Medicaid Benefit Qualifications

Estate Planning: Basic Questions Asked About Medicaid Benefit Qualifications

Murray | LobbEstatePlanning

Careful estate planning often plays a crucial role in obtaining adequate healthcare services. As older Texans approach retirement, they often begin re-evaluating their finances to see if they can afford long-term health care and other medical services. While some wealthy citizens can cover all their needs with expensive medical insurance policies – others must learn more about possible Medicaid coverage. Caregivers must also master this type of information for loved ones.

Here is a look at some of the basic questions people often ask while trying to determine if they will be fully able to meet all their future medical needs.

Key questions Texans often ask their lawyers about qualifying for Medicaid benefits

Q: Can many Texans age 65 and older qualify for Medicaid benefits?

A: Yes. However, everyone must carefully review all their assets, in advance, to avoid being

turned down for one of the various types of Medicaid services they may need.

Q: What is the Medicaid “Look Back” period?

A. Our state and federal governments are fully aware that dishonest citizens may try and “hide”

certain gifts to others before their health rapidly declines. Therefore, Texas has a five-

year “look back” period that allows government workers reviewing Medicaid applications

to “flag” questionable requests. These tend to involve gifts that were made during the five

years prior to a person applying for Medicaid coverage or benefits. If sizeable assets were

given away or sold for less than their fair market value, Medicaid can deny an application,

triggering a period of months or years during which the applicant will be ineligible for

Medicaid benefits.

Q: Well, doesn’t the IRS gift tax exemption always allow seniors to give annual gifts of a certain

size to family members or others?

A: No, that law was not intended to provide wealthy people with an excuse to give away

money or possessions – without possible Medicaid consequences — during the five years

prior to applying for some Medicaid benefits. All citizens must do their part to keep the

Medicaid program solvent – and not bankrupted by any type of fraud.

Q: What types of assets are considered “countable” when the government evaluates whether

a single or married person is eligible for Medicaid benefits?

A: Countable assets include investments, stocks, bonds, credit union funds, cash, and all monies

in checking and savings accounts. Real estate properties owned — but not lived in by the

applicant — are also among the investigated assets.

Q: Are any types of assets considered exempt when Medicaid eligibility is being determined?

A: Yes. Here is a list of some of the most common types of properties that are not counted when adding up the value of a Medicaid applicant’s assets.

  • Household furnishings
  • Personal belongings
  • Irrevocable burial trusts
  • An applicant’s primary home
  • An automobile

Q: Are there different Medicaid programs that provide services to the elderly? If so, do they

involve different qualifying criteria?

A: Yes. There are several Medicaid programs offering different services and their qualifying

standards can vary to some degree.

Here is a brief list of four Medicaid benefit programs.

1. The Star-Plus Waiver program. This managed care, limited enrollment program exists to

provide adult foster care, assisted living and specific in-home support services. The latter

program is designed to help seniors keep functioning in their own homes, without a

nursing home placement – which is far more expensive.

2. The Community First Choice (CFC) program. This can provide personal care and

support services in a senior’s own home (like preparing meals). In some cases, the senior

needing help may be allowed to choose a relative to provide their care.

3. Primary Home Care. Like the Community Frist Choice program, this one may also let

seniors choose their own caregivers to help provide needed services in their home.

4. Day Activity and Health Services (DAHS). This program is run like most day care

centers. It can help a home caregiver keep a regular job and know that a loved one is

safe during the day. Single seniors living on their own also can benefit from this program

that is run during normal weekday work hours. Certain medical services can also be

provided to seniors who attend.

Please feel free to contact one of our Murray Lobb attorneys. Once we create a formal working relationship, our firm can provide you with the critical legal advice you require for all your business, corporate, or estate planning needs. We are also available to draft the various contracts and other documents you need while conducting your daily business activities.