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Ray
Ray, Lawyer
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My husband is in rehab in a skilled nursing facility of a nursing

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My husband is in rehab in a skilled nursing facility of a nursing home. If for whatever reason he becomes a permanent resident of the nursing home, will Medicare take all our savings and leave me with nothing before Medicaid starts paying? What about my home do they take that and leave me homeless? What can I do to at least keep half of our savings and possibly half of his Social Security and Retirement for me?

RayAnswers :

Thanks for your questions and good afternoon.My sympathy here for your dilemma and situation..

RayAnswers :

Here medicare pays only for a limited period and then if you are eligible medicaid takes over.Make sure you understand the difference because it is apples and oranges here.

RayAnswers :

You may benefit greatly by talking to a local NAELA lawyer here in Texas.NAELA--national academy of elder lawyers specialize in possibly sheltering assets while making the spouse here medicaid eligible.

RayAnswers :

That said lets go through medicaid eligibility for Texas here.

RayAnswers :

First the homestead eligibility wise is exempt as a resource.

RayAnswers :

So that should not be an eligibility issue except that at some point once both of you decease medicaid has estate recovery and may assert a claim in your probate down the road.

RayAnswers :

His social security will be taken as his copayment for his care.I wish I could tell you otherwise that is unlikely to change.

RayAnswers :

Here are the eligibility limits for Texas medicaid..

RayAnswers :

The limits for assets and qualifying for benefits are as follows:


Single Individual: $2,000.00


Married Couple: $3,000.00 (this is when both spouses are residents of the nursing home)


Community Spouse at home: ½ of the total assets but not more than $115,920.00 of the total countable assets. (This occurs when one spouse is in the nursing home (Institutionalized Spouse) and the other is living at home (Community Spouse).


Countable Assets


Examples of countable assets include: CD's, savings accounts, checking accounts, bonds, stocks and money market accounts. Below is a list of assets that are "excluded assets"; that is, they are not counted when determining Medicaid eligibility.


Major Asset Exclusions



  • Homestead - If the spouse or certain dependent relatives continue to reside in the home, it is excluded. Also, if the applicant intends to return to the home, the home is excluded. However, a person who is eligible for Medicaid benefits in Texas may not exclude a home in another state.

  • Estate Recovery: Without proper planning, a nursing home resident may not be able to leave their home to their family, but instead their heirs may have to sell the home to repay the state for the amount of Medicaid benefits received. Click on "Estate Recovery Info" at left for more information.

  • Vehicle - One vehicle is excluded if its current retail value is $4,500.00 or less. However, the value of a vehicle used for medical purposes at least four times per year is unlimited. In some cases, another vehicle may be exempt

  • Life Insurance - If the total face value of all of the policies is equal to or less than $1,500.00, then the cash value is excluded as an asset. If the total value exceeds $1,500.00, the cash value is considered an asset.

  • Burial Funds and Prepaid Funeral Contracts - Up to $10,000 of an irrevocable burial contract is excluded as an asset.

  • Properly Structured Immediate Annuities - Assets placed into a properly structured Medicaid Friendly Annuity are excluded assets. There are several requirements when applying for Medicaid benefits that must be met in order for the assets placed into the annuity to be excluded. Annuities are underwritten by licensed insurance companies.

RayAnswers :

So a NAELA lawyer may be able to shelter some of your savings here and some other assets.

RayAnswers :

Sometimes a medicaid qualifying annuity here that pays a monthly amount or other means can help you preserve some of your assets.

RayAnswers :

You can locate a NAELA lawyer here.

RayAnswers :

Once you have a few minutes to digest all of this please follow up.I have a number of years in medicaid and related issues here.I will be happy to respond to your questions.I know that all of this can be quite overwhelming.

RayAnswers :

You have time limited days here under medicare, again this is different than medicaid which if eligible pays after the medicare days run out.

RayAnswers :

For your understanding here most skilled nursing homes in Texas will have what are called dually licensed beds.In other words they bill medicare as long as it lasts because it pays better, and then once that runs out again assuming he is eligible then medicaid takes over.

RayAnswers :

I will be around here please follow up and I will respond.Thanks for letting me assist you today.

RayAnswers :

One of your best friends here that represents all residents here is the Ombudsman.They can help you with all kinds of questions and any care issues.They are state employees of HHSC a state agency that deals with and regulates nursing homes.

RayAnswers :

You can find your husbands Ombudsman here.

Customer:

We have a secondary insurance, I think I'm going to see if they will pay an extension on his snf because he was sick with a urinary tract infection the first week and was unable to do much therapy.

RayAnswers :

Certainly you should do so.

RayAnswers :

In general when someone is on a skilled level thats the highest level of nursing care.It usually means they are going to need that level of care.

RayAnswers :

There are also a couple of levels of rehab nursing here.In the big cities they have a skilled level one, then a second one if they progress at a lower level.The idea or theory is that by end of their days on medicare they are supposed to be rehabbed to a level where they can eithler be out patient or say supervised living.That does not always happen of course.Some are never able to leave nursing homes unfortunately.

RayAnswers :

But it is great idea here for you to persistently talk to the staff about his progress.Remember the meter is running days wise.

RayAnswers :

And consider a NAELA lawyer to do some medicaid planning.

RayAnswers :

It is very possible here to shelter some assets.

RayAnswers :

And there are a lot of things that can be done.

Customer:

We're both hoping that he'll progress enough so that he can transfer to a rehab hospital for additional extensive therapy.

RayAnswers :

Just know that there will be ups and downs.I have a client that took a year and a half, several hospital stays, and a stay in skilled care but he survived a triple bypass and got off dialysis and now lives at home.I am not sure that all end up that way but he did.

RayAnswers :

It just has a lot of ups and downs, kidney infections, cold, bugs, etc.

RayAnswers :

I do hope your spouse here can get better in rehab but certainly doesn't hurt to do some medicaid planning.

Customer:

Thank you very much, you've given the info I need, I appreciate it.

Ray and 9 other Legal Specialists are ready to help you
Thanks for your recent medicaid/estate question.If you have new ones please post for Ray.Thanks again for the rating and letting me help you.I wish you the best.

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