. goes to the facility. The institutional spouse is allowed to keep $60. from the applied income for personal items such as haircuts, etc.
The Community Spouse is allowed to keep one home with equity of no more than $814,000., one car, pre-paid funeral contracts as above, and one-half of the remaining assets not to exceed $117,240. What does this mean? It means if a couple has 1 Million dollars in either or both names, the Community spouse can keep $117,240. and if the couple has $100,000 in either or both names, the Community spouse can keep $50,000. There is also a minimum amount that the Community spouse can keep of $23,499 regardless of the total.
For a single individual who is in, or going into, a long term skilled facility he or she can keep the same $1,600, the same pre-paid funeral contracts, and the same amount in cash value of life insurance ($1,500.). They can’t have a car, a home of any value, or any other assets including cash. As before, all of their income, less $60. goes to the long term care facility.
If you need help with this or other elder care / senior care legal matters, you can find thousands of Elder Care Professionals from across America on ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.
You can also find Elder Law Attorneys on ElderLawAttorneys.us and Estate Planning Attorneys on EstatePlanningAttorneys.us – 2 additional websites sponsored exclusively by the national ElderCare Matters Alliance.
George P. Guertin, Esq.
Senior Partner, Guertin and Guertin, LLC
North Haven, Connecticut
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