By Paul Lorrah
What you should know about Medicaid in Delaware.
Delaware's Medicaid program has strict income limits for qualifying for nursing home care coverage.
When a loved one needs long-term care one of the first thoughts that come to mind is - "How Will We Pay for That Care?"
Delaware's Medicaid program pays for long-term care costs for At-Home Care, Assisted Living and Nursing Home Care.
Long-term care costs are rising each year, in 2017 the average cost of skilled nursing care in Delaware was $310/day or $113,150 per year.
Assisted Living is a bit less around $78,000/year but still will be an amount that is difficult for most families to afford especially since the average stay in an assisted living community is about 3 years and even then, most people transition to skilled nursing for another average of 21 months.
So, just on the averages alone, a family could be expected to pay approx. $432,000 for long-term care. A cost which most people just don't have the ability to pay for.
That's why 73% of all individuals receiving skilled nursing care rely on Medicaid to pay their costs.
What is Medicaid?
Medicaid is a program is funded by state and federal dollars and is intended to pay for long-term care costs for those who are aged [over 65], blind or disabled. Today's article will focus on those who are 65 or older. This program is part of the Social Security Act [title XIX]. Medicaid is very different from Medicare, Medicaid is a program that requires strict eligibility requirements be met. Medicare, will not pay for long term stays in a nursing home or any stays in an assisted living community.
How can I qualify?
Delaware residents who are 65 and older and who need long-term care must qualify both medically and financially for Medicaid benefits. The applicant's gross income is capped at $1,858/per month [over that limit must use a Miller Trust] and the maximum assets a person can have is $2,000 [anyone who is married and/or has more assets than that should consult a Medicaid planning specialist to provide asset protection guidance].
The application process is lengthy and difficult. You must apply with the Delaware Department of Health and Social Services. The application process begins with an intake portion, which requires a call to the Medicaid intake office. They will ask medical and financial questions and send an application packet to you. You must complete the application properly and supply all supporting documents. You must then call to schedule a personal financial interview with a Medicaid caseworker who will review your application and make a list of all documents that you did not bring but must supply. This will continue back and forth for up to 90 days. At any time that you miss a deadline to supply information, you will receive a denial.
The Medicaid program has what is called a "look back period" of 5 years, which means the Delaware Medicaid office, Delaware Department of Health and Social Services, can examine an applicant's complete financial history for up to 60 months prior to the date you file the application for Medicaid benefits. In that financial examination any withdrawal or check written for more than $250 will be examined to ensure the finds were used in accordance with Medicaid guidelines as well as all deposits other than those form regular income sources.
You will need to provide copies financial statements for all open accounts and any account closed in the past 60 months.
If the applicant or applicants spouse has sold any property in the past 5 years, you must provide proof of how much was received and where all of the money has gone from the time of the sale to the date of the application.
Any funds that have been given away may be counted as an improper transfer and may result in a penalty or denial.
Life insurance policies that have a cash value will count as an asset and will need to be addressed as well.
You may be able to retain your home without it counting as an asset under certain criteria, however, the equity you can have in your home is capped at $560,000 .
What is Estate Recovery?
Estate recovery is a process in which the Delaware Medicaid program has the right to attempt to recoup any funds paid on behalf of an individual from their estate when they pass away. Which means if you are married and have a house your house may not be counted as a resource for the application process, however, it may be susceptible to estate recovery. If you own a home, you should consult a Medicaid a planning specialist to provide asset protection guidance].
The Delaware Medicaid program is tricky and anyone with any assets at all should seek the guidance of a Medicaid Specialist to ensure that they and their family is properly protected.
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