The More Expensive Route

Nursing Homes are now allowed to help you fill out applications for benefits for free. Under a recent regulation change, nursing home personnel are allowed to help families of seniors making the transition from rehabilitation to long-term care to complete an application for Medicaid benefits. These benefits will pay the entire cost of care except for the “applied income” that each applicant must contribute. That income in the case of a married applicant may be as little as $0. For most single applicants it is their entire social security income less a personal needs allowance of $60. Since no one but the front office knows whether someone is private pay or Medicaid, the nursing home Medicaid benefit is a great deal for families. But, since the rules for qualification have not become any easier, why would the government think that this was a good idea? The answer is surprising.

The rules for Medicaid eligibility in Texas are still focused on four areas: medical necessity, resources (assets), income, and gift penalties. They have not changed. Moreover, the state still has the right to appear in the probate of a deceased beneficiary and make their claim for “repayment” out of estate assets. So, it is just as difficult to qualify, and just as devastating to run up the bill. This is where making applying easier pays off for the government. The result is that more deniable applications are submitted. More uncounseled families believe they have to private pay until all the resources are spent, and HHSC accomplishes the goal of protecting the public purse making seniors spend down their legacy before they obtain access to benefits they paid for. In the next of this series, we will look at this from the Nursing Home side.

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