Disclaimer: This article has been posted for general information purposes only. You should not act upon the information in this article without first retaining legal counsel.
By Robert C. Gerhard, III, Certified Elder Law Attorney
The hardest work should be done now that you have successfully navigated the Medicaid application process and long-term care Medicaid benefits have been approved. However, you still need to pay attention to some remaining details.
- Stay Under the Asset Limit: Keep the balance of funds under the applicable resource limit which will be either $2,400 or $8,000, depending on the Medicaid recipient’s income. Actively look for ways to spend the remaining money for the benefit of the nursing home resident.
- Remit Income to Nursing Home Monthly: In most cases, Social Security and pension income needs to be paid over to the nursing home each month. The nursing home business office may be able to help you arrange for income to be paid to the facility automatically. Setting up automatic payment eliminates a recurring monthly task and ensures there is no disruption of income payments.
- Keep Resident Fund Account Low: Maintain the balance in the Resident Fund Account at the nursing home to a bare minimum. Often the $60 personal needs allowance from income accumulates in this fund, sometimes pushing a Medicaid recipient’s total assets over their resource limit. Money left in this account upon the Medicaid recipient’s passing is often subject to Medicaid’s estate recovery payback, so it makes sense to spend this money for the benefit of the nursing home resident if possible.
- Review Beneficiary Designations on Life Insurance: Ensure any exempted life insurance policies designate beneficiaries. If no beneficiary is named on a life insurance policy, the proceeds will likely pass to the Medicaid recipient’s probate estate upon death, resulting in the loss of funds to the Medicaid estate recovery program.
- Save All Financial Records: Continue to save financial records such as bank statements, copies of checks, and any documents verifying the gross amounts of Social Security and pension income.
- Report Changes: Financial changes need to be reported to the County Assistance Office promptly, usually within 10 days. For example, if a Medicaid recipient sells an asset such as real estate, notice must generally be provided. Likewise, if the Medicaid recipient’s spouse dies or receives an inheritance, notice must be provided. Failure to report changes as required can result in “overpayments of benefits” that can major problems in the future. Contact an elder law attorney if a Medicaid recipient inherits money or sells an exempt resource, since there may be things that can be done to protect the money, legally.
- Funeral and Cemetery Plans: Take a moment to contact the funeral home to make sure all arrangements are pre-planned with the funeral home and cemetery. You may have prepaid these arrangements during the Medicaid spend-down, but if not, make sure there is a plan in place to pay for these services at the time of need. Make sure the nursing facility is provided with contact information for the funeral home.
- Be Ready for Annual Renewal: The County Assistance Office reviews eligibility for Medicaid long-term care benefits each year. This annual review occurs roughly one year from the date of initial authorization. The caseworker at the County Assistance Office checks copies of current financial statements, documentation of any accounts closed since the last review, and proof of gross income to make sure eligibility continues. If the recipient is over their resource limit, benefits can be discontinued. If the renewal is not completed or if documents are missing, the County Assistance Office can discontinue benefits.
- Double Check Renewal Notices. The County Assistance Office will issue notices periodically and these notices need to be reviewed carefully for accuracy, especially if the spousal allowance of income is decreased. There are ways to fix inaccurate notices, normally by filing an appeal and speaking with the caseworker.
- Stay in Touch with Your Elder Law Attorney: If you had help from an elder law attorney during the Medicaid spend-down and application process, stay in touch with this law firm. The elder law attorney can spot issues before they become problems and can handle the annual review process to help make sure benefits continue uninterrupted.
About Gerhard & Gerhard, P.C.
Robert C. Gerhard, III Esquire is the managing shareholder of Gerhard & Gerhard, P.C., an estate planning and elder law firm located in Montgomery County, Pennsylvania. Attorney Gerhard specializes in elder law, with emphasis on Medicaid Planning, Medicaid Applications, and Medicaid Appeals. He is the author of the Pennsylvania law treatise, Pennsylvania Medicaid, Long-term Care. If you would like to schedule an appointment with Attorney Gerhard, please contact us.
