The Medicaid Redetermination Storm


The Medicaid Redetermination Storm

When people go to the nursing home, and they run out of money, they will go onto Medicaid which pays for the nursing home. Bear in mind that Medicaid is a needs-based program, which means that you cannot have much money to be eligible. Sometimes people on Medicaid may accrue additional resources, if they sell something they own, be it a car or house. However, if you are on Medicaid, you are not allowed to have this money. One of the requirements is that you notify Medicaid if your financial situation changes. You also need to have an annual redetermination regarding your Medicaid eligibility.

The Rules are Changing

During Covid, Medicaid financial redeterminations were put on hold. This is because it would have been unfair for anybody on Medicaid to lose their benefits during a pandemic. It is estimated that between 5 and 14 million Americans on Medicaid may lose their coverage, when Medicaid rules revert in April.

How This Affects You

Medicaid treats single people differently than married people, and they treat assets differently than income. If a single person or widow needs the nursing home, they are not allowed to have much money to be eligible for Medicaid. This means that Joe, a single person, must spend most of his money to become eligible for Medicaid. He is only allowed to keep between $2400 and $8000, depending on his income.

Assuming the amount he’s allowed is $8000, he can also own a house and a car.  However, all of Joe’s monthly income must go to the nursing home, which means he can only keep $45 per month for personal needs. While Joe still owns a house and car, there are likely going to be insurance and utility expenses, with no money to pay these bills. Joe’s kids, via a Power of Attorney, may decide to sell his house. Essentially Joe will lose Medicaid if he gets money from the house sale.

You Can’t Afford to be Over-Resourced

During the pandemic, even you were over-resourced, you would still receive Medicaid benefits. What will happen in April 2023, is that Medicaid will request all those currently on Medicaid, to complete forms detailing their financial situation. If you are over-resourced, you will lose Medicaid benefits. It may not only be having money from the sale of a house or car causing you to be over-resourced. Some people may have been keeping their income, instead of rightfully paying it to the nursing home every month. If the amount in their bank account exceeds the $8000 that is allowed, they will lose Medicaid.

Nursing Homes Will Also Be Affected

More than the redetermination affecting individuals on Medicaid, it will also affect nursing homes. This is because many nursing residents will be losing their Medicaid eligibility. The nursing homes don’t want to have to discharge residents in this situation. If you are a health worker in a nursing home, please reach out to us. We can make a plan to ensure your residents stay on Medicaid and get the care they need, while the nursing homes also get paid.

Let Us Help You

If you or somebody you know is in this position, reach out to us, before Medicaid approaches you. We can offer you a FREE Consultation, if you are receiving nursing home Medicaid benefits, which includes the LIFE Program. Let us put you in a financial position to keep some of your money and protect your assets. We also want you or your loved one to be able to remain in the nursing home, and have it paid for. We can help mitigate the stress and financial loss. 

I urge you to encourage anybody you know who may be affected by this redetermination, to watch this Video, or call us on 724 546 4227.

Don’t Forget…

We also offer our Elder Law and Estate Planning Workshops, which you can register for on our website, where you will learn about Medicaid in more detail. We’ll also talk about death taxes, federal estate tax, and the Pennsylvania Inheritance Tax. We’ll explain the difference between Wills and Trusts and the difference between Revocable and Irrevocable Trusts.