Nursing Home Planning

The average cost of one month in a nursing home in southern Maine is around $10,000. Planning ahead for this type of expense is important. There are four options open to families to pay these exorbitant costs: self-pay, long term care insurance, Medicare, or Medicaid/MaineCare. Most advanced planning for nursing home care involves a combination of these options, with the final goal being MaineCare eligibility.

What is MaineCare?
MaineCare is Maine’s Medicaid program. MaineCare will pay the cost of long-term care for an individual who meets all of the criteria set forth in the MaineCare regulations. There are several different types of long term care programs for which MaineCare offers assistance. The main programs are for nursing home level of care and residential care (also referred to as assisted living and boarding home care). The nursing home program also encompasses a program called Medicaid Waiver (MedWaiver) which pays for nursing home level of care services in one’s home.

Determining eligibility
In order to qualify for MaineCare (long term care), an individual must meet both the medical and financial criteria. The medical condition of the individual seeking eligibility will be assessed by a State agency. The person may be assessed at nursing facility level of care (highest medical need). If the individual does not meet this level of care, he may still be eligible for residential care. Next, for any of long-term care programs, the individual must meet financial criteria; they must have less than $10,000 in countable assets. Countable assets include, but are not limited to, bank account balances, values of IRAs, fair market values of boats, cash values of life insurance policies, etc. In addition, some or all of the value of certain assets are exempt from the individual’s countable assets, most notably a primary residence. Finally, the spouse of a MaineCare applicant may also retain assets in his/her name. What the spouse may keep depends on the program for which the applicant is applying. Even if an individual meets both the financial and medical criteria, they may still be disqualified from receiving MaineCare benefits if they have given away a certain amount of money or assets. Generally, when a person makes a gift, the State will impose a penalty period in which that person is not eligible to receive benefits (a person, may, however, transfer assets to certain individuals, such as a spouse, without penalty). Pursuant to the Federal Rules, this penalty will start running as of the date of application. Therefore, transferring assets without adverse and unexpected MaineCare consequences requires careful adherence and knowledge of the MaineCare rules. Carlin & Shapiro, P.A. can help guide you through these rules to ensure that a future penalty is not assessed for someone who may otherwise be eligible for benefits.

Changes to the Estate Recovery Program
If a person receives MaineCare assistance during their lifetime, the state of Maine may make a claim against their estate, after they pass away, for the money paid for their care during his lifetime. The State is aggressive in considering the value of a jointly held interest in the estate as a means of recovering more funds. Carlin & Shapiro, P.A. can analyze your current situation and assist you in creating a plan to address these issues.