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| Kersten and Associates 900 Fort Street Mall, Suite 400, Honolulu Hawaii 96813 Phone (808)531-3137 Fax (808)261-2626 kerstenandassociates@live.com |
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Skilled Nursing home care currently paid by Medicare - 20 days at 100% and then all but $137.50 a day (for 2010) for days 21-100, then nothing, and at only Medicare approved facilities. Admission to a skilled nursing facility must occur within 30 days of a hospital confinement of 3 or more days; must be an extension of the hospital treatment; and must be for daily skilled nursing and/or therapy services which as a practical matter can only be provided on an inpatient basis.
Only 5% of nursing home entrants qualify for Medicare benefits.
Custodial care - help with eating, bathing, dressing, etc. is not covered. 95% of those receiving long term care need custodial care which is not covered by Medicare.
Must be hospitalized for 3 days and within 30 days of your release your physician must certify that you need skilled care 24 hours a day.
Medicare does not pay for nursing home or home health care due to cognitive impairment.
Medicare pays for only 18% of all long term care currently.
Home Health Care - Only part-time or intermittent skilled nursing care, physical and occupational therapy, speech and pathology services, and only from Medicare-approved home health agencies. If such skilled care is required, then coverage for a home health aide may be included. You would be responsible for 20% of the cost of medical equipment and 100% of outpatient drugs.
Under Medicaid you are allowed to keep the greater of either the joint monthly income of two spouses, not to exceed $2,739 in 2009 or all the income of the spouse not confined in the nursing home.
The program also allows the spouse of a nursing home resident to keep one home, one car, and one-half of the couple's assets but not more than $109,560 (for 2009) in savings or investments.
All other resources are to be liquidated and spent before an ill spouse can receive Medicaid benefits.
The reduction in assets must occur before applying for benefits or legal and tax ramifications would occur. Effective February 8, 2006 the transfer of assets to individuals must occur 5 years before, or if assets are transferred to eligible trusts, the transfer must take place 5 years before application for Medicaid benefits. If individual transfers were done before 2/8/06, the 3-year transfer rule would still apply. Be wary of attorneys or advisors who tell you they can protect your assets and still get you Medicaid benefits…You may want to ask them if they are willing to sign a guarantee before proceeding with any documents or incurring any fees.
