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Medicaid Eligibility: Nuts and Bolts
Pennsylvania looks at resources to determine eligibility for Medicaid for a single individual or a couple
Income is not a factor. If the person applying for Medicaid or his or her spouse has too many assets, many legal steps are available to become eligible for Medicaid without spending down all of the excess funds on the nursing home!.
Call Nancy Busch for a consultation. With her help, you may be able to preserve
assets and save thousands of your hard-earned dollars.
CAUTION: Medicaid laws are highly complex and laws change frequently. If you make
a mistake on a Medicaid application, you may be denied benefits.
Consult with Attorney Busch who has the experience to guide you through Medicaid law and the laws on transfers.
Medicaid Law:
- Eligibility
- Citizenship—The Medicaid applicant must be a citizen or a resident alien of the United States, must need nursing home placement, or must be physically or cognitively impaired such that nursing home placement is required.
- Assets—The Medicaid applicant if single must have countable assets below either $2400 or $8000, depending on whether their income is over or under $2094 per month.
- Exempt Assets
- Prepaid funerals for both spouses—each county has different monetary limits.
- Tangible personal property
- One automobile
- Income-producing property such as real estate
- Retirement plan of community spouse such as IRA, 401(k) (for the spouse not in nursing home)
- Life insurance if combined cash values of all policies are less than $1500 for both spouses
- Transfers on or after February 8, 2006
- All transfers made by the applicant or the applicant’s spouse on or after February 8, 2006, whether from an individual or to an individual or from a trust or to a trust, have a five year look-back period. The ineligibility period does not begin to run until such time as the applicant is in a nursing home and has applied for Medicaid (as opposed to when the gift was made).
- Example: Susie gives $50,000 to her son on January 1, 2010 to pay for his college tuition. On January 1, 2012 Susie enters ManorCare Nursing Home as a permanent resident. She applies for Medicaid ten days later and only has $4,000 in her bank account. However, due to the gift that she made in 2010, she has a penalty for Medicaid. That penalty period means that she is not eligible for Medicaid until after the penalty period expires because she has made a gift during the five year period before her application for Medicaid. Under the law, the penalty is calculated from the time that the application is made on January 11, 2012 not on January 1, 2010, when the gift was made. If the penalty is, for instance, six months long, she cannot be covered by Medicaid until after that period expires.
- All transfers made by the applicant or the applicant’s spouse on or after February 8, 2006, whether from an individual or to an individual or from a trust or to a trust, have a five year look-back period. The ineligibility period does not begin to run until such time as the applicant is in a nursing home and has applied for Medicaid (as opposed to when the gift was made).
In the event that an applicant has been denied Medicaid eligibility as a result of gifting, or if Medicaid has been delayed as a result of an order by the Department of Public Welfare, Attorney Busch may be able to take legal action to reduce the period of ineligibility. Contact Attorney Nancy Busch for consultation.
