When to apply for medicaid for your aging family member

Imagine your parent or spouse has had a fall or a stroke and is hospitalized. Usually, the following days and weeks are spent getting him or her stable, talking to family and doctors, and

wrapping your mind around the incident that happened. It can be a shocking and overwhelming time. Often, these events are the beginning of a major life shift where the family has to come to

terms with a loved one’s changing needs and abilities. Where will he live? Who will take care of him? Do we have the right documents in place or do we need to go to court for assistance? And

who’s going to pay for everything? From the hospital, the patient may be discharged for rehabilitation in a skilled nursing facility. The goal of rehabilitation is to improve the patient’s

abilities, and he or she will stay for only a limited period. Insurance and Medicare will cover some (sometimes all) of the cost for a stint in rehabilitation. This is the point when the

patient’s unpaid family caregivers are scrambling to figure out what comes next. The writing may be on the wall: It may be clear that your loved one can’t go home without significant help

and may need to move into assisted living or nursing care. This is also the time to explore Medicaid eligibility if you haven’t already done so. INTRODUCTION TO MEDICAID Private pay for

facility care or at-home care is costly. Adult day care averages around $25,000 a year, and a private room in a nursing home can be over $116,000 a year, according to Genworth's 2023

Cost of Care survey. Aside from the private-pay option, veterans’ benefits or long-term care insurance kicking in, this is where Medicaid health coverage may begin for many people in

America. If you’re not familiar with how Medicaid works and haven’t applied for it before, it can add to your caregiving stress to try to figure it out without assistance. Be wary of taking

nonprofessionals’ advice as truth. Get the facts for yourself. Medicaid is a federal and state program that helps 72 million Americans with health care and long-term care costs as long as

there is a medical need for care and the person is financially qualified. Every state has different Medicaid laws. (You can find the state and information about eligibility here.) In most

states, if your loved one receives Supplemental Security Income, they may automatically qualify for Medicaid. If you review your state’s income and asset eligibility requirements and know

without a doubt that your loved one qualifies, you may be comfortable applying without assistance through a Medicaid office. In those cases, nursing homes or social workers may work with you

to fulfill the applications. However, if there’s any question about whether the patient has resources or income that would prevent them from receiving Medicaid, a qualified professional can

save time, money, stress and a disqualification from Medicaid. The professional could be an elder law attorney, Medicaid planning professional, or Area Agency on Aging or geriatric care

manager. They should be able to advise you on the different planning techniques that could be used, including how to legally lower your assets in advance of applying for Medicaid and how to

avoid financial moves that could disqualify your loved one.