Who is Eligible for Medicaid?

As you can see from our website, the attorneys at the Potter Law Firm are highly committed to educating their clients and the residents of Kentucky and North Carolina.  We offer a comprehensive electronic library of special reports covering numerous estate planning and elder law issues.  We also update our blog periodically in order to provide updates on the ever-changing laws in this field.  Finally, our free estate planning and elder law seminars are always a go-to source for information.  We want residents of Kentucky and North Carolina to stay informed. Below, you will find the answers to some of the most frequently asked questions regarding Medicaid eligibility.

Medicaid Eligibility in Kentucky and North Carolina

As allowed by the Affordable Care Act, Kentucky has expanded its Medicaid benefits eligibility to now include medical coverage for individuals who previously did not qualify for Medicaid benefits. North Carolina has not. Regardless of the expansion of coverage, there are basic eligibility requirements for all Medicaid applicants which, if not met, will result in automatic denial of the application. The basic requirements for Medicaid eligibility in every state are as follows:

• The applicant must be a resident of the state.
• The applicant must be a citizen of the United States or an alien of legal status.
• The applicant must be considered low or very low income based on household size and gross monthly income.

The Income Requirements for Medicaid Eligibility

In addition to the above basic requirements, there are income limitations that are imposed. On a basic level, Medicaid is available to individuals and families who are considered low-income. More specifically, in order to be eligible the applicant’s household income must fall 133 percent below the federal poverty level (FPL) based on the number of individuals in the household. The income limit is higher for pregnant women and children or for the individuals in long-term nursing home care.

Medicaid Eligibility for the Aged, Blind, and Disabled

To receive Medicaid benefits for the blind or disabled, you must be evaluated by a doctor who will certify your condition. In both Kentucky and North Carolina, if you receive Supplemental Security Income, you are automatically eligible for Medicaid and do not need to apply. The monthly income limit for a family of two, when the applicant is aged, blind or disabled is $1,372. In addition, total resources may not total more than $2,000 for an individual or $3,000 for a couple. The value of your residence, a vehicle, home furnishings, clothing, and jewelry are not counted towards these limitations.

Understanding Medicaid Countable Assets and Resource Allowances

There is a $2000 limit on countable assets for an individual, but some things are not countable, including your home (with an equity limit of $572,000 in 2018). Plus, if you are married and in need of long-term nursing home care and you apply for Medicaid while your spouse is still capable of independent living, your spouse could keep half of the assets that are considered to be countable. This is called the Community Spouse Resource Allowance.  Be aware, though, that federal and state rules may allow the spouse living independently to save money in addition to this allowance if you do Medicaid planning.

Why You Need Medicaid Planning

If you are wondering why there is a need for Medicaid planning, since Medicaid can cover necessary medical costs, it is because it may be difficult to meet the Medicaid eligibility requirements. Considering that every Medicaid program’s eligibility standard includes limits on both assets and income, it is best to plan for eligibility because many seniors struggle to meet those limits. Many Kentucky seniors can deal with the income limits by establishing a Qualified Income Trust that applies excess monthly income to the nursing home in a way that enables applicants to meet the eligibility standards, and North Carolina has separate income limits based on the cost of care.  Assets can be more problematic, though.  With proper Medicaid planning, a family may be able to save significant assets for a spouse living independently (a “community spouse”), a disabled child, a child who has provided care for parents, or other family members in appropriate circumstances.  The key is to engage in Medicaid planning as early as possible, before the money is spent.

Medicaid Can Provide Long-Term Care Coverage

The Medicaid program provides long-term care coverage for those who need help meeting the high cost of nursing home care. Since its creation, the program has expanded its coverage to the point where it now serves as the single most important payment source for the country’s nursing homes. Without it, millions of American seniors would be unable to afford the cost of care and would find themselves struggling to cope with their health care and daily living needs.

Join us for a free seminar today! If you have questions regarding Medicaid eligibility, Medicaid planning, living trusts, or any other estate planning matters, please contact the experienced attorneys at The Potter Law Firm for a consultation. You can contact us either online or by calling us at (704) 944-3245 (Charlotte, NC, or Huntersville, NC) or for individuals in Kentucky at (606) 324-5516 (Ashland, KY) or at (859) 372-6655 (Florence, KY).