Planning ahead is important for clients who wish to maximize their eligibility for MaineCare and other government benefit programs in the future. MaineCare is one of several needs-based programs that provides a person with financial assistance for long term care, either in a nursing home setting or at home, and it is the most common. Most of the rules associated with MaineCare eligibility are designed to prevent people from intentionally making themselves poor (for instance by giving away assets to children) in an effort to become eligible for benefits, and yet retain their assets to pass to their family. Maine’s strict eligibility rules and guidelines for MaineCare assistance are put in place to avoid these situations.
One of the chief concerns of a family facing the decision of having loved one enter a nursing home is how they will pay the cost. Most health insurance plans and Medicare provide very limited coverage for patients in nursing homes. Unless you have long-term care insurance to cover your care, the only option is to pay for the care yourself until your assets are exhausted and then apply for MaineCare.
Generally, to qualify for MaineCare eligibility, your financial assets can be no more than $10,000. This includes cash, stocks and bonds, bank accounts, your IRA, and real estate not your principal residence. Also, if you have transferred any financial resources to your family members or friends within five years of the date you apply for MaineCare, those transfers may be counted as available resources, and may affect your eligibility and cause you to incur a penalty.
There are a number of resources that are not counted in determining your eligibility for MaineCare however, including an automobile, household goods, clothing, jewelry, a pre-paid funeral package, and your home if you state an intention to return to it after your nursing home stay, or if it is used as the principal residence of your spouse or dependent child.
Once you qualify for MaineCare by showing that your resources have been spent down, you will have to prove that your monthly income is insufficient to pay for your nursing home care. Generally, all of your income, but not your spouse’s income, is counted. This includes pensions, Social Security, and interest and dividends from bank accounts and other investments. You are, however, permitted to keep at least $40 per month as a personal needs allowance.
If you are married and living at home with your spouse, different rules apply in determining your eligibility. Generally, your spouse is permitted to keep his or her income and any qualified retirement funds. Also, your spouse is permitted to keep a portion of the resources owned by either of you, in addition to the resources mentioned above that are not counted in determining your eligibility for MaineCare.
Contact Lisa to learn more about navigating the complexities of MaineCare planning and asset protection.