Being hospitalized later in life can lead to a lot of difficult questions and decisions. Will rehab in a nursing home be necessary after the hospitalization? Will rehab be fully successful or is long-term care needed in a nursing home? Will rehab be moderately successful and further care is required in an assisted living facility? Will some amount of in-home care be needed? How much will this care cost?
Medicaid is a program that may pay for all or a portion of this care. These are the top tips to keep in mind with Medicaid and navigating this transition from a hospital:
1. Be cautious about applying for Medicaid. It’s not uncommon for hospital staff to encourage patients or loved ones to file for Medicaid or actually file the application for the patient. This could make sense for a single person (i.e. someone who is not married or is the surviving spouse) who has assets less than $9,660, needs rehab care, and is likely to stay long-term in a the nursing home. But, this is almost always not appropriate for a patient who is married. A married person will almost always have too many assets to be eligible for Medicaid at that time. In 2025, Medicaid allows the healthy spouse to keep the lesser one-half of the couple’s countable assets or $157,920. So in other words, the couple will need to spend-down or do Medicaid planning the other half of the assets for that married spouse to be eligible. The one exception is for couples who have assets less than $31,584. Applying prematurely for Medicaid can cause significant issues that may complicate the process later or even cause ineligibility. It’s important to seek advice about whether it’s actually appropriate to apply for Medicaid at that time.
2. Consider whether Medicaid is the best option at that time. If your spouse or loved one is eligible for Medicaid or planning be done to get eligible, consider whether it’s appropriate to pursue Medicaid at that time. Medicaid can be very helpful in a couple of care settings. The first and most common is a nursing home. If your spouse or loved one needs rehab care and then will remain long-term in a nursing home, it’s almost always best to consider pursing Medicaid. The cost will likely be $11,000-$13,000/month, and Medicaid may cover all or a significant portion of that cost. If your spouse or loved one is transitioning to assisted living, it may not be appropriate to pursue Medicaid. Not many assisted living facilities accept Medicaid upon moving in or at all. Lastly, if a spouse or loved one is being discharged to their own home, Medicaid may be an important option. It could cover in-home care. Also, PACE is a special Medicaid program that provides a number of supports to allow somebody to stay at home as long as possible. Getting advice on these options at that time is very important to know whether Medicaid should be pursued and when.
3. Avoid legal missteps when later applying for Medicaid. Avoiding legal missteps is critical when later applying for Medicaid. The biggest missteps are how assets are spent or transferred. Medicaid has very complicated rules about the use of assets and what’s called “divestment.” Divestment is a transfer of assets that’s illegal under the Medicaid rules and results in a penalty period. This penalty period will prevent Medicaid from paying the nursing home, assisted living facility, or in-home care from a month to many years. The divestment rules often don’t make sense and oftentimes result in unintended penalties. For this reason, it’s important to be aware of these rules to avoid these legal missteps.
If you have any questions about these issues or being proactive in planning for a transition after the hospitalization of a spouse or loved one, feel free to contact me at phmulder@cunninghamdalman.com.
