Unexpected health crises often force quick decisions about nursing home care, making advance planning essential but sometimes impossible. When this happens, understanding your remaining options can make a meaningful difference for both your finances and your peace of mind.
It happens far too often. A fall, a stroke, or other tragedy suddenly forces you to make difficult decisions about moving your loved one into a nursing home. Ideally, you have already made plans for when you are faced with these difficult decisions, so some stresses are alleviated because you are better equipped to know how your assets are affected.
Although planning in advance is preferred and encouraged, life does happen. Crisis planning becomes necessary when a person has already entered a nursing home, or must be placed in one very soon, and has been informed that he or she has too many assets to qualify for Medicaid assistance.
Information provided by friends, family, social workers, nursing home intake staff, and even Medicaid workers can be out of date or even wrong. Although as well-intentioned as these individuals are, the laws governing Medicaid eligibility are complicated and ever-changing.
Related Post: Protecting Your Estate and Assets When Moving to a Nursing Home
In Missouri, what was previously named Medicaid is now known as MO HealthNet. In most cases, when a family member goes into a nursing home some of their assets can be saved. However, this is a very complex area of law, and no two people have the same set of circumstances. A consultation with an attorney practicing in the area of Elder Law can save you time and money, even when you are confronted with a crisis situation.
Because Medicaid (MO HealthNet) has a five-year look-back period, to protect all of your assets from being spent on nursing home care, those assets would have to be transferred out of your name five years prior to entering a nursing home.
What if you started your planning, but it hasn’t been five years yet?
What if you haven’t even started planning and you are thrown into crisis planning?
Just because you or a loved one has not engaged in advance Medicaid or long-term care planning does not mean you’re out of options. It’s often still possible to qualify for benefits if you act quickly and strategically. For example, many people who enter a nursing home initially pay out-of-pocket until funds run low, then apply for Medicaid once they meet eligibility requirements.
That said, the window to protect assets narrows significantly once care is needed. So professional guidance from an attorney or Medicaid-planning professional becomes even more important to help you understand what qualifies as countable vs. exempt assets, what transfers are permissible, and whether any “spend-down” or restructuring strategies may still apply.
If you’ve already initiated nursing home care and haven’t planned in advance, several “crisis-planning” strategies might still help preserve some assets or reduce costs. For instance:
Spend-down carefully: You may need to spend down countable assets to meet Medicaid’s limits but doing so indiscriminately (for example, giving away money as a gift) could trigger penalties. Many spend-down moves (like paying off debts, medical bills, or non-countable expenses) are legally acceptable.
Explore income and resource protections for a spouse: If the person entering care is married, state and federal Medicaid rules may protect the “community spouse,” allowing the non-applicant to retain some portion of income and assets
Evaluate substitute care options or alternatives to a full nursing home stay: Depending on health needs and Medicaid availability in your state, in-home care or assisted living (when eligible) may provide partial relief or delay full nursing home admission.
While presumably less ideal than planned, these strategies can make a significant difference when time is of the essence.
Facing a nursing home need without prior planning often brings complex legal, financial, and emotional challenges. Medicaid eligibility rules differ by state, have strict income and asset thresholds, and include rules about transfers, penalties, and timing.
A skilled elder law attorney can help you navigate this complexity. They can review your assets, advise on permissible spend-down strategies, help protect assets for a spouse or dependents, and guide you through application procedures helping avoid costly mistakes in a time of stress.
Applying for Medicaid benefits to cover the cost of nursing home care is complicated and can be confusing and overwhelming. If you take on this process on your own, a mistake in the application process or improperly gifting or transferring assets in an attempt to meet the Medicaid eligibility spend-down rules can cause a significant delay in the start of Medicaid benefits or a requirement that your family gives back assets.
If you find yourself unexpectedly facing long-term care needs without prior planning, take action now. Even if the ideal planning window has passed, there may still be options to minimize financial damage, preserve some of your estate, and qualify for Medicaid or other assistance. Contact a qualified elder law attorney to evaluate your situation and help you make informed decisions as soon as possible.
With consultation from an Elder Law attorney, you may be surprised what can be saved, even during crisis planning. Often, strategic last minute gifting strategies coupled with moving some assets to a qualified income stream can allow for saving a portion of assets to family members. Spouses have even more options since there is no gift penalty between spouses.
Whether you or a family member are pre-planning or are facing a crisis with long-term care and are unsure of the benefits available to you, please contact Assertion Law Firm LLC and 417 Business & Elder Law. You are never beyond the point of being able to apply for Medicaid with the right amount of preparation.
Please call our office at (888) 887-4170 if you have any questions about this article.
Unexpected health crises often force quick decisions about nursing home care, making advance planning essential but sometimes impossible. When this happens, understanding your remaining options can make a meaningful difference for both your finances and your peace of mind.
