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Medical Assistance Application Process

Timing of filing the application is the most important aspect to consider in the application process.

When your loved one enters a nursing home, the next step may be to file an application for medical assistance benefits. The application is very time consuming to complete and can be a minefield if you do not have all of the information necessary or you rely upon the nursing home to file a document that can be fraught with mistakes. Taking the time to seek legal guidance for completing the form may be a very wise move.

However, to get you started, here are some pointers:

  • Always check the intent to return home box otherwise the home will be counted as a resource.
  • If a spouse remains in the community (CS) the house should be transferred to the community spouse (CS) by the institutionalized spouse (IS).
  • The wills of a married couple will need reviewed and possibly redone to protect assets of the CS.
  • If the IS/CS has a business, those assets may not be a countable asset for purposes of determining the couple’s resources if those business assets create income which would be counted along with one’s pension and/or social security benefits.
  • A CS may need more money to live on, and money from the IS can be earmarked for the CS. This involves specific calculations. This alone may be worth seeking legal help.
  • To help shelter resources, burial trusts can be set up for not only the IS but the CS as well.
  • If resources are transferred within the 5 year look back period, a penalty maybe imposed on the CS and medical assistance may not be awarded until the penalty period runs which it will even if the IS returns home until the penalty period expires.
  • When using the caregiver child exception for the transfer of the home, must show proof that the child has actually been living there and but for the child’s caregiving, a doctor’s report will verify that the elder parent would have otherwise been institutionalized.
  • If you have a disabled child, all of an IS’s assets can be given to the disabled child and the IS can immediately qualify for medical assistance but must be careful that the transferred assets to the disabled child will not jeopardize their benefits.
  • When one needs a skilled care facility, apply for medical assistance benefits first and then the VA benefits. For this level of care the MA benefits will provide greater medical coverage.
  • The resource determination i.e. what the CS may keep is only done one time. The snapshot is taken the first day in the nursing home as long as it was a stay of 30 consecutive days.
  • Children may be required legally (Act 43) to care for parents. This can be a very vulnerable area for any of the children if transfer of resources is not done correctly. Legal guidance is very crucial if a child plans to transfer assets from parents to the children.
  • Estate recovery occurs after an IS dies. The executor must request a statement from DPW (Department of Public Welfare) regarding the amount of MA (medical assistance) benefits the decedent received. DPW must respond in 45 days or forfeit their claim.
  • Sometimes gifts may not be counted as a penalty. Legal help in this area is essential.
  • Special rules apply if only needing nursing home care for 6 months or less.
  • Before completing the MA application, the medical doctor of the applicant must file an MA51 indicating that the nursing home candidate needs skilled care.
  • Personal property in the home can be gifted without triggering any penalty period.

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