Estate Planning

How to qualify for Nevada Medicaid for Long Term Care Services

Medicaid is known as a program for medically needy people who are impoverished. Nevada’s Medical Assistance to the Aged, Blind, and Disabled is no exception- but it is important to understand what Medicaid considers “impoverished.”

Nevada Medicaid income and asset limits

For the most part, families who need long term care are told they must meet the following Medicaid income and asset limits to qualify: about $2,000 per month income and less $2,000 assets for a single person. Well-meaning case workers and Medicaid personnel usually tell the family to “spend down” until the asset limit is met, and turn away families who have income over the limit.

In reality, families who have more than these limits should be directed to an elder law attorney who is versed in the definition of “impoverished.” Many people are surprised to learn that, in fact, people with higher income and assets are routinely approved. Often families do not discover this information until they have spent significant amounts of money on medical care unnecessarily.

A Las Vegas elder law attorney can create a strategy to help you protect your income and assets while still meeting the eligibility requirements for Medicaid. Origins Legal Group, for example, uses an effective combination of legal tools to help you access Medicaid, without having to spend your life savings on medical care.

The ways to qualify for Medicaid may include converting countable assets, using estate plans that have lifetime benefits, spending on personal and exempt items, and purchasing certain types of annuities.

Countable Assets for Nevada Medicaid

The Nevada Medicaid application for long term care benefits asks if you have any of these common assets: a personal residence, checking and savings accounts, life insurance, revocable living trust bank accounts, certificates of deposit, retirement accounts, savings bonds, and stocks.

The value of these items is countable toward the Medicaid limit for a single person. For married people, even if the spouse who needs long term care does not appear on these accounts, the assets are still counted toward his or her asset limit. This is true even if the property or account is “separate property,” and not community property.

For married people, there is some protection for the home, but Medicaid can place a lien on it after the death of the spouse who needs long term care. An elder law attorney can help you plan for this “estate recovery” on your personal residence.

An effective Medicaid qualification strategy can protect these assets from healthcare costs by changing them from countable to “exempt.” Please note: giving away assets or taking names off the accounts does not accomplish this, and in fact, for every $8,000 gifted or in accounts where the owners are changed for the last five years, the Medicaid applicant has to pay for care out of pocket for one month before Medicaid will help. This penalty period should be avoided if possible! Gifting and re-titling should not be done without the help of an elder law attorney.

Estate Plans and Trusts for Nevada Medicaid Qualification

When it is time to qualify for Medicaid, we advise clients that we can create two trusts to make countable assets and income exempt. In response, we almost always hear, “I already have a living trust.”

A living trust is revocable, which means that in the eyes of the Medicaid office, the assets in the trust are countable toward the limit.

In fact, while living trusts have some benefits (mainly, avoiding probate and ensuring that your assets go to the people you have chosen without court intervention), they are ineffective for making sure you have assets left to give after you pass! For this reason, we highly recommend that people over the age of 65 upgrade their estate plan, as follows.

Nevada has important laws on trusts that many states do not. In fact, Nevada trust laws allow elder law attorneys to create what we call “estate plans with lifetime benefits.” These trusts are not the same as revocable trusts and because of their specialized nature, cannot be purchased on document preparation sites. They are custom drafted by an elder law attorney to help save tens of thousands on long term care costs if long term care is ever needed.

Occasionally, we will use these trusts at the time of the Medicaid application, but they are most effective when created five years in advance of the need for long term care. For example, we work with families who recently received a dementia diagnosis while the patient is still capable of speaking for him or herself.

Long term care trusts are not the only way we use trusts to access long term care benefits under Medicaid. In some cases, a Medicaid applicant will fund a trust for a special needs family member, such as a grandchild with autism. This is a penalty free way to change the nature of the assets from countable to exempt, without having to spend it on long term care.

Finally, we encourage families to purchase irrevocable burial contracts, which are like a trust for burial needs, because the cost of services continues to rise. Most families end up spending on these services anyway, and this is yet another way to change assets from countable to exempt by spending on something the family will benefit from, rather than paying for long term care.

Purchasing Personal and Exempt Items to Qualify for Medicaid

Sometimes, when all other strategies have been exhausted, there may still be assets left. In this case we suggest that families use the money that would otherwise have to be spent down on long term care to purchase things they need and which are exempt. This could include new hearing aids, remodeling a bathroom to be more accessible for the spouse who will stay at home, and upgrading the family car. If the family needs legal services, such as a guardianship proceeding, revisions to the estate plan, in addition to the Medicaid planning, it is a good time to purchase those items as well, with money that would otherwise have to be spent on care.

Medicaid Annuities

Nevada Medicaid does allow limited use of annuities to qualify for long term care benefits. With an annuity, you pay upfront a sum of money, and then receive a stream of payments for a certain period of time. For families who still have assets over the Medicaid limit after using the strategies above, purchasing an annuity with the rest of the money may be a good solution.

Please note: traditional annuities will not work. There are specialized Medicaid annuities that meet complex requirements set by the federal and state governments.

Medicaid annuities have a few downsides that should be discussed carefully with an elder law attorney before applying.

We have written before about the goals for Medicaid planning. In short, most families agree that it is better to preserve assets that would otherwise have to be spent for long term care using strategies like those outlined above, while still qualifying for Medicaid. At $7,500 to $14,000 per month for nursing home care costs in Las Vegas as of late 2017, the money goes a lot further in the hands of the family than it does in a nursing home.

If you are applying for Medicaid long term care for yourself or a family member, contact us today for a confidential and free consultation. We offer flat fee options for Medicaid planning services, from writing a strategy you can implement, to applying for you and working with the Medicaid office on your behalf.

Contact us at 702-850-7799 to schedule your appointment.

The benefits of accessing long term care services through Nevada Medicaid

Nevada Medicaid

Nevada Medicaid pays for long term care costs in nursing homes, some assisted living facilities, and memory care centers. It may also provide for some home-based care. Without Medicaid, families would be forced to pay for these expensive services out of pocket until they ran out of money.

In other articles, we have discussed the requirements for accessing long term care benefits through Medicaid. Accessing long term care funding through Nevada Medicaid is about more than just creating eligibility for benefits. In fact, with the help of your elder law attorney, Medicaid planning can fulfill many of your personal wishes and be sure that the cost of care does not diminish the quality of life of you or your loved ones.

Why you should hire an elder law attorney to help you access funding for long term care

The classic way to qualify for Medicaid benefits is to spend down assets which exceed the Medicaid limits for long term care program benefits.

This approach works, but has many downsides. First, the Medicaid rules are 1,600 pages long, so without an advocate, you have no way of knowing if the spend down amount is accurate. That is, you may spend more than you have to, and you cannot usually get that money refunded.

More importantly, the Medicaid spend down is usually the least efficient and most expensive way to qualify for long term care benefits. It spends the money and assets that the healthy spouse needs to live on, leaves you with little or nothing to pass on to your children and family, and depletes you of the reserves you need to maintain your quality of life and ensure you are getting the quality of care you desire.

For most people, spending money on things that they value is more desirable than paying a nursing home.

Elder law attorneys can help protect your income and savings from long term care costs, prevent the state from taking your family home to pay for care, ensure your spouse does not become impoverished, and qualify you for Nevada Medicaid, even if you are a middle-class family.

Identifying your goals for Medicaid planning

Planning for long term care is complicated, but possible. There are many ways to access long term care funding, so the best place to start is with your unique goals.

For example, most people do not think of estate planning when they think of long term care benefits. In fact, estate planning traditionally considers what happens after we pass away. Now that the need for long term care is so high, and the cost so much, individuals are beginning to wonder whether they will have anything left at the end of their lives to pass on. After all, an estate plan is useless if there is little or nothing left to give.

The earlier you plan, the higher the likelihood that assets will be left to leave for your family, regardless of your healthcare costs. Ensuring that there is something left to pass on after a lifetime of hard work is a commonly cited reason why families choose to work with an elder law attorney to find ways to pay for long term care.

Community spouse resource allowance

Another common and important goal for long term care planning is ensuring that the healthy or “community” spouse is not impoverished by the cost of a nursing home care for the spouse who is sick. Medicaid planning can shift income and assets for the benefit of the community spouse so that he or she can live independently and with dignity.

Quality of life for disabled children

This is true, too, for special needs children who may be disabled themselves. There are special planning techniques to ensure that your care does not leave a disabled child destitute.

Protecting the home from estate recovery

Protecting the family home from Nevada Medicaid’s expanded estate recovery is another goal that careful planning can achieve. You may have heard that, for married couples, the personal residence is not counted by the Nevada Medicaid office when it makes a benefits determination. While this is mostly true (with some limits and exceptions), unfortunately Medicaid liens can follow your spouse or children if they choose to sell the house if you do not engage in further planning.

Understanding coverage under Nevada Medicaid’s Long Term Care Support Services

There is no doubt that Medicaid is a valuable program that helps people live out their lives in qualify facilities where they receive adequate care and attention. But as our population ages and more people need the state’s assistance to pay for care, states will have to make their Medicaid budgets go further, likely by cutting services.

Recall earlier that we said that the traditional way to qualify for Medicaid (spending down assets until you have less than stated limits) is the most expensive and least efficient way to pay for long term care costs. One of the reasons is that it leaves no room for you to adapt to changes in the Medicaid program: by spending down, you have no money left to change course, access additional services, or purchase goods and services which will maintain your quality of life or improve the quality of care you receive.

A big goal for Medicaid planning with an elder law attorney is empowering your family to improve the quality of care you are receiving through outside purchases that you have funded in advance, so that you have peace of mind that long term care will not diminish your quality of life.

For most clients we speak to, the need for long term care is an uncomfortable topic. No one wants it, but by having a plan for the worst-case scenario, we can vastly improve the likelihood that you will live a comfortable life, well cared for, and still have a legacy to leave to your children and grandchildren.

Just as every person is unique, so are goals for Medicaid planning. Some clients are happy to use minimal planning that saves just a little for a rainy day and to leave to their children. Other families want the most flexibility and prefer to take more significant steps in this area.

If you would like more information about how your personal goals impact your access to long term care funding through Medicaid, please call our office at 702-850-7799 to discuss with an elder law attorney.