Entering a nursing home or assisted living facility can be one of the most confusing and stressful times that a family will ever have. In addition to changing a living situation, families are thrust into an alphabet soup of different government agencies and programs.
We have discussed in prior articles the use of irrevocable trusts to protect assets from nursing home costs and the ideal time to divest assets to children. This article focuses on the different programs available to help with nursing home costs and the eligibility criteria for each program.
Nursing Homes and Medicaid
Medicaid is the federal government program designed to help pay for nursing home costs. Nursing homes are the most traditional form of senior living, and often provide rehab and other medical care to their residents.
A person has to be “elderly, blind, or disabled” in order to obtain Medicaid benefits. Anyone over age 65 is considered “elderly” in the eyes of Medicaid. There is also a financial asset threshold in order to obtain Medicaid assistance with a nursing home stay.
The financial eligibility threshold changes depending upon whether a person is single or married. A single person is allowed to have $2,000 of “available assets” while married couples have higher asset thresholds. The graphic below illustrates the different financial eligibility thresholds:
Assisted Living Facilities and Family Care
Assisted Living facilities may accept government benefits (but are not required to). Family Care is the official name in Wisconsin for assisted living Medicaid benefits. Family Care is administered by the State of Wisconsin, which has contracted with six Managed Care Organizations (MCO’s) to run the day to day aspects of the program throughout the state.
Assisted living facilities often create their own rules on when/how they will accept Family Care for a resident. Many local facilities accept Family Care, but require that a resident private pay for their stay for a certain number of months before transitioning to the Family Care program. Other facilities accept Family Care right away, but limit the total number of Family Care residents in their facilities at any one time. We strongly recommend that families understand the individual policies for a particular assisted living before moving a resident into that particular location.
Family Care has the same financial eligibility requirements as Medicaid, but adds an additional requirement to the mix. In order to be eligible for Family Care, a prospective recipient must first be determined “functionally eligible” by the Aging and Disability Resource Center (“ADRC”) in their county.
If you have any questions on whether Medicaid or Family Care is a fit for your loved one, please reach out to one of our Elder Law attorneys at McCarty Law for more information on how these programs might be able to help.