The Medicaid look back rule applies when applying for Medicaid benefits to cover certain kinds of care, including nursing home care. The rule can make a big impact for seniors who are depending upon Medicaid to pay for their nursing home services when other types of insurance fail to provide essential coverage. Unfortunately, the rule can result in seniors being disqualified from getting care covered for a period of time, which can lead to substantial financial loss for families.
The Law Offices of James A. Miller, P.C. can explain the Medicaid look back rule and can help seniors and their families to understand options for trying to protect as much personal wealth as possible when seeking coverage for nursing home care. Give us a call to find out more about how a Worcester Medicaid planning lawyer can provide assistance with getting qualified for Medicaid and working within the look back rule.
What is the Medicaid Look Back Rule?
The Medicaid look back rule is a rule that is aimed at preventing people from giving away all of their property and possessions just to qualify for Medicaid when they need nursing home care.
Nursing homes can cost more than $100,000 a year, which means it is very difficult for people to just pay for nursing home care when they need it. If you have to pay out of your own personal income and family wealth, you could spend your entire monthly income, be forced to tap into retirement savings, and be forced to sell property just to get funds to pay for nursing home care.
Unfortunately, this spending down and loss of your personal wealth is frequently what happens when you need nursing home care. The reason this happens is because while Medicaid pays for custodial care in a nursing home, almost no other insurance will cover this kind of care. Private policies, Medicare, and Medicare Advantage Plans provide no coverage for custodial care at all in most cases, and provide only limited coverage for short durations in a nursing home where skilled medical service is provided.
Since Medicaid pays for nursing home care when no other insurers will, those who have to go into a nursing home will typically try to get Medicaid to cover them. The problem is, Medicaid eligibility rules allow coverage if you have limited income and few assets. In Massachusetts, seniors with more than $2,000 in assets may not get Medicaid.
Many seniors respond by trying to give away their wealth to loved ones so they can drop below $2,000 in assets and get Medicaid coverage. The Medicaid lookback rule is designed to stop this from happening by looking back at five years of financial records and imposing a period of disqualification based on the value of any assets transferred, sold at less than market value, or given away over the prior five years.
The disqualification period is determined by dividing the value of the assets given away or transferred over the prior five years by the average monthly cost of nursing home care. Whatever this number is equals the number of months in which Medicaid won’t pay for nursing home care.
How can You Get Medicaid to Pay for Nursing Home Care?
The best way to get Medicaid to pay for nursing home care is to make a Medicaid plan at least five years prior to needing care, and to ensure the assets you are trying to protect are no longer countable resources for Medicaid. If it is already too late to do this, you should talk with an experienced attorney about what kinds of financial moves you can make to get covered for nursing home care through Medicaid as soon as possible while protecting as much wealth as you can.
Getting Help from A Worcester Medicaid Planning Lawyer
The Law Offices of James A. Miller, P.C. can provide help with getting qualified for Medicaid. Because of the Medicaid look back rule, you should strongly consider trying to work with a Worcester Medicaid planning lawyer as early as you can to protect assets well before you need to get nursing home care paid for. However, even if the need for care is imminent, our legal team can still assist you with trying to get Medicaid as quickly as possible while protecting as much of your wealth as possible.
To find out more about how Medicaid planning can fit within your estate planning process, download a free estate planning worksheet. You can also give us a call at 866-370-3888 or contact us online to talk with an experienced attorney who can help you.
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