Qualifying for Medicaid Nursing Home Benefits in Louisiana

Louisiana residents wishing to qualify for long-term care Medicaid benefits must navigate the complex state and federal rules and exceptions to the rules governing Medicaid. Individuals over age 65 who need long-term care must satisfy income and asset limitations discussed below. The process of obtaining Medicaid eligibility should not begin with the filing of a Medicaid application. Prior to filing a Medicaid application you should consult with Louisiana Elder Law attorney, John Sirois, to determine if all of the criteria have been met to qualify for Medicaid long-term care. Filing a premature application or failing to satisfy the Medicaid eligibility criteria may unnecessarily delay benefits. For more information, contact Metairie Medicaid planning attorney, John Sirois at 985-580-2520 or my email at john@jsiroislaw.com. Click here to download John’s Medicaid Term Care Planning Checklist.

The Louisiana income and asset rules described below are the basic rules to qualify for Medicaid long-term care benefits in Louisiana. Additional planning techniques allow Medicaid applicants and spouses to protect assets that exceed the basic limits. Neither Medicaid caseworkers nor nursing home staff will inform you of your rights to protect assets in amounts that exceed the basic exemptions. Consult with an elder law attorney to determine how to protect most or all of your assets that exceed the basic exemptions described below.

Louisiana Medicaid Income Limitations

To qualify for Medicaid long-term care, the applicant’s monthly income must not be greater than $2,313 (2019) for a non-married applicant. This amount is also known as the long-term care special income limit (SIL), and it includes the income of Medicaid applicant from all sources. Married couples may retain more of their income to provide for the spouse not in the nursing home by using the Minimum Monthly Maintenance Needs Allowance discussed below. If the Medicaid applicant’s income is greater than $2,313 per month (2019) but less than the monthly rate of the nursing home and all of the other requirements are met, the applicant may still qualify after certain adjustments are made to their income. This alternate way of qualifying for Medicaid long-term care benefits is called the Spend-Down Medically Needy Program (“spend down”). For example, Boudreaux meets the resource test (discussed below), and his monthly income is $2,700 per month. Because his income is greater than the SIL ($2,313 per month in 2019), he does not qualify under the first test. However, if after certain deductions are made to “spend-down” Boudreaux’s income, his monthly income is less than his particular nursing home facility rate (e.g. $6,000), he passes the Spend-Down Medically Needy Program Test. After an individual is eligible for Medicaid, a portion of the institutionalized spouse’s income is applied to the cost of care. This amount is the Patient Liability Amount. If you have questions about qualifying for Medicaid long-term care in Louisiana, contact Houma-Thibodaux Medicaid planning attorney, John Sirois, at 985-580-2520.

How Much Income Can A Spouse Keep?

A spouse not receiving care in a nursing is allowed to keep all of his or her income. The Minimum Monthly Maintenance Needs Allowance permits the spouse in the nursing home to transfer income to the community spouse (the spouse not in the nursing home) to meet a minimum threshold of monthly income. If both spouses are in a nursing home, there is no community spouse and the Minimum Monthly Maintenance Needs Allowance is not available. If the community spouse’s monthly income is less than $3,165.50 (2019), the institutionalized spouse may transfer income to the community spouse to reach this minimum amount of monthly income. Income sheltered under the Minimum Monthly Maintenance Needs Allowance does not count towards the income limit and reduces the amount of countable income for Medicaid eligibility purposes. In addition, the Minimum Monthly Maintenance Needs Allowance provides an exception to the Patient Liability Amount. If the community spouse has insufficient income to meet the Minimum Monthly Maintenance Needs Allowance threshold, income from the institutionalized spouse is diverted to the community spouse rather than used to pay a portion of the cost of care as the Patient Liability Amount. If you have questions about income you may keep if your spouse qualifies for Medicaid Long-Term Care, contact Terrebonne – Lafourche elder law attorney, John Sirois at 985-580-2520.

Louisiana Medicaid Asset Limits

In addition to the income test, Medicaid applicants must also pass a resource (asset) test to qualify. You cannot qualify for Louisiana Medicaid if you have countable resources in an amount greater than $2,000. If you and your spouse are in a nursing home, your combined resources cannot be greater than $3,000. Contrary to what your attorney, financial advisor, nursing home administrator or Medicaid caseworker may have told you, you do not have to spend your life savings to qualify for Medicaid long-term care benefits. There are numerous strategies to protect your assets for you and your heirs in addition to a number of exempt resource provisions under the Louisiana Medicaid rules. Resources include cash, bank accounts, real estate, investments, retirement accounts, and all assets or possessions which can be converted into cash. If you are concerned about protecting assets from Medicaid spend-down, contact Houma Medicaid planning lawyer, John Sirois, at 985-580-2520 or my email at john@jsiroislaw.com. Click here to download John’s long-term care planning checklist.

How Many Assets May a Spouse Keep? 

There is an additional exception to the asset limitation provided for married couples when one spouse enters a nursing home. The Community Spouse Resource Allowance enables your community spouse at home to retain assets to maintain his or her standard of living if the other spouse enters a nursing home. The spouse at home (the community spouse) is allowed to retain $126,420 (2019) of nonexempt assets. Assets in value exceeding this amount are deemed available when applying for Medicaid. After qualifying for Medicaid, the community spouse’s resources may increase over the Community Spouse Resource Allowance without disqualifying the Medicaid recipient’s benefits. However, the Medicaid recipient’s resources may not exceed $2,000 at the time of applying for and while receiving Medicaid long-term care benefits.

For Louisiana Medicaid purposes, there is no distinction between separate and community property. Therefore, all of the resources of both spouses are considered at the time of applying for Medicaid. So a pre-nuptial agreement will not help to protect assets. If your resources exceed $2,000, you will be required to spend-down the excess resources by paying for your long-term care expenses out of pocket. After you spend-down your excess assets, you may qualify for Medicaid. The good news is we have a number of strategies available that allow you to avoid losing your life savings to the nursing home – even if a loved on is currently in a nursing home.

Basically, Medicaid will take a resource snapshot of both spouses at the time of application. If the asset and income tests are satisfied at that time, assets and income received solely by the community spouse subsequent to qualifying for Medicaid will not disqualify the institutionalized spouse for Medicaid.

Contact John E. Sirois, Thibodaux Elder Law and Medicaid Attorney, at 985-580-2520 to learn how you can legally protect your assets from nursing home spend-down or to set up an initial appointment.

Click here to download John’s Long-Term Care and Medicaid Planning Checklist.

Read John’s book, Louisiana Retirement and Estate Planning, for more information about long-term care and Louisiana Medicaid planning.