Medicaid

Question: My mother is widowed and is beginning to decline in health.  I have two siblings.  We know that in order to qualify for Medicaid, Mom cannot have more than a certain amount of assets in her name.  She rents a house, but has approximately $150,000.00 in various CD accounts.  A friend of hers told her that she can give up to $14,000.00 to each of us annually without penalty and still qualify for Medicaid if she needs it in the future, is she correct?

Answer: NO!  We often see clients who believed this to be true, and thinking that they were doing the prudent thing did exactly this sort of gifting, resulting in long periods of ineligibility when the time came to apply for Medicaid. To begin with, what your friend is likely referring to is the $14,000.00 gift exemption under the Internal Revenue Code.  Under the Code, all gifts made in any given year are subject to a gift tax.  However, the first $14,000.00 gifted to each individual in any given year is exempted from the gift tax, and for that reason, for many individuals, gifting during lifetime is a way to distribute wealth and reduce their taxable estate at death.

Oftentimes, seniors and their children believe that this same exemption holds true for Medicaid eligibility, and that gifting this amount of money away annually will not affect them should they need to apply for Medicaid benefits in the future. Medicaid requires that all Medicaid applicants account for all gifts and transfers made in the five years prior to applying for Institutional Medicaid.  These gifts are totaled, and for each approximately $12,000.00 that was gifted, one month of Medicaid ineligibility is imposed.  It is also important to note that the ineligibility begins to run on the day that the applicant enters the nursing home rather than on the day that the gift was made. 

For example, if your mother had taken the advice of her friend, and gifted each of you $14,000.00 per year for three years, she would have given virtually all of her money away.  If at the end of those three years she then needed Medicaid, those gifts would be considered transfers “not for value” and would have made her ineligible for Medicaid benefits for approximately eleven months.  What makes this even more difficult for some families is that an inability to give the money back or help mom pay for her care is not taken into consideration, causing many families great hardship.  It is important for families who have done this sort of gifting to know that there are still options available to them.  An Elder Law attorney who concentrates their practice in Medicaid and Estate planning can help to you to optimize your chances of qualifying for Medicaid while still preserving the greatest amount of assets.     

By: Nancy Burner, Esq. and Robin Burner Daleo Esq.

Question: What does the term “look-back” refer to in the context of Medicaid planning?

Answer: The look-back period refers to the five-year period immediately prior to the submission of application for Chronic Medicaid.  The Department of Social Services, the Agency tasked with reviewing and either approving or denying Medicaid applications, requires that full financial disclosure be provided for this five year time period for all applicants and their spouses.  Medicaid requires complete copies of all financial statements as well as verification of the source of all deposits.  In addition, Medicaid requires a trail of all withdrawals over $1,000.00.  Absent proof to the contrary, Medicaid presumes that these withdrawals are gifts and will assess a penalty for such withdrawals.  For example, if in the review of the financial statements, Medicaid uncovers cash withdrawals equaling $50,000.00.  In many cases, the applicant explains that they have taken these cash withdrawals to pay their monthly expenses.  Absent proof of such, Medicaid will assume that these monies were gifted or transferred away; and for every $11,898.00 of withdrawals that cannot be traced; a like penalty will be assessed resulting in a period of Medicaid ineligibility.   In this case, the applicant would be ineligible for Medicaid for a period of 4.2 months.  It is important to note that the same would hold true if these monies were given away to children or other family members.  Medicaid has a right to full financial disclosure during this time period and failure to disclose is grounds for outright denial of a Medicaid application.  There are a few instances where transfers during the look-back will not create a penalty.  These are exempt transfers and are limited to transfers to: spouses, disabled children, transfers of the homestead to a caretaker child and transfer of the homestead to a sibling with an equity interest.  Absent one of these exempt transfers, all transfers and transactions will be scrutinized during this time period.  It is important to note that although these transfers are exempt, the requirements of the look-back with respect to full financial disclosure still apply.  Another important point to realize is that the look-back period only applies where an individual is applying for Chronic Medicaid to cover the cost of a skilled nursing facility.  Where the coverage needed is for Community Medicaid to cover the cost of an aid in the home, there is no look-back.  This means that there is no retrospective financial disclosure required nor are there any penalties assessed for transfers made during the five years prior to the submission of the homecare application.

By Nancy Burner, Esq. and Robin Daleo, Esq.

What is a Caretaker Agreement?

Question:        I am currently in a position where I need to make some decisions regarding my mother’s living arrangements.  I have found the appropriate level of care for her at an assisted living facility that will cost approximately $5,000 per month.  My sister would like to avoid assisted living placement and wants my Mother to move in with her.   Can my Mother move in with my sister and pay her the $5,000 a month that would have otherwise been paid to the assisted living facility?  What are the legal and/or tax implications of this arrangement?

Answer:          You Mother can pay your sister a fair rate for taking care of her.  Additionally, in the event that  your mother moved into your sister’s home it would be reasonable for your sister to collect rent from your mother pursuant to a valid rental agreement.  Assuming that your sister can provide Mom with care that is comparable or superior to the assisted living facility, the price quote you received is likely a reasonable measure of what the end cost of your mother’s care room and board should be. 

It is advisable for your mother and sister to enter into a written agreement as to the services your sister will be providing mom with in order to avoid any future misunderstanding, these agreements are commonly referred to as “caretaker agreements.”   The agreement should outline with specificity the services to be rendered as well as a valuation for these services if they were to be purchased privately.   The agreement should also indicate the hourly rate that your sister is to be paid for the services provided as well as the anticipated hours that your sister will provide these services.   Your sister should report the money received as taxable income.  If in the future, your parents ever needed to apply for Medicaid, the Department of Social Services will require proof of the agreement, proof that your sister has claimed that income on her annual income tax return, and proof of the hours that she actually provided service. 

            If not properly documented, the payments from your Mother to your sister could have implications with regard to your Mother’s future eligibility for Medicaid benefits.   Medicaid considers all payments for less than adequate consideration to be gifts that result in periods of ineligibility.  Without a caretaker agreement, your sister’s services would be considered to have been proffered for “love and affection” and any payments made to her could be considered uncompensated transfers or gifts.  Likewise, any payments made to your sister in excess of the prevailing rate for the services rendered could also be construed as transfers and/or gifts.  For this reason also, it is imperative that your family sit down with an Elder Law attorney before entering into a caretaker agreement.  If drafted properly, a caretaker agreement will enable your sister to provide services to your Mother without creating a Medicaid eligibility problem later on. 

By: Nancy Burner, Esq.  and Robin Burner Daleo, Esq.

MEDICARE STANDARD FOR REIMBURSEMENT FOR SKILLED CARE – “RULE OF THUMB” IS NOT THE LAW

Common scenario: Client is hospitalized for 3 days or more and then sent to a rehabilitation center.  No worry, as a Medicare recipient, my client is entitled to 100 days care in a skilled nursing facility.  Under traditional Medicare, the first 20 days paid in full and there is a co-pay for days 21-100.  All told, that Medicare coverage is worth more than $10,000.  Problem: The client is advised that she has reached a “plateau,” Medicare will no longer cover her stay, physical therapy will be discontinued.  Without therapy the client must return home and her condition now deteriorates.  This finding that the patient must improve was not based upon the law or regulations.  Nevertheless, this scenario was repeated over and over again, denying Medicare coverage to patients that desperately needed such care to prevent deterioration or maintain their health.    

Medicare is a benefit that you have paid for and for which you are entitled, it is not a benefit for the indigent.  The improvement standard, was a “rule of thumb” used to evaluate Medicare patients and resulted in the denial of much needed skilled care for thousands of Medicare patients.  The denials were based on a finding that there was no likelihood of improvement in the patient’s condition.  This standard ignored the fact that these vulnerable patients needed skilled care in order to maintain their current state of health and to prevent them from deteriorating.  More often than not, if the patient was not improving Medicare coverage was denied. While this standard was widely used, it was inconsistent with Medicare law and regulations. 

A recent court case has sought to remedy the unfair and premature denial of skilled benefits for Medicare recipients.  The case in question dealt with Medicare coverage for skilled care in three distinct settings: (1) skilled nursing facility; (2) home health benefits; and (3) outpatient skilled therapy.  This class action lawsuit was commenced to clarify the Medicare regulations and to stop the wrongful denials of coverage based upon a “rule of thumb”.  Even though the term “plateau” does not appear in the Medicare regulations, it is this term that is often used and relied upon to deny coverage.  The appropriate standard is whether the covered services will “maintain the current condition or prevent or slow further deterioration.”  By applying the “rule of thumb,” coverage was denied to critically ill patients who needed the coverage most.

The case of  Jimmo v. Sebelius was brought by six Medicare beneficiaries and seven national organizations against the Secretary of Health and Human Service. These Medicare recipients argued that Medicare coverage should be determined by the individual’s need for skilled services from a health care professional and not whether the individual was showing signs improvement.  The case was recently settled in favor of the plaintiff Medicare recipients.  All six plaintiffs were Medicare beneficiaries receiving skilled care until a determination was made that the patient had reached a “plateau” and coverage was denied.  As a result of this litigation and the recent settlement, patients will now be able to continue receiving vital services provided by Medicare, even where improvement in the patient’s condition cannot be documented. 

            The settlement clarifies the guidelines as to how much and for how long Medicare coverage will apply.  Nursing home care duration will remain at the 100 days per benefit period, so long as the patient spent three days in the hospital.  However, nursing home residents will no longer be denied because there is no improvement in their condition.  Home health coverage for skilled needs will have no limit on duration, as long as the doctor finds the care necessary.  Finally, out-patient therapy will continue when a health care provider finds that further treatment is medically necessary and the cost of care can exceed the $1,900.00 limit that was previously applied.   In the event costs reach $3,700.00 and treatment is still necessary, the health care provider can submit medical documentation to support 20 additional sessions.  This will mean coverage for thousands of Medicare patients who need the skilled care but cannot otherwise afford it. 

            The settlement agreement also provides for review of cases where a patient was denied skilled care at a nursing facility, home health care, or out-patient therapy services after January 18, 2011.  Procedures will be set up for individuals to submit an application for re-review of the initial determination based upon the old standard.  The standard codified in the settlement is effective immediately.  Healthcare providers must consider not only whether a patient is likely to improve, but also whether the services will prevent a decline, or maintain a status quo.  A determination that a plateau has been reached is irrelevant in determining whether services should be continued.  Many health care providers are unaware of this recent turn of events and are likely to continue to apply the old standard.  Medicare patients must be vigilant in protecting their right to services.   

-By Nancy Burner, Esq.

Question:

My husband suffers from Alzheimer’s disease and may soon need a nursing home.  I have been told that if he needs to go to a Nursing Home, they will take our house and I will have to give them all of his income, is this true.

Answer:  

No, it does not have to be.  Because Medicaid is needs based program, certain income and asset requirements must be met in order to be eligible.  The good news is that those requirements take into account that where there is a situation where one spouse requires nursing home care, there is often a spouse still residing in the community who depends on the joint income and assets to pay their expenses.  For that reason, the Medicaid program allows certain spousal allowances.  Specifically, where there is a spouse living in the community, that spouse is entitled to keep up to $2,898.00 in combined income after payments of medical premiums.  What this means is that where you have a husband and wife, and one spouse requires Nursing Home care, the community spouse can keep his or her income and as much as the institutionalized spouses income to bring them up to $2,898.00.  In addition, although the applicant is permitted to have no more than $14,400.00 in his name at the time of application (not including certain exempt retirement accounts, and an irrevocable pre-paid burial) the community spouse is permitted to keep $115,920.00 in liquid assets plus a home.  However, under New York Medicaid Law, the community spouse also has the option of signing a “spousal refusal” and so long as that document is timely filed with the application, the Medicaid agency will determine eligibility for the institutionalized spouse without considering the assets or income of the community spouse. Assuming a spousal refusal is signed the community spouse can maintain significantly more assets in his or her name without affecting the eligibility of his or her spouse.  This is a particularly important provision of the law when planning for Nursing Home Care for an individual with a spouse in the community.  Many of our clients are surprised to learn that transfers of assets can be made to the community spouse, and that the traditional five year look back does not apply.  In practice what this means is that when faced with a crisis, planning can be done in month one and the spouse in need of care can be eligible for Medicaid the following month. In closing, although pre-planning is always the preferred method, Medicaid planning can be done at virtually any point in the process, ensuring that your loved one receives the care that he or she needs while minimizing the financial impact on your family.

By Nancy Burner, Esq. and Robin Daleo Esq.

Question:  My Aunt, who is widowed with no children, recently fell and broke her hip.  She will need long term nursing care.  She owns her own home, which is worth approximately $250,000.00 and has $200,000.00 in an Annuity.  She has not done any planning, is it too late to for her to protect some of her assets?

Answer: No, although pre-planning is always recommended, it is never too late.  As you likely know, the cost of Nursing Home care on Long Island averages $12,000.00 per month.  Medicare does not pay for Nursing Home Care (with the exception of Rehabilitation), nor does private health insurance.  This leaves Medicaid and private pay as the payment sources for Long Term Nursing Home Care.   Medicaid is a means tested program, in order for your Aunt to be eligible for Medicaid to pay for her stay, she must first meet certain asset requirements.  An  applicant for Medicaid may have no more than $14,250.00 in her name; this figure is exclusive of retirement assets, which are exempt so long as they are in pay out status.  In addition, she is permitted to have an irrevocable pre-paid burial account.  It is also important to note that when applying for Medicaid, the Department of Social Services will “look back” five years at your Aunt’s  financial statements.  The purpose of this look-back is to see whether she has transferred any monies out of her name in the five years prior to the application for Medicaid.  While certain transfers of assets are exempt, the general rule is that transfers in the five years immediately preceeding the application for Medicaid will create a penalty period during which an applicant will not be eligible to rely on Medicaid as a pay source.   All that being said, even though your Aunt requires Nursing Home care now and has not protected her assets, she still may be able to protect up to fifty percent of her assets.  Promissory Note planning can be implemented; even at the last minute, and can, in most circumstances, enable the applicant’s family to preserve a large portion of the assets that would otherwise need to be spent down in order to pay for care.  In summary, while pre-planning is always preferred, asset protection is possible at any time.  A consultation with an Elder Law attorney who is well versed in the Medicaid guidelines would be a prudent next step for you. 

By Nancy Burner, Esq. and Robin Burner Daleo, Esq.

Question: My mother is currently in a Nursing Home receiving rehabilitation.  Her covered Medicare days are set to expire next week, but she will need to remain in the Nursing Home for a while longer.  We would like to apply for Medicaid to cover her stay. Her plan is to return home but are concerned that Medicaid will put a lien on her house.

Answer: As you are likely aware Medicaid is a means tested program and therefore in order to be eligible, an applicant cannot have more than $14,250.00 in assets in their name, excluding retirement funds.  Additionally, under certain circumstances, the principal residence of the applicant, known as the “homestead” will be considered exempt property. The homestead is defined by the Department of Social Services as the primary residence occupied by the applicant, his spouse, or the applicant’s minor or disabled child.  Where an applicant applies for Chronic Medicaid but does so with the intention to return home, the homestead will be exempt. In this situation, the fact that the applicant is not occupying the homestead does not immediately impact the exempt status of the home.  The thought being that the intention to return home is sufficient to save the exempt status.  It is important to note that the homestead loses its exemption if the Medicaid agency determines that it is unlikely that the applicant will return home.  Additionally, the intent to return home can only be maintained for a period of up to six months.  After that time, Medicaid presumes that the applicant is unable to return home and the homestead becomes a resource like any other, subject to recovery.  In either of these situations a lien will be placed on the home for an amount equal to the cost of services paid on behalf of the applicant. For this reason, it is important to monitor the situation closely so as to not lose other planning options available to you.  Under most situations, when applying for Medicaid, even where pre-planning has not been done, there is an opportunity to preserve some or all of an applicant’s resources.  In the situation that you described, because your mother’s intention is to return home after her rehabilitation, and medical evidence supports this intention, her homestead will remain exempted for Medicaid purposes.   

-By Nancy Burner, Esq. and Robin Daleo, Esq.

Question: Is there any program that will help to pay for the cost of in home care for my Mother who has Dementia?

Answer: Yes, in New York, the Community Based Medicaid program will pay for the cost of care in the home so long as certain requirements are met.  First, the applicant must meet the necessary income and assets levels.  It is important to note that there is no “look back” for community Medicaid which means that for most people, with minimal planning, these requirements can be met.   Persons over the age of sixty-five are presumptively disabled for the purpose of Medicaid eligibility, so while there is no need to prove disability, the individual who is looking for coverage for the cost of a home health aide must be able to show that they require assistance with their activities of daily living.  Activities of daily living include dressing, bathing, toileting, ambulating and feeding.  Community Medicaid will not provide care services where the only need is supervisory; therefore, it is important to establish an assistive need with the tasks listed above.  For some clients, this is not a difficult threshold to reach.  However, for many of our clients, when we first inquire as to whether the individual in need of care requires assistance with these tasks the answer is no.  Only after additional discussions does it become clear that they do in fact require assistance with many of these activities.  The reason for this discrepancy is that all that needs to be established is that he person applying for assistance is unable to complete these tasks unassisted.  It is not necessary that there be a showing that they are unable to manage any part of the task, only that they need some level of help.   Once this need is established, the amount of hours awarded will depend upon the frequency with which the tasks are necessary.  For example, an individual who only needs help dressing and bathing may receive minimal coverage during the scheduled times, maybe two hours in the morning and two hours in the evening.  Contrast that with an individual who requires assistance with ambulating and toileting, here because these tasks are considered “unscheduled” the hours awarded will be maximized.  In fact, where the need is established, the Medicaid program can provide care for up to twenty- four hours per day, seven days per week.  The Community Based Medicaid Program is an invaluable program for many seniors who wish to age in place but are unable to do so without some level of care. 

By: Nancy Burner, Esq. and Robin Daleo, Esq.

Question: My mother is going into a nursing home and applying for Medicaid.  I was told that her annuity is a resource and must be used to pay for her care.  Is that true?

Answer:  The answer depends upon what type of annuity your mother owns.  Annuities that are purchased with after tax dollars are treated as resources.  Annuities that are purchased with retirement savings are protected under certain conditions. 

Annuities are investment products where the purchaser pays a lump sum into an annuity contract with income payments until death or payments deferred until a later time. There are penalties for early withdrawal, the terms vary depending on the contract. Typically, these types of annuities have a cash value that can be withdrawn and are available resources for a Medicaid applicant.   Under the Deficit Reduction Act of 2005, if an applicant or his spouse purchases this type of annuity, it will be considered a “transfer” unless the state is named as a beneficiary after the community spouse or a disabled child.  

If these annuities are “annuitized” then the cash is no longer available and the owner is entitled to a stream of payments.  As long as the annuitized payments are paid over the applicant’s life expectancy, then the annuity payment is counted as income. There is no principal and no transfer penalty.

In contrast, if your mother’s annuity was purchased with pre-tax dollars, i.e. if it is an IRA annuity, then the result is entirely different.  IRA principal is protected provided the applicant is taking “periodic payments”.  So, if your mother has an IRA worth $100,000 but her distribution is $12,000 per year, $1,000 per month will be deemed “income” and the balance of the IRA will be protected. There are very particular requirements under the Medicaid regulations for taking distributions.  One major dispute revolves around the proper distribution to be taken by the applicant.  The agency in this county requires distributions to be taken at twice the amount of the IRS minimum distribution rules.  We have been successful in challenging this larger distribution, but the regulations are not clear.  In some cases the difference is not great, but with large IRA’s the difference can be significant.  

Please note that this is a brief overview of annuities.  Keep in mind that there are many products on the market and there may be many variations in terms.  

By Nancy Burner, Esq. and Robin Daleo, Esq.

The last year has been a roller coaster ride for Elder Law attorneys and their clients.  In April of 2012, Governor Cuomo was successful in passing a budget which sought greater recovery from the estates of Medicaid applicants and their spouses.  In particular, the new provisions of the law expanded the definition of “estate.” This meant that when an applicant and or his surviving spouse died, Medicaid could seek recovery against any asset in which the decedent held an ownership interest in at the time of death.  The expanded definition included interests in joint tenancy, tenancy in common, joint accounts or property with rights of survivorship and life estate interests.  In particular, this was a disappointment for many people who retained life estates in their homes with the belief that the real property would be fully protected for their heirs.  The only favorable portion of the change was the new method of valuing life estate interests which resulted in a much lower value attached to the life estate.  This new method reflected current mortality tables and the lower interest rate environment and meant less to be collected by Medicaid. 

The general rule has been that the Medicaid program could be reimbursed ONLY from the probate estate of the Medicaid recipient or his surviving spouse.  In reality, many assets in which a Medicaid recipient or his spouse retained an interest were “non-probate” assets.  Non-probate assets pass to the beneficiary outside of the last will and testament.  For instance, a joint bank account would pass to the other named owner or the bank account would name a beneficiary who would inherit the account at death.  Other examples of non-probate assets would be life insurance policies that name beneficiaries, IRA accounts, annuities, as well as jointly owned property.    In the context of Medicaid planning, many seniors have transferred their homes to their children and retained a “life estate.”  Upon their death, the real property passed to the children, by operation of law, that is, without the need to probate a will.  In that instance, as long as the asset did not pass through the probate estate, Medicaid could not seek recovery against that asset.

The good news is that two weeks ago, Governor Cuomo’s new budget repealed the law which sought expanded estate recovery.  As a result, the protection of real property with the use of life estate will be restored to its original form.  Upon the death of the life tenant, there will be no reimbursement to Medicaid. 

In addition to the repeal of expanded estate recovery, there was concern that the new budget would eliminate spousal refusal in Community Medicaid cases where the recipient is living in their home with their spouse and receiving services.  It has always been the law in New York State that the “community spouse,” or the spouse not receiving Medicaid services, could claim that they are unable to contribute funds to the care of their spouse because they need the money for their own support.  This is especially important on Long Island, where the cost of living is high and spouses would to prefer to live together with services delivered at home.  We are happy to say that with the passing of the new budget, spousal refusal is still alive and well in New York State.

It is important to note that recovery is permitted against the states or Medicaid recipients or their surviving spouses.  This is because the law is clear that there can be no recovery against the estate if there is a surviving spouse.  So for instance, if a husband is in the nursing home and receives Medicaid and his wife is in the community, there can be no recovery against the estate assets, if any, of the Medicaid recipient because he is survived by a spouse.  By the same token, if the community spouse dies, there can be no recovery against her estate for the same reason- she is survived by a spouse.  When the surviving spouse dies, any monies paid by Medicaid for either spouse, within 10 years of her death, for either spouse, would be recoverable.  This is why it is very important for the community spouse to do further estate plan once her spouse has obtained Medicaid. 

On a further note, the Medicaid regulations provide that there can be no recovery against any estate where there is a disabled child.  Therefore, if a Medicaid applicant or the surviving spouse dies with a disabled child, even if that child is not dependent upon the parent, there can be no recovery against the estate.   The law and regulations dealing with estate recovery are complex but at least for today, there are still options and prudent planning opportunities.  

Question: My Dad is a widow and lives at home alone.  Up until now he has been able to care for himself.  Recently, he has begun to show signs of memory loss and is having a hard time getting himself up and ready in the morning.  He owns his own home and he has a small bank account with about $30,000.00.  We have researched the possibility of having someone come in to the house to help him during the day but are concerned about the cost.

Answer: This situation is not uncommon and it sounds as though Homecare Medicaid may be the solution for you.  Homecare, sometimes referred to as Community Medicaid is available to those individuals who are disabled and require assistance with one or more of their activities of daily living.  In order to be eligible for Community Medicaid the applicant may not have more than $14,250.00 in his name (2012 figure); this figure does not include the value of his home or one car.  Qualified retirement funds are also excluded from the equation so long as the applicant is taking his required monthly distribution.  It is important to note that community Medicaid, unlike Chronic (Nursing Home) Medicaid does not have any “lookback”  period, therefore it is possible for you to do planning in one month, and have Dad qualify for Medicaid in the next.  With respect to income, an applicant, under the Medicaid guidelines is entitled to keep a maximum $812.00 per month of his income in 2012.  However, in the event that your Dad’s income exceeds this number, a Pooled Trust can be established to preserve his “excess income.” The monies directed to the Pooled Income Trust would then be used to pay for his household expenses.     As I mentioned earlier, you would have to do some planning in order to get Dad’s assets under the resource limit of $14,250.00.  Oftentimes, we recommend the creation of an Irrevocable Trust to hold and protect those assets which are in excess of the allowable amount.  Another option would be to use your father’s excess resources on allowable spend downs such as the pre-arrangement of funeral expenses.  Once Dad is asset eligible, a Medicaid application would have to be filed with the Department of Social Services.  This process requires full financial and personal disclosure.  Once the application has been approved, DSS will send a nurse evaluator to see Dad to determine his needs.  Medicaid can pay for an aid in the home and can also pay for certain qualifying adult day-care services, including the transportation to and from the center.  The amount of hours that Dad would be approved for will be determined at the home visit and will be decided based on his need for assistance with specific tasks.  From the information that you have provided it seems as though Homecare Medicaid is a good solution for you.  Please keep in mind that prior to engaging in any estate or Medicaid planning I would recommend that you consult with an attorney experienced in this field.  The laws surrounding Medicaid are changing rapidly and consultation with an expert can help you navigate the process and decide what is best for your family.  

By Nancy Burner, Esq. and Robin Daleo, Esq.