Medicaid is a federal health insurance program jointly managed by Texas and the federal government that helps pay for medical care for people with limited incomes. Many older people first encounter Medicaid when they need to reside in a skilled-nursing facility.
Medicaid offers a way to receive quality long term care beyond what many Texans can afford. However, eligibility can be complicated. A Texas Medicaid payment for nursing homes lawyer can help you understand if you qualify.
At Marc Whitehead & Associates, our Texas Medicaid eligibility and asset protection lawyers have over 120 years of combined experience helping people navigate complex legal issues. Contact us today and let us know what we can do for you.
When Is Medicaid Necessary?
For many nursing home residents, Medicaid helps bridge the gap between their income and their total cost of care. People with little or no income and assets may take advantage of Medicaid almost immediately.
However, people with significant assets are required to spend them down until they reach eligibility for Medicaid payments. This means exhausting savings and other financial resources to pay for your costs that aren’t covered by your income. In Texas, this is called the Medically Needy Pathway.
Once you are accepted for Medicaid, you will accrue debt each month until you pass away. Then, the state of Texas can claim your remaining assets to recover costs. While you are usually not required to sell your home to pay for care, it could be part of the estate recovery process.
Do You Always Need Medicaid?
If you can afford to pay all of your care-related expenses out of pocket, you will never need to apply for Medicaid, and you would likely be ineligible anyway. Avoiding Medicaid means no estate recovery process and the protection of your assets.
However, even people with above-average incomes should not assume they can afford a nursing home stay. Skilled nursing care is expensive, and in Texas, depending on your needs, you can expect to pay $6,000 or more per month.
A Texas Medicaid payment for nursing homes attorney can help you plan for various scenarios and offer advice on how best to manage your finances.
Medicare Vs. Medicaid
Medicare and Medicaid are both federal healthcare programs. People are occasionally confused about their role in nursing home payments. Although they have different requirements, both can help pay for skilled nursing stays in different circumstances.
Medicare is available for anyone over the age of 65 once they apply for Social Security. If you are admitted to a nursing facility, Medicare will often pay for the first 100 days, provided you had a qualifying hospital stay.
That means you may not need to pay out-of-pocket for your stay, provided you can return to your home while your Medicare payments are still in effect. Once Medicare runs out, you must pay for your care on your own.
Do You Need a Lawyer to Apply for Medicaid?
Your social services and financial resources agents at the skilled nursing facility will be more than happy to help you apply for Medicaid. It is in their best interest to do so, as without it, they do not get paid for a portion of your care.
When you or your loved one begins the Medicaid process, it is always a good idea to run everything past a Medicaid payment for nursing homes lawyer in Texas. We can review documents and offer advice to ensure that your interests are accurately represented.
While a nursing home probably isn’t going to break any rules or violate your rights intentionally, mistakes can happen. It is important to have a legal representative on your side who understands the process.
What Disqualifies You from Medicaid?
You must meet certain criteria to be eligible for Medicaid to pay for your nursing home stay in Texas:
- You must be a legal resident of Texas
- You must require a skilled nursing level of care
- The nursing home must be Medicaid certified
- You must meet income and resources requirements
However, some actions can disqualify you from Medicaid, even if you meet the other criteria. One error many people make is misunderstanding how to manage their assets prior to entering a skilled nursing facility.
The 5-Year Lookback for Medicaid
When you apply for Medicaid, the state will request a full accounting of your assets. However, they don’t just want to know what you have today; they look back five years to see if you had any assets you sold or gave away.
Giving away large amounts of money and selling real estate or other high-value assets for less than market value could mean you are ineligible for Medicaid for a specific period. There are some exceptions, and it is important to know the difference.
Speak with an elder care attorney long before you expect to need skilled-nursing care. They can help you put together a plan to manage your money and protect your assets in a way that won’t compromise your Medicaid eligibility.
What if Your Medicaid Application Is Denied?
If you apply for Medicaid and are denied, you are forced to pay for your care on your own. You have options, such as appealing the decision, reapplying, or requesting a reversal.
An elder law attorney can help you understand your rights and how to choose the best path forward.
Contact a Texas Medicaid Payment for Nursing Homes Lawyer
Medicaid helps many people who could not otherwise afford it get the healthcare they need. However, for older Texans with assets, it presents a list of complications. In some cases, it is possible to protect some or all of your estate while remaining eligible for Medicaid.
A Texas Medicaid payment for nursing homes attorney can help you understand your options and devise a strategy. We can make sure you avoid many of the common mistakes people make that make them ineligible for Medicaid.
Since 1992, the team at Marc Whitehead & Associates has worked to help Texas residents with complicated legal issues. Contact us today.