Like many people, you may have gone through your working years without ever needing to qualify for Medicaid benefits because you were fortunate enough to have employer sponsored health insurance coverage. As a senior, however, you may find that Medicaid is the only option available to help you cover the high cost of long-term care for you or your spouse. Ideally, you will recognize the potential need to qualify for Medicaid far enough ahead of time to include Medicaid planning in your estate plan. The need to plan ahead for Medicaid eligibility is just one thing you may not already know about the Medicaid program. To help you familiarize yourself with the program, consider the following five things you need to know about North Carolina Medicaid.
- There are actually different types of Medicaid. Medicaid is primarily funded by the federal government; however, it is administered by the individual states. Because the states administer the program, they there are some differences in the eligibility guidelines and benefits available among the states. Within the State of North Carolina, there are actually several different types or categories of Medicaid as well, including: Families with dependent children; infants and children; pregnant women; and aged, blind, and disabled. The eligibility guidelines vary somewhat within the programs.
- Medicaid has income and asset limits. Medicaid is intended to provide healthcare to low income individuals and families. As such, the program uses income and asset limits when determining eligibility. The income limits for “aged, disabled, or blind” Medicaid are $990 for an individual and $1335 for a couple. If you are receiving Supplemental Security Income (SSI) you will automatically qualify for Medicaid. The asset limits are $2000 for an individual and $3000 for a couple. Fortunately, not all assets are counted when determining the value of your assets. The value of your home, a car, home furnishing, clothing and jewelry are not counted.
- Medicaid will cover long-term care expenses. The older you are, the higher the odds are that you will eventually need long-term care – and the cost of that care is usually high. Nationwide, the average cost of a year in LTC is about $80,000. Even if you still have private health insurance, it will probably not cover LTC unless you purchased a separate LTC rider at an additional cost. Don’t count on Medicare to chip in either as Medicare only covers LTC under limited circumstances, and then only for a maximum of 100 days. The good news is that North Carolina Medicaid does cover long-term care expenses.
- Medicaid uses a five-year “look-back” period. The Medicaid five-year “look-back” period is where many people have a problem. If you failed to plan ahead by including Medicaid planning in your estate plan years ago, and you now need to qualify for benefits, your finances will be scrutinized to determine if your income and/or assets exceed the program limits. Moreover, if you transferred any assets for less than fair market value within the five-year period prior to applying for benefits, they will likely discount the transfer and add the value of the asset back into your estate for the purpose of determining your eligibility.
- Medicaid may also pay for long-term care in your home. The North Carolina Medicaid Community Alternatives Programs (CAP) offers home and community based services to adults with disabilities who are at risk of needing nursing home care. In addition, the Program for All-inclusive Care for the Elderly (PACE) provides care to the individual in the home, such as in-home personal care services and home health care.
If you do not yet need Medicaid, now is the time to add Medicaid planning into your estate plan to ensure that you will qualify if you need it down the road. If you are in need of Medicaid benefits now, and you failed to include Medicaid planning in your estate plan prior to now, you may still be able to utilize some Medicaid planning strategies to help protect your assets and get you qualified for benefits. The key is to consult with an experienced North Carolina Medicaid planning attorney about your options.
For more information, please download our FREE estate planning worksheet. If you have additional questions about North Carolina Medicaid contact the experienced Medicaid planning attorneys at The Law Offices of Cheryl David by calling 336-547-9999 to schedule an appointment.