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What You Need To Know About Delaware’s Medicaid Programs

When an individual in Delaware requires assistance in the form of home care, or the broader –institutionalized– care available through assistive living facilities or nursing home, they may need to apply for Medicaid benefits. Federal rules in the Medicaid program involve a complex interplay of rules related to income, overall assets the person owns, as well as rules related to the transfer of assets. Navigating the complex legal structure in applying for Medicaid should involve the guidance, advice and detailed assistance of an elder law attorney with experience in the Medicaid application process — a lawyer who also has knowledge of asset protection strategies.

In Delaware, there are two unique types of Medicaid programs – those involving home-based, or community-based services, and those programs related to nursing facility programs.

Community-Based Medicaid Programs In Delaware

Elderly/disabled individuals who wish to have the assistance of services while remaining in the community at home, or in an assisted living facility, typically apply for Medicaid benefits through the community-based Medicaid program. 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.

After submitting the proper application documents for benefits and the government has established the date for Medicaid eligibility, the individual may retain a limited amount of their monthly income. However, the balance must go toward paying for community-based care. The amount an individual may keep changes frequently. The value also differs for single individuals and for married couples. Our elder law attorneys can help you to understand the going rates—or current rates, that may be available to you in light of your individual circumstances. Moreover there may be strategies to allow you to retain additional income, such as special-needs trusts or pooled trusts, depending on your individual circumstances.

In the process, the applicant must report all assets, which include those resources and assets that belong to the individual, as well as the resources belonging to any spouse. The resources an applicant may retain varies under the individual circumstances—a single applicant may be allowed to retain a modest amount of $2,000. However, where there is a spouse living in the home, the resource allowance may protect up to $120,000. Certain circumstances and strategies may allow you to retain more.

Nursing Facility Medicaid Program in Delaware

In many cases, an individual requires more assistance than can be provided at home. In some situations, a caregiver is no longer available. In others, the degree of care exceeds what a home caregiver can manage or provide. 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 what is known as the Medicaid “look-back” period. This involves a financial review of the previous 60 months. The financial analysis includes reviewed financial statements of all accounts, whether or not the accounts remain open or are currently closed. Proof of income, as well as a review of tac returns over the previous three years are also required in addition to the application, which is extremely detailed.

The government will search for any transfers of assets, including gifts – which may include gifts to any children, grandchildren, churches, charities, friends and so forth — that occurred during the 60-month look-back period. It is crucial to consult with an elder law attorney before gifting any assets, as each gist may result in a penalty period related to Medicaid eligibility.

The state of Delaware shall begin a complete financial review of all applications. This includes conducting an IRS report, looking back for a period of the three previous years. The state will request a report from the Department of Motor Vehicles to determine ownership of any vehicles. The government will also seek a report involving financial institutions, which includes records involving both the applicant and his or her Social Security numbers to identify records 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.

Unfortunately, with the complexity of the Medicaid application process, most people seeking to file an application without the guidance of an experienced lawyer make mistakes in the application itself, do not provide the full and proper documentation necessary within the timeline allowed, or provide unnecessary information that can complicate the application process. Moreover, these kinds of mistakes or errors 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.

A Medicaid benefits applicant will be required to pay nearly all of his or her income toward their care. Spouses of a Medicaid beneficiary are allowed to retain his or her own income. However, if the spouse remaining in the community falls short on paying his or her own expenses, the institutionalized spouse may contribute some of his or her income to the non-institutionalized spouse prior to paying the nursing care facility.

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.