Question: My 90-year-old father is going to need nursing home care soon. I understand that there are financial requirements that must be met in order for him to become eligible for Medicaid. However, the social worker at the hospital also mentioned that there needed to be a medical report determination made by my father's doctor as to whether or not he would "medically qualify" for Medicaid. Can you please explain?
Answer: The social worker is correct. Not only is it necessary that you meet the financial requirements of Medicaid in order to have Medicaid pay for your nursing home care, but your health situation has to be such that you require your care to be provided by a nursing home. Specifically, a doctor will provide a written report to Medicaid addressing the deficiencies of daily activities that the patient is experiencing. If there are not enough deficiencies in daily activities, it may be that the patient will not receive the "medical pass" necessary to become eligible for Medicaid.
Ten years ago, there was almost a presumption that if a person was ninety years old they would be eligible for Medicaid from a health care standpoint. I have seen more and more cases recently where clients 90 years or older are not deemed to be eligible from a healthcare standpoint for Medicaid. In such a case, if the loved one cannot stay at home, the only option would be to be admitted into an assisted living facility. Typically, assisted living facilities cost approximately half as much as nursing homes. However, Medicaid will not pay for these services.
Question: I heard at the VFW that Congress was considering eliminating the benefit for veterans for nursing home care. Is this true?
Answer: A few months ago, Congress held hearings with respect to the VA benefit "aid and attendance." This benefit can provide up to approximately $2,000 a month for the veteran and approximately $1,100 for a widowed spouse to pay for the care in a nursing home or assisted living facility or at home for a veteran or their spouse. Unlike the rules associated with qualifying for Medicaid, the rules for qualifying for aid and attendance do not prohibit the transfer of assets. That is, while there are rules regarding how much a veteran can own in assets and still be eligible for aid and attendance, there is no rule that prohibits a veteran from gifting his assets to his children and then applying for aid and attendance.
As a result of the hearings, there was a proposal that Congress consider enacting a three-year look-back for those veterans and spouses who apply for aid and attendance. If the applicants made gifts within a three-year period, they may be ineligible for receiving aid and attendance. Because there has been a lot of resistance from veterans' groups and advocates, it is questionable as to whether or not this bill would pass Congress and be signed by President Barack Obama.
If you would like to submit a question for publication, email it to rrokisky@rokiskylaw.com. Jeffrey J. Rokisky is an elder law attorney with offices in Wheeling, Weirton, Elkins, Clarksburg and Robinson Township.
