The truth is that State Medicaid programs are complex and many of us have preconceived notions about Medicaid coverage of nursing home care. Here are 10 common myths about Medicaid in the nursing home setting:

1. Medicaid coverage means substandard care.
False. Providing substandard care to Medicaid recipients and discriminating based on the resident’s pay status is illegal under both state and Federal law. Besides, typically the caregivers and staff do not know which resident is a Medicaid recipient as there is no public identification of pay status.
2. You must be poor or broke to qualify for Medicaid.
False. You may own property and qualify for Medicaid as certain assets are non-countable or exempt under the Medicaid regulations.
3. You must transfer or hide your assets to protect them.
False. This is a crime. While it is not illegal to plan or structure your assets in order to qualify for Medicaid nursing home benefits, you must fully disclose the details to the State Medicaid agency.
4. The state will take your house to qualify you for Medicaid.
False. In most states, the resident can maintain a principal residence and will not be a countable asset if a spouse or specific individuals live in the house. Keep in mind that there are estate recovery laws which allow the state to seek reimbursement from your estate to recover Medicaid costs after your death.
5. You cannot qualify for Medicaid after you have become a nursing home resident.
False. You may qualify for Medicaid benefits prospectively even if you entered the nursing home in private pay status. There is a disclosure requirement – you must disclose up to 5 years of financial records and transactions when applying for Medicaid coverage.
6. Once you become eligible for Medicaid, you remain eligible permanently.
False. Medicaid is not for life but once your eligibility is established, it will be maintained unless your circumstances change (i.e. inheritance, settlements, sell an exempt asset, Medicaid rules change).
7. Medicaid will not cover all the nursing home care and services you want.
False. There is no difference in the type of care or services available to Medicaid recipients as they are entitled to the same nursing home services as other residents.
8. All nursing homes accept Medicaid patients.
False. Although a large percentage of nursing homes accept Medicaid recipients, not all of them do. There are some that will transfer you to a Medicaid nursing home if you spend down your resources in a non-Medicaid nursing home, then qualify for Medicaid.
9. Your agent under a Power of Attorney can retitle your property to qualify you for Medicaid.
False. It depends on the type of Power of Attorney. Many power of attorney documents do not contain the gifting provision or power to make gifts. The power to do so must be explicitly granted to the agent.
10. Your income may to be used to pay for your spouse’s nursing home bill.
False. In the majority of state, only the income of the nursing home spouse is used to pay the nursing home expenses.

Here at Schutjer Bogar, we assist you with the often grueling Medicaid eligibility process so that you can focus on what matters most – your health.

Monica works out of our Manhattan office with Trisha Cowart

As you may be enjoying sweet treats this week in honor of Valentine’s Day, the day we take time out of our busy schedules to celebrate the love we have for our significant others, it is also a good time to remember the spouses of our residents.

I know many of you have witnessed the emotional struggles of many spouses coming to the realization that they are no longer able to provide the level of care their beloved requires. We seek to do everything in our power to make this transition easy for them, however, navigating the labyrinth of Medicaid regulations affecting community spouses can cause additional stress.

In our continued effort to make a spouse’s transition easier, offer the following reminders:

1. Be sure to provide all resource information to the caseworker during the application process. A common denial of a Medicaid application is not due to the resident having excess resources, but instead a failure to provide necessary resource information.

2. You usually have a right to appeal the spousal resource assessment. In determining Medicaid eligibility, the caseworker will issue a form dictating the amount of resources the spouse is allowed to retain. When this assessment is filed with an application for benefits both the resident and spouse will usually have appeal rights.

3. There are community outreach programs to help with this transition. Many communities have support groups for caregivers and family members.

I still believe that love conquers all, and hope you do too! Happy Valentine’s Day!

Julie works out of our Canfield, OH office.