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What You Need To Know About Delaware’s Medicaid Programs

If a client requires home care or institutionalized care in a nursing home or assisted living facility, an application for Medicaid benefits may be needed. 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 kinds of Medicaid programs: home and community-based services and nursing facility programs.

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, including a look-back period of up to 60 months for financial transactions, current proof of income, and 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 must go toward 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 also may be methods to keep additional income involving pooled trusts and special-needs trusts, depending on the circumstances.

Resources, which are assets belonging to the applicant and/or a spouse, must be reported. A single individual is allowed to keep only a modest amount of $2,000, but if there is a spouse at home, the resource allowance may be as much as $120,000. Certain circumstances and strategies 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 shall need the services of a skilled nursing facility, you must apply for the nursing facility program.

This application has the same strict eligibility criteria as mentioned above, including a look-back period of 60 months involving all financial statements of any open or closed accounts during that time. 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 shall look for any gifts or transfers made in the look-back period (gifts to children, friends or 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 shall begin a complete financial review. It shall conduct an IRS report for the past three years, it shall request a report from the Department of Motor Vehicles to see what vehicles are owned, it shall request a financial institution report under the applicant’s and his/her spouse’s Social Security numbers for any financial accounts as well as any property owned. If any assets or financial documents are located that have not been reported, the state shall request additional documentation based on its 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 that can complicate the process. These types of errors shall almost always result in a denial, which shall 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 toward their care. Spouses are 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 other spouse before paying the nursing home.

Uncertain About Your Options? Contact Us Today.

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, shall be happy to help you navigate it, explaining each step along the way. 

You can easily reach us our Milton or Wilmington offices online or over the phone at 302-655-4500. Contact us to get honest answers and compassionate advice.