By Attorney Curtis A. Edwards
When it comes to planning for long-term care and nursing home expenses, Medicaid is a critical program for many individuals and families in Wisconsin. With nursing home costs in Wisconsin ranging anywhere from $8,000 to $12,000 a month, it is essential to understand how Medicaid planning can be a valuable tool in preserving your wealth while ensuring you receive the care you need.
Medicaid vs. Medicare: Know the Difference
Medicaid, not Medicare, is the primary program that provides financial assistance for nursing home care and home-based long-term care in Wisconsin. While many people use the terms Medicaid and Medicare interchangeably, it is important to recognize that they are two distinct programs with vastly different coverages and eligibility requirements. Before delving into Medicaid planning, it’s crucial to understand the fundamental differences between Medicaid and Medicare:
Medicaid, is a state and federally funded program that provides health care and long-term care services for low-income individuals, including seniors. To qualify for Medicaid, your income and assets must fall below certain thresholds.
Medicare, on the other hand, is primarily a federal health insurance program for people aged 65 and older. While it covers some medical expenses, it offers limited coverage for nursing home and long-term care costs.
Key Aspects of Medicaid Planning
- Protecting Your Home
One of the most common concerns for individuals who may need to go into a nursing home is that they will lose the family home. Many people mistakenly believe that they must sell their home in order to qualify for Medicaid. However, this is not the case in Wisconsin. Your primary residence is typically not considered an asset as long as you reside in it or have the intent to return, even if returning seems impractical due to your current health condition. This means that you can retain ownership of your home while receiving Medicaid benefits for nursing home or long-term care services.
- Asset Transfers
Medicaid has strict rules regarding asset transfers. Most notably, the program penalizes asset transfers made within a specified look-back period (typically five (5) years). These penalties are designed to discourage “gifts” or transfers for less than fair-market value that could be perceived as an attempt to qualify for Medicaid by impoverishing oneself artificially. However, not all transfers result in disqualification and there are permissible ways to spend down assets within the guidelines to qualify for Medicaid.
- Spousal Impoverishment Protection
Medicaid provides protections for married couples to prevent financial hardship when one spouse enters a nursing home or requires long-term care. These protections are based on specific dollar amounts but typically allow the community spouse (the one not receiving Medicaid benefits) to retain up to 50% of the couple’s assets up to a maximum of $148,620. If the community spouse’s share of the assets is below $50,000, then 100% of the assets up to $50,000 can be retained by the community spouse. These allowances ensure that the community spouse can maintain a reasonable standard of living while ensuring the institutionalized spouse’s care needs are met.
- Income Allocation
Medicaid planning can also involve the strategic allocation of income. Specifically, income can be transferred from the institutionalized spouse to the community spouse to help equalize their financial situations. This can be a crucial step in ensuring both spouses have the resources they need.
- Gifting Strategies
While outright gifting can raise concerns, strategic gifting within Medicaid’s guidelines can be part of an effective planning strategy. It’s essential to consult with an attorney experienced in Medicaid planning to determine the best approach for your unique circumstances.
Seek Professional Guidance
In conclusion, Medicaid planning can be complex and nuanced, with each individual’s financial and familial circumstances requiring a tailored approach. With careful planning and the expertise of a knowledgeable attorney, you can ensure a financially stable and secure future for yourself and your loved ones. If you have any questions or are interested in learning more about this topic, please contact Lin Law LLC at (920) 393-1190.