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Medicaid Eligibility

Basic Information About Medicaid Eligibility

Wright Abshire, Attorneys
Houston, Texas
(713) 660-9595 ∙ (800) 280-4759
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There are four basic Medicaid eligibility requirements. A person applying for Medicaid must satisfy all four Medicaid eligibility requirements in order to achieve Medicaid eligibility.

The elder law firm of Wright Abshire, Attorneys, in most cases will be able to help Medicaid applicants who have been denied Medicaid benefits because they failed to comply with one of the four Medicaid eligibility requirements.

In many cases, we are able to help our clients achieve Medicaid eligibility by modifying their estate planning documents or taking other financial planning steps. For help with estate planning and Medicaid eligibility, contact our office today to schedule an immediate consultation with one of our experienced elder law and estate planning lawyers.

The Four Medicaid Eligibility Requirements

  1. Categorical Requirements. To achieve Medicaid eligibility, a person must be at least 65 years of age, blind or disabled, and be a U.S. citizen. Certain resident aliens may also qualify. Undocumented aliens may qualify for Medicaid only for coverage of an emergency medical condition.

  2. Medical Necessity. To achieve eligibility for the Medicaid nursing home program, the applicant must have a medical need for licensed nursing care and must meet the risk assessment criteria for nursing home placement.

    3. In many cases, the opinion of the applicant's doctor that the applicant needs to be in a nursing home or assisted living facility will be enough.

  3. Income Eligibility. Under Medicaid rules, the applicant may not receive direct income of more than $1,911 per month (as of January 1, 2008). If the applicant's monthly income exceeds the cap amount, then a Miller trust can usually solve the problem.

    4. Income eligibility is often a major stumbling block for Medicaid applicants. Some applicants will make poor decisions regarding how their pensions or other regular income is handled — decisions that may block Medicaid eligibility. Before you make a decision that could negatively affect your Medicaid eligibility, consult an experienced Medicaid lawyer.

  4. Asset Eligibility. If one spouse is entering a nursing home, the asset cap for the institutionalized spouse is $2,000. If both spouses are entering a nursing home, the asset cap is $3,000. These asset caps are subject to many exceptions. Generally, a home valued at up to $500,000 does not count as an asset for an individual, nor does the spouses' home at any value if one spouse continues to live in the home. However, don't be mislead into believing that you're eligible and your house is necessarily safe without seeking legal representation.

    5. Asset eligibility is the most complex aspect of Medicaid eligibility. If your assets are higher than $2,000, you should not assume that nothing can be done to achieve Medicaid eligibility. Joint assets are another confusing issue — we can help you structure the ownership of all assets so that you can preserve as many assets as possible while still achieving Medicaid eligibility.

Contact Wright Abshire, Attorneys, for a Consultation

Before you engage in a so-called Medicaid spend-down — to lower your asset levels and achieve Medicaid eligibility — contact our office for a consultation. We may be able to restructure your estate plan to preserve your assets for future generations while still allowing you to achieve Medicaid eligibility.

To schedule a confidential appointment, send us an e-mail or call us toll-free at (800) 280-4759.

From our wheelchair-accessible offices in Bellaire, Texas (a city within Houston), we represent clients throughout the Houston area as well as statewide. We also represent clients from other states with elderly family members in Texas. Our attorneys can make home, hospital or nursing home visits outside of the Houston area when necessary. And in some cases, many of our legal services can be provided over the telephone for our clients' convenience.

A Few Medicaid Planning Scenarios

Melanie, 68, is healthy. She is pre-planning for long-term care ("LTC"). She has assets totaling $300,000. An elder law attorney may be able to help Melanie reposition her assets so that she will qualify for Medicaid within five years. If she needs Medicaid sooner, the plan can be revised at that time.

Doris gave $100,000 to her son in October 2006, when she was in good health. She suffered a stroke in January 2007, and she entered a nursing home and applied for Medicaid in February 2007. She was notified that Medicaid would not help with her nursing home costs because of the $100,000 gift that she made in October 2006. An elder law attorney may be able to help get Doris qualified for nursing home Medicaid despite the $100,000 gift.

Vivian, 72, owns an out-of-state homestead. She entered a nursing home and applied for Medicaid. Her application was denied because she owns an out-of-state homestead. After consulting an elder law attorney, Vivian may be able to take certain actions that could allow her out-of-state home to be exempt for Medicaid eligibility purposes.

Bob, 85, lives at home (i.e., he is the community spouse). His wife, Barbara, 82, entered a nursing home. The couple's combined assets are $200,000. An elder law attorney may be able to arrange for all of the couple's assets ($200,000) to be protected for Bob's needs at home. Thus, Barbara may be able to qualify for Medicaid without having to spend down any of the couple's assets.

For more information about qualifying for Medicaid, contact the Houston, Texas, elder law firm of Wright Abshire, Attorneys.