Medicaid is generally the easier one for most people to be eligible for. It’s based on your income and assets, so if you plan ahead you can move around money and assets to meet the requirements for nursing home coverage.

Medicare is more strict about when they cover nursing home costs, and it only covers a maximum amount of 100 days in a nursing home. There are some specific qualifications related to your care and the money you spend on it. To begin, the patient must be over 65 and have been in the hospital for at least 3 days. After that, the patient must be admitted to a Skilled Nursing Facility, where Medicare will cover the first 20 days of care. Then, you can get the remaining 80 days of care covered once you’ve paid your copayment, assuming that these three requirements are also met:

1. You are admitted to the Skilled Nursing Facility within 30 days of your hospitalization.
2. You are receiving skilled care, not only custodial care, for the same reason you went to the hospital.
3. A doctor must order this as necessary care.

To be eligible for Medicaid coverage, you need to have countable assets lower in total than $2,000. These countable assets include both income and property, but there are exceptions. In terms of income, anything money you receive from pensions, employment, alimony, Social Security Income, Social Security Disability, stock dividends, or IRA withdrawals are counted. In terms of assets, any real estate that you don’t permanently live in, investments, credit union, IRAs, stocks, cash, bonds, checking and saving accounts are counted in your total assets. Anything that is not listed there will not count in your Medicaid eligibility.

All of the patients income needs to go toward the nursing home, with less than $60 allowed to be kept for a monthly allowance.

Yes, in Michigan there is a 5 year look back period that applies to Medicaid eligibility. This means that for all non-exempt assets (such as real estate you don’t permanently live in) must be sold at a fair price at least 5 years before your Medicaid application. Giving money or assets away, selling for less than fair market value, or transferring assets to others within this 5-year period will result in an ineligibility period.

In Michigan, if you transfer or sell assets below their fair market value during the 5-year look back period, then you’ll have to wait out a 12-month ineligibility period before your coverage starts. The 12-month ineligibility period begins when all of the following happen:

• You are admitted to a nursing home.
• Your Medicaid application has been filed.
• And you have passed the Medicaid Needs Assessment.

Most of the requirements stay the same to qualify for Medicaid to cover your home health care. You still must have less than $2,000 in countable assets for individuals and less than $3,000 in countable assets for couples. In order to qualify for home health care under Medicaid, you must be unable to independently complete activities of daily living (ADLs) and instrumental activities of daily living (IADLs). These include things like dressing, bathing, grooming, cooking meals, shopping, and more. Medicaid will cover 28 hours of home health care a week in most cases, with more coverage offered in certain situations. You can live in your own home or the home of a loved one and receive this care.

You can choose to have a caregiver provide your home health care services if you write up a caregiver agreement. You’ll have to pay payroll taxes on what you pay the caregiver, and they will have to pay income taxes. If valid in these ways, then the payment doesn’t count as an uncompensated transfer of assets and won’t affect Medicaid eligibility. If your caregiver is a family member, you will need an independent estimate from a home health care company to ensure the pay is fair.

There are three kinds of trusts that affect Medicaid eligibility in different ways. The first, a revocable living trust, means that your assets and income are considered available according to the needs assessment. This means that a creditor who takes on a beneficiary role (which could be Medicaid) has full access to any benefits of the trust.

The irrevocable living trust limits the benefits to a creditor like Medicaid, usually down to income only. This means Medicaid has access to the income but not the underlying principal of the trust, as long as the trust was created at least 5 years before your Medicaid application.

The final kind of trust, the testamentary trust, works a bit differently. As opposed to the living trust, the testamentary trust is funded when the first spouse passes away. The only benefits of these trusts that are considered by Medicaid are those to be paid to the surviving spouse. This kind of trust is not subject to the 5-year lookback period since the trust is only funded upon death.