Utah Senior Planning aims to help citizens of the community find the best options available for long-term healthcare needs. The firm uses innovative approaches to help seniors qualify for public benefit assistance to help lower the cost of care. We provide counsel relating to benefit programs such as Medicaid and VA, while assisting clients with insurance, financial, legal, and health care planning. We also recognize that these issues are complex and can be overwhelming to those in need of answers -- especially during a period of crisis. 

We hope this information can help those interested or in need and are happy to answer specific question in greater detail. We always offer a free consultation and you can schedule one today by giving us a call at (801) 546-9556. 

What is Medicaid?

Medicaid is health insurance coverage, primarily for low-income, medically-needy, and otherwise vulnerable individuals. Medicaid is jointly funded by federal and state governments, with management done at the state level. 

What does Medicaid cover?

There are many different types of Medicaid programs in the State of Utah, ranging from programs designed to help children or pregnant women to those geared to assist individuals who are aged, blind, or disabled or in need of long-term care. Utah Senior Planning specializes in Medicaid coverage for those in need of long-term care. 

Does Medicare cover long-term care?

No. Medicare will cover up to 100 days of a rehabilitation stay, only 20 of those days covered completely. Medicare does not cover care provided in an assisted living, skilled nursing, or other long-term care facility.  

What are the eligibility requirements for the Medicaid program?

Medicaid is a means-tested program and applicants must meet both financial and medical eligibility requirements. For Long-Term Care Medicaid, sometimes called Nursing Home Medicaid, an individual must, among other criteria, have less than $2,000 in countable assets and require the care provided by a nursing home. Eligibility determinations are made by the Department of Workforce Services and differing rules govern differing programs. 

What is the "Look-Back Period?"

Because Medicaid is designed for destitute individuals, both federal statutes and state policy enforce a 'look-back' period on an applicant's transferred assets. A Medicaid applicant is prohibited from transferring any assets for less than fair market value and this embargo extends five years in the past. Any transfers made during the 'look-back' period will result in a period of ineligibility equal to the fair market value of the transferred asset.

Can I gift assets to family members and subsequently apply for Medicaid?

No. Gifted assets, whether personal or real property, will result in a sanction and the applicant will be ineligible for Medicaid. The 'look-back' period applies to gifts made to spouses, children, friends, or any other third-party. If you have made gifts, we can discuss ways in which you can cure such transfers and be made eligible for Medicaid.

Do I have to sell my home to get Medicaid coverage?

No. Medicaid exempts your primary residence during its financial verification procedure so long as you provide the necessary documentation. If you sell your home while receiving Medicaid benefits, you must notify Medicaid within 10 days and subsequently spend the proceeds to under the asset limit by the end of the month in order to maintain eligibility. 

Can the State of Utah place a Medicaid lien on my home? 

Yes. Eligibility for Long-Term Care Medicaid is conditioned on the individual consenting to estate recovery proceedings. The State of Utah is required to seek reimbursement from the estates of deceased Medicaid beneficiaries who were aged 55 and older at the time they received medical assistance. This procedure, often called Estate Recovery, means that the State of Utah Office of Recovery Services may recoup the amount paid out in benefits. The enforcement mechanism of this procedure often takes the form of a lien.

Are there ways to protect my home from Estate Recovery?

Yes, but with caveats. Federal law allows for Estate Recovery only if, at the time of death, there was no surviving spouse or child under the age of 21, or child who is blind or permanently disabled. Additional protections can be implemented in pre-planning and spousal cases. 

What is VA Aid and Attendance?

The Department of Veterans Affairs has allocated funding to help veterans and their spouses with regular, reoccurring, and unreimbursed medical expenses.  The Aid and Attendance benefit is designed to help those needing assistance in performing routine activities of daily living. 

Who is eligible for VA Aid and Attendance?

Aid and Attendance is both a merit and means-based benefit.  An applicant must meet both financial and medical eligibility requirements. A veteran must have served in active duty for at least 90 days total, with one of those days during a Congressional-mandated wartime period.  A surviving spouse of a veteran can also be eligible for the program.

What are the rules for VA Aid and Attendance eligibility?

Financially, the VA looks at an applicant's income in comparison to his or her unreimbursed medical expenses. The applicant also discloses to the VA his or her assets. The VA makes a determination on whether the applicant has sufficient resources to offset costs. An applicant must also be rated as in need of the aid and attendance of another person by an M.D. or D.O. 

Does VA have a look-back period?

Not yet. The VA does not have the same five-year look-back period as Medicaid but federal regulations are pending and would authorize the VA to implement a three-year look-back period. This change is expected to be effectuated in the Spring of 2016.

What long-term care does VA Aid and Attendance cover?

A veteran or spouse who resides and receives care in an assisted living or skilled nursing facility is likely to qualify.

Can I receive VA Aid and Attendance and stay in my home?

Yes. Aid and Attendance is a pension and deposits into the veteran or surviving spouse's bank account making the money portable and able to used to help subsidize acceptable medical costs. That means that a veteran or spouse could pay out-of-pocket for needed in-home care and such costs would meet the criteria necessary to be an acceptable medical expense for purpose of VA eligibility. 

How much can I receive from the VA?

The maximum benefit amount:  veteran and spouse $25,440 per year; veteran $21,456; surviving spouse $13,788.

What is an Advance Healthcare Directive?

Often called a "living will," an Advance Healthcare Directive explains the medical treatment and pain management you would or would not want to receive in order to keep you alive, as well as allowing you to name an agent or Health Care Power of Attorney to carry out your wishes. 

Is there a particular form that the Advanced Healthcare Directive has to satisfy?

Utah law (Section 75-2a-117) provides a template for the Advance Healthcare Directive and so long as it is substantially similar, it is presumed valid. We prefer to use this form

We hope this information can help those interested or in need and are happy to answer specific question in greater detail. We always offer a free consultation and you can schedule one today by giving us a call at (801) 546-9556. 

*** The preceding is not to be construed as an engagement of our services and while we try to keep up-to-date and correct information, we do not warrant any of the content. ***