Medicaid matters to elders and individuals with special needs because it is the only government program providing substantial help paying for long-term care. Yes, some long-term care is paid for by Medicare, but only when there is a skilled need, and usually is limited to no more than 100 days. Although anyone accessing this website can view The Medicaid Book, it is primarily intended for attorneys and other professionals interested in understanding Medicaid. We have other pages on this website written in more general terms for non-attorneys. These materials are
Chapters
- Chapter 1 – Overview of Medicaid
- Chapter 2 – Eligibility Basics
- Chapter 3 – Financial Eligibility, Generally
- Chapter 4 – Issues When there is a Community Spouse
- Chapter 5 – Working with the Client
- Chapter 6 – Planning with Real Property
- Chapter 7 – Planning with Personal Property
- Chapter 8 – The Medicaid Application
- Chapter 9 – Medicaid Fair Hearings
- Chapter 10 – Post-Eligibility Issues
- Chapter 11 – Home and Community Based Waivers
- Chapter 12 – Medicaid Estate Recovery
- Chapter 13 – SSI Eligibility and How it Relates to Medicaid
Appendix
BLOG POSTS
Medicaid Post Eligibility Treatment of Income and Incurred Medical Expenses
After Medicaid eligibility is established, 42 C.F.R. § 435.725 addresses how income is treated. For clarity, if the Medicaid recipient is married,income of the non-recipient spouse does not count toward eligibility and is not part of the patient cost share. Specifically, 42 U.S.C. § 1396r-5(b)(1) states “no income of the community spouse shall be deemed […]
Medicaid’s Refusal to Provide 24/7 Care in the Community Might be Discrimination
In Harrison v. Young (5th Cir. June 6, 2024), the Fifth Circuit considered Ms. Barbara Harrison’s claim challenging Medicaid’s denial of funding for medical services that she claimed are necessary for her survival. Harrison has severe physical and intellectual disabilities. She cannot walk or talk, and she is fed through a tube in her stomach. […]
New Article Discussing Medicaid Enrollment and Wealth Transfers
On June 11, 2024, the Gerontologist published an article on Medicaid enrollment and Intergenerational transfers of wealth among older adults. The article was based on a review of data from 2008 through 2018 analyzing estate planning and family wealth transfers of older adults aged 65 and older who became Medicaid recipients. There were 8,347 respondents […]
Medicaid’s “any circumstance” test for trusts
Medicaid’s “Any Circumstance” Test for Trusts In case you missed the memo, Medicaid doesn’t like trusts. The rules relating to trusts you create with your money or property are found at 42 U.S.C. § 1396p(d). To put this discussion in context, we’ll begin with the sections relevant to the “any circumstances” test, but the full […]
SNT Trustee Ordered to Reimburse Some Conservator Expenses
SNT Trustee Ordered to Reimburse Some Conservator Expenses In Weidner v. Stevenson (Cal. App. 2nd Dist. May 13, 2024), Roberta Davis established a special needs trust inside her living trust for her disabled adult son, Daniel. Daniel was under a conservatorship. Daniel’s aunt, Charlyne, was the successor trustee of the trust after Roberta’s death, while […]
SNT Payback Provision Enforced
In Agency for Health Care Administration v. Spence (Fla. App. 3rd Dist May 22, 2024) the Court of Appeals reversed a probate court order authorizing distributions from a special needs trust without first reimbursing the Medicaid agency. Ryan Spence was a disabled child adopted by Kathleen Spence. After Spence was killed, a settlement agreement allocated […]
Long-Term Care Partnership Policies
Long-Term Care Partnership Policies One example of good planning is purchasing long-term care insurance. The greatest risk to non-taxable estates (those under $12.9 million) is the cost of long-term care. With long-term care insurance, you can shift that risk to an insurance company. A partnership policy is a special long-term care insurance policy that protects […]
Superior Court Review of Georgia ALJ Decision
In ____ v. Brock, Judge Schwall, Fulton County Superior Court), affirmed an administrative law judge’s Final Decision as supported by the administrative record. Here, the most interesting portion is the language discussing how a Superior Court reviews the appeal of an ALJ decision. The case began when DHS found suspicious transactions on a food stamp […]
Home purchased after nursing home admission was not an exempt homeplace
In a Texas case decided on May 3, 2024, the Texas Supreme Court reversed the Court of Appeals and trial court, siding with the Medicaid agency on whether a home purchased after admission to a nursing home was exempt. Clyde and Dorothy Burt sold their home to their daughter and moved into a rental property. […]
Preliminary injunction granted barring state from terminating QI Medicaid
In Parker v. Louisiana Department of Health (April 30, 2024), the U.S. District Court for the Eastern District of Louisiana granted a motion for preliminary injunction prohibiting the State from terminating a grandmother’s QI Medicaid based on the State’s determination of family size. The Plaintiff, a 71 year old widow who was raising her grandchild, […]
