Two Tests to Qualify for Medicaid: Medical and Asset Tests

Posted on: Jul 26, 2017

Medicaid is a government program that provides health care coverage to eligible seniors, people with disabilities, children, and pregnant women. The program is jointly funded by the state and federal government. In Washington State Medicaid is called Apple Health.
Receiving Medicaid benefits can be a critical component when Planning for Long-Term Care. The annual cost of Long-Term Care can exceed $100,000. Medicaid pays for Long-Term Care needs. To qualify for Medicaid you must meet medical eligibility and financial eligibility requirements.
Qualifying for Medicaid: The Medical Test
Qualifying for Medicaid requires that you need help with two or more Activities of Daily Living (ADLs). These are basic personal tasks of everyday life. Qualifying ADLs include moving, eating, dressing, bathing, managing medication, and going to the bathroom. If the Medicaid applicant has a significant cognitive impairment, then he or she can qualify for benefits if substantial assistance is needed with only one ADL.
The Washington State Department of Social and Health Services (DSHS) makes the determination of the Long-Term Care needs of Apple Health (Medicaid) applicants.
Qualifying for Medicaid: The Asset Test
In order to qualify for Medicaid, an applicant must have assets below a certain level. Some assets do not count toward the resource eligibility determination. Exempt resources that are not counted include your home, one vehicle, household furnishings, a burial plot or urn space, or a life insurance policy with a face value of less than $1,500. Countable resources include cash, investments, real property (not your home), and certain other assets and valuables.
A single recipient cannot have more than $2,000 in non-exempt resources. Resource eligibility for married recipients is more complex, particularly when the recipient’s spouse will remain living at home. In these cases, eligibility is based on the total amount of resources that both spouses own. As a general rule, married couples cannot have more than $56,726 in non-exempt resources (community spousal resource allowance of $54,726 plus $2,000 for the Medicaid applicant’s spouse).
What if I have too many assets?
If you have more non-exempt resources than is allowed, there are ways to protect those assets while still obtaining Medicaid Long-Term Care benefits. Options include purchasing exempt resources or appropriate spend down items to then fall within the resource limits. A solid plan utilizing our Smart Spend-DownTM procedures and our Medicaid Asset Preservation StrategiesTM can help you avoid unnecessarily depleting your family’s assets.
It is important to have your Estate Planning documents support your plan to qualify for Medicaid. For guidance on determining Medicaid eligibility or Asset Protection Estate Planning TM contact Elder Law Group PLLC here.
Elder Law Group PLLC has been recognized as one of the fastest growing law firms in the U.S. as an Annual Law Firm 500 Award honoree. Contact us or call (509) 468-0551 (Spokane office), or (509) 579-0206 (Tri-Cities office), for personal, compassionate, and competent guidance on Long-Term Care planning, Asset Protection Estate Planning TM, or other legal needs of seniors, the disabled, or vulnerable adults and their families.

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