Applying for Medicaid

In the event the client requires home care or institutionalized care in a nursing home or assisted living facility, an application for Medicaid benefits may be required. Due to complex income, asset and transfer rules, the application should always be made with the aid of an experienced elder law attorney.

In Delaware, there are two different kinds of Medicaid programs, the Home and Community Based Services and a Nursing Facility program.

Community Based Program

Community based Medicaid applications are for any elderly/disabled person who wishes to remain in the community, either in their home or in an assisted living facility. This program has strict financial and medical eligibility criteria, with a look-back period of up to 60 months for financial transactions, current proof of income, along with documentation of all assets as well as past income tax filings.

Once benefits have been applied for and a Medicaid eligibility date has been established, the applicant may keep a limited amount of their monthly income and the balance is required to be contributed to their care. The amount you may retain is constantly changing and is different for a single individual and a married couple. Consult with an elder law attorney for the going rates in your community at any given time. There are also may be a number of methods to keep additional income involving pooled trusts and Special Needs Trusts depending upon the circumstances.

Resources, which are assets belonging to the applicant and/or community spouse, must be reported and a single individual is allowed to keep only a modest amount of $2,000. If there is a spouse at home, the resource allowance may be as much as $120,000. Certain circumstances and strategies may be available which may allow you to retain more.

Nursing facility Program

In many cases, an individual can no longer stay at home, maybe they need too much care or their caregiver is no longer able to manage their care. If an individual's care progresses to where they will need the services of a Skilled Nursing Facility, you will need to apply for the Nursing facility Program.

This application has the same strict eligibility criteria as mentioned above, a look-back of sixty months including all financial statements of any open or closed accounts in this time period. Additionally, three years of tax returns and proof of income are also required in addition to the application, which is extremely detailed.

The Department of Social Services will look for any gifts or transfers made in the look-back period (gifts to children, friends, grandchildren, church donations, charitable donations, etc.). Each gift may incur a penalty period so do not allow gifts before speaking with an experienced elder law attorney.

On all applications the State will begin a complete financial review. They will conduct an IRS report for the past three years, they will request a DMV report to see what vehicles are owned, they will request a financial institution report under the applicant's and his/her spouse's Social Security number for any financial accounts as well as any property owned. If any assets or financial documents are located that have not been reported, they will request additional documentation based on their findings which may delay the application or even incur a denial. That is why it's imperative that you speak with an experienced elder law attorney prior to submitting an application for Medicaid benefits.

In our experience, most individuals who attempt to file for Medicaid benefits without the assistance of counsel, either complete the application incorrectly, do not provide the correct documentation within the timelines or give unnecessary information which can complicate the process. These types of errors will most always result in a denial, which will leave the applicant and possibly a family member responsible for unpaid bills to a nursing home until an approval can be obtained.

An individual applying for Medicaid benefits is required to pay virtually all of their income towards their care. The community spouse, if there is one, is allowed to keep their own income but if they fall short of their monthly expenses, the institutionalized spouse is allowed to contribute some of their income to the community spouse before paying the nursing home.

The Medicaid system is difficult and confusing under the best circumstances. The Elder Law Attorneys at The Law Office of Denise D. Nordheimer, Esquire, LLC will be happy to help you navigate it, explaining each step along the way.