Medicare and health insurance don’t pay for long-term nursing home care. Medicaid, does, but impoverishment is the price of admission to the Medicaid program. Proper planning enables one to qualify for Medicaid benefits while protecting substantial assets for spouse and family. In order to qualify, applicants must prove that they have limited income and assets. Before beginning the application process, it is helpful to understand what information you will be required to provide to prove your eligibility.
In Pennsylvania, an unmarried applicant’s non-exempt available assets cannot exceed a total of either $8,000 or $2,400 depending upon one’s monthly income level. Monthly income cannot exceed the nursing home cost. A married applicant’s spouse can retain up to a maximum of $137,400 (in 2022) of non-exempt assets. Pennsylvania requires Medicaid applicants to provide the necessary information to prove that they meet these eligibility criteria. The burden of proof is on the Medicaid applicant—not on the state. In addition to needing to provide identifying information such as a birth certificate and proof of citizenship, following are some of the documents that you may have to provide to the Medicaid agency when you apply for benefits. Contact Vasiliadis Pappas Associates for our free comprehensive list:
- Proof of income. A copy of any pay stubs, Social Security statements, and/or pension checks; income tax returns for the past five years; and verification of any other sources of income, for example, rental income or dividends.
- Bank records. Copies of bank statements for the past five years.
- Property. A copy of the deed to any property owned within the past five years and a copy of the most recent property tax bill.
- Retirement accounts. Statements for the past five years of retirement accounts.
- Insurance. Copies of insurance policies, including health insurance, life insurance, and/or long-term care insurance.
- Car registration. Registration information for any cars owned by you.
- Burial arrangements. Copies of any prepaid funeral contracts or deeds to burial plots.
Pennsylvania uses an electronic database to verify some of the information. Intentionally giving false information is a serious criminal offense.
The state looks back five years from the date an application is filed to determine whether you transferred assets for less than fair market value during that time. Applicants who gave away assets will likely be subject to a period of ineligibility. One should only make gifts under the guidance of an elder law attorney experienced in Medicaid planning.
Not all assets will be counted against you for the purposes of Medicaid eligibility. Personal possessions, one vehicle, your principal residence, and prepaid funeral plans are exempt “noncountable” assets. However, the state will likely still request information about these assets.
After you begin receiving benefits, you are not done. Medicaid reviews your income and assets every year to ensure that you are still eligible. Updated financial information must be annually submitted.
The Medicaid application process is complicated, and submitting an application without an attorney’s help, particularly if you are applying for nursing home benefits, is not a good idea. The process generally takes several months or more, as Medicaid keeps asking questions and demanding further documentation for the answers provided. The lawyers at Vasiliadis Pappas Associates have helped thousands of clients protect assets and qualify for Medicaid. We’re available to help you and your loved ones as well.
Contact Vasiliadis Pappas Associates for assistance if you or a loved one encounters this situation.