Medicaid Myths

Myths about Medicaid

Myth #1:  I can find all information I need regarding Medicaid from Missouri’s Medicaid office.

Reality:  That is like saying that I can find all the relevant strategies and rules regarding taxes from the IRS office.  Although the Medicaid office can answer basic questions they are not in the position to be advisors.

 

Myth #2:  Medicare can cover my nursing home bill

Reality:  Medicare coverage for nursing homes is very limited.  First, the care must be considered medically necessary.  The service must be provided by a certified skilled nursing facility, and the patient must have stayed in a hospital for 3 days prior to admittance.

Medicare will pay the full cost of covered services at a skilled nursing facility for up to 20 days.  From days 21-100, Medicare will pay all covered services after a $152 co-payment requirement for each day.  After the 100th day, Medicare will no longer pay and the patient is required to pay 100% of the bills.

Refer to the chart below

Skilled Nursing Facility (If daily skilled care is needed after a 3 day hospital stay)    
PatientMedicare PaysPatient Pays
Day 1-20100%0
Day 21-100100% after copayment$152
After 100 days0%100%
Home Health Care100% minus 20% of covered medical equipment20% of Medicare-approved amount for medical equipment
Hospice Care100% minus $5 per prescription. 95% of Medicare approved payment for respite care per dayCopayment $5 per prescription. 5% of Medicare approved payment for respite care per day (Cannot exceed $1216)
Blood Transfusion during Hospital Stay100% after first 3 pintsFirst 3 Pints per year

 

Myth #3.  I have to own nothing to qualify for Medicaid

Reality:  You can owned some property and still be eligible for Medicaid.  The key is understanding what is “countable” and what is not under the Medicaid rules.  For example, your primary residence is not a countable asset under Medicaid rules up to a certain value.  The truth is that you don’t need to be without assets to qualify for Medicaid.

 

Myth 4.  Gifting away my assets will disqualify me from Medicaid

Reality:  Although there are penalties for gifting some type of assets. Not all gifts create penalties.  It depends on what is given away, to whom, and when.  The rules regarding gifts are complicated and you should consult a knowledgeable elder law attorney before making any type of gift.

 

Myth #5:  I have to wait 5 years after gifting away assets in order to get Medicaid

Reality:   Medicaid imposes a penalty on certain gifts made within 5 years of Medicaid application.  Gifts made prior to the 5 year period are exempt from Medicaid penalties.  However, certain asset transfers do not incur a penalty.  For example, transfers made to your spouse, blind or permanently disabled child, or a trust solely benefiting any permanently disabled persons under age 65.  The rules regarding asset transfers under Medicaid are complex and require proper guidance to avoid future problems when applying for Medicaid benefits.

 

Myth #6:  I must spend down all my assets before I can get Medicaid benefits

Reality:  Some private nursing facilities prefer private payments over Medicaid because Medicaid pays them less.  They would like you to believe that if you are currently paying for private care, you are required to spend down all your assets before Medicaid will kick in.  The truth is that a knowledgeable   attorney can help develop a plan for Medicaid eligibility and asset preservation in the best interest of the client.

 

Myth #7:  There are ways to hide my assets and be eligible for Medicaid

Reality:  Intentionally providing false information on a Medicaid application is a crime and the penalty can be costly.  The IRS shares any information they have with the Medicaid agency.  If you are found to intentionally misrepresent information on your application you may be required to pay back Medicaid.  It is important to work with someone that understands the Medicaid  rules and regulations.  This person can LEGALLY help guide you thru the Medicaid process.

If you have more questions, you can contact us!

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