How Do I Apply for Medicaid?

Medicaid eligibility can be obtained (in most cases) retroactively for up to 3 months.  Planning in order to meet Medicaid’s income requirements should be done before you submit an application for Medicaid.  Contact us to request a Medicaid consultation with one of our attorneys to discuss your situation and let us help you.

Medicaid Planning

What Assets Can I Have and Still Qualify?

As of 2016, an individual applicant must have an income less than $2,199 per month.  A car of any value, prepaid burial plans/plots and irrevocable funeral plans, personal effects and furnishings, and a burial account with a cash value up to $2,500 will not be counted as an asset.  Medicaid laws count a homestead of greater than $552,000 in value as an asset, which would require spend-down, in most cases.  A spouse may have assets up to $119,200.  A Medicaid Applicant may have $2,000 in assets.  The law allows for a minimum and maximum income to be diverted to the spouse still living at home. Contact us for additional details on qualification requirements.

Medicaid Planning

What if I Have More Assets or Income than is Allowed?

A Qualified Income Trust (QIT) can be used to hold excess income and assist in meeting the qualifications.  Contact us to inquire about a QIT.  Be cautious about using annuities for asset protection or giving away assets.  Balloon annuities were commonly used prior to the Medicaid laws enacted in Florida in November 2007.  Now Balloon Annuities are allowed only under limited circumstances and require naming the State of Florida as the primary beneficiary.  Medicaid also has a look-back period preventing applicants from giving away assets as an effective form of qualification. The transfer penalty is calculated based on total amount of assets transferred during the 5 year look back period prior to receiving a Medicaid Application. For every $8,346 of non-exempt transfers made, the Applicant will be ineligible for Medicaid benefits for 1 month. Attorneys are the only ones who can give you this advice.

Commonly CPAs and Financial Advisors recommend gifting $14,000 to one or multiple people, which is acceptable for tax purposes, but often creates a penalty for Medicaid.

Please contact us today to schedule a consultation to discuss your situation and options for Medicaid Planning.

What are VA Aid and Attendance Benefits?

Aid and Attendance is a benefit paid by Veterans Affairs (VA) to veterans, veteran spouses or surviving spouses. It is paid in addition to a veteran’s basic pension. The benefit may not be paid without eligibility to a VA basic pension. Aid and Attendance is for applicants who need financial help for in–home care, to pay for an assisted living facility or a nursing home. It is a non–service connected disability benefit, meaning the disability does not have to be a result of service. You cannot receive non–service and service–connected compensation at the same time. Aid and Attendance benefits are paid to those applicants who:

  • Are eligible for a VA pension
  • Meet service requirements
  • Meet certain disability requirements
  • Meet income and asset limitations

Who is Eligible for Veterans Affairs Basic Pension and Aid and Attendance?

A pension is a benefit that the VA pays to wartime veterans who have limited or no income and who are at least 65 years old or, if under 65, are permanently or completely disabled. There are also “Death Pensions,” which are needs based for a surviving spouse of a deceased wartime veteran who has not remarried.

What are the Service Requirements for Aid and Attendance?

A veteran or the veteran’s surviving spouse may be eligible if the veteran:

  • Was discharged from a branch of the United States Armed Forces under conditions that were not dishonorable AND
  • Served at least one day (did not have to be served in combat) during the following wartime periods and had 90 days of continuous military service:
    • World War I: April 6, 1917, through November 11, 1918
    • World War II: December 7, 1941, through December 31, 1946
    • Korean War: June 27, 1950, through January 31, 1955
    • Vietnam War: August 5, 1964 (February 28, 1961, for veterans who served “in country” before August 5, 1964), through May 7, 1975
    • Persian Gulf War: August 2, 1990, through a date to be set by Presidential Proclamation or Law.

If the veteran entered active duty after September 7, 1980, generally he/she must have served at least 24 months or the full period for which called or ordered to active duty (there are exceptions to this rule).

What are the Disability Requirements for Aid and Attendance?

Veterans, spouses of veterans or surviving spouses can be eligible for Aid and Attendance benefits if they meet the following disability requirements:

  • The aid of another person is needed in order to perform personal functions required in everyday living, such as bathing, feeding, dressing, toileting, adjusting prosthetic devices, or protecting himself/herself from the hazards of his/her daily environment; or
  • The claimant is bedridden, in that his/her disability or disabilities require that he/she remain in bed apart from any prescribed course of convalescence or treatment; or
  • The claimant is in a nursing home due to mental or physical incapacity; or
  • The claimant is blind, or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to 5 degrees or less.

What are the Income Requirements for Aid and Attendance?

The claimant’s countable family income must be below a yearly limit set by law. Countable Income means income received by the claimant and his or her dependents. It includes earnings, disability and retirement payments, interest and dividends, and net income from farming or business. A claimant must report all income, but the VA will exclude any income that the law allows. Public assistance, like SSI, is not counted as part of countable income. The annual income limits for the Aid and Attendance program are higher than those set for the basic pension. The maximum Aid and Attendance benefit that can be paid monthly to a single veteran is $1,788, but the veteran must have countable income of $0 to receive the maximum benefit.

The following chart includes the set yearly income rate/annual pension Aid and Attendance limit set by Congress; it also includes the maximum monthly benefit:

Aid and Attendance Maximum Annual Pension  Rate (MAPR) CategoryIf you are a… Basic Pension MAPR 5% of Basic Pension MAPR(The amount you subtract from medical expenses…) Annual Aid and Attendance Pension RateYour yearly income must be less than…
Single Veteran $12,868 ($1,072 per month) $643 $21,466 ($1,788 per month)
Veteran with Spouse/ Dependent $16,851 ($1,404 per month) $842 $25,448 ($2,120 per month)
Two Veterans Married to  Each Other $16,851 ($1,404 per month) $842 $34,050 ($2837 per month)
Surviving Spouse $8,630 ($719 per month) $431 $13,794 ($1,149 per month)
Surviving Spouse with  One Dependent $11,296 ($941 per month) $564 $16,456 ($1,371 per month)

Unreimbursed Medical Expenses

A portion of unreimbursed medical expenses paid by claimants may reduce the countable income.

Unreimbursed medical expenses include: cost of a long term care institution or assisted living, health related insurance premiums (including Medicare premiums), diabetic supplies, private caregivers, incontinence supplies, prescriptions and dialysis not covered by any other health plan. Only the portion of the unreimbursed medical expenses that exceed 5% of the basic pension MAPR may be deducted (see above chart for this amount).

Example A: Single Veteran/No Spouse or Dependents — Income Less Than MAPR

  • Jim is disabled and needs help paying for care. His yearly income is $40,000 and he has $35,000 unreimbursed medical expenses this year.
      • $12,868 basic pension MAPR x 0.05 = $643
      • $35,000 medical expenses – $643 = $34,357 medical deduction
      • $40,000 Jim’s income – $34,357= $5,643 Countable Income
    • The countable income is subtracted from the maximum annual Aid and Attendance Rate to determine the benefit amount.
      • $21,466 (Aid and Attendance Rate)– $5,643 (countable income)= $15,823
    • Jim’s Aid and Attendance benefit would be $15,823 or $1,318/monthly

Example B: Single Veteran/No Spouse or Dependents — Income Over MAPR — No Med Deduction

    • Frank’s countable income is $1,300 per month ($15,600 per year). Because his annual income is more than $12,868  (more than $1,072 monthly), and he does not have any medical expenses to deduct, he is not eligible for VA Veterans Pension with Aid and Attendance.
    • Frank may reapply again when his countable income falls below the limit or when he has unreimbursed medical expenses that would reduce his income.

Example C: Married Veterans — Income Below MAPR — Need Aid and Attendance

    • Both Carlos and Patricia live in a senior apartment and need a caregiver 24 hours a day to remain safely in their house. SSI is their only monthly income.  Since SSI is not counted, their countable income for VA purposes is $0. They are eligible for $2,837 per month ($34,050 annually), the maximum benefit to help pay for their care.

Example D: Surviving Spouse of Veteran — Income Above MAPR — In Assisted Living

    • June is an assisted living facility. Her income is $12,000 per year in Social Security. Her children help pay for the assisted living cost of about $4,000 monthly. Thus, June’s unreimbursed medical expenses are $4,000 per month or $48,000 per year.
      • $8,630 MAPR x 0.05 = $431
      • $48,000 – $431 = $47,569 total unreimbursed medical expenses
      • $12,000 income – $47,569 expenses = June has $0 countable income.
    • Thus, June would be eligible for the maximum benefit of $1,149 per month to help her children pay for the assisted living facility.

What are the Asset Requirements for Aid and Attendance?

Net Worth (the value of your assets) also affects eligibility. VA pensions are a need–based benefit, and a large net worth might affect your eligibility. All personal goods are exempt from the net worth. These goods include the home you live in, a vehicle used for the care of the claimant, and household goods and personal effects such as clothes, jewelry and furniture. Unfortunately, there is no asset limit set by law, and the determination of eligibility can be made at the discretion of a VA caseworker.  Often the figure of $80,000 of assets is quoted but the VA has not actually published this as their guideline and often uses a sliding scale.  As a general rule of thumb applicants should have less than $40,000 when applying for Aid & Attendance.


What if I have too many assets?

A VA Accredited Attorney can assist you in establishing an Irrevocable Trust.  Currently, there is no look back period to make transfers to an Irrevocable Trust.  The VA Applicant and his/her spouse can not be the Trustee of beneficiary of this Irrevocable Trust in order for assets to be excluded from consideration when applying for benefits.  Often, children or other close family members are named as the Trustee and Income beneficiary of the trust.


What do I do with my house?

Although homestead is generally exempt from consideration for VA benefits and/or Medicaid the proceeds of the sale of a home may disqualify applicants from benefits they have previously qualified for!  A house can be transferred to an Irrevocable trust with no penalty imposed.  Once the house is owned by the Irrevocable Trust, if it is sold, the proceeds stay within the trust and therefore would not cause disqualification from benefits.


Can an insurance agent help me with VA benefits?

Only a VA Accredited attorney or Veteran Service Organization Representative (VSO) may assist in the application of benefits.  The Florida Supreme Court recently ruled on this matter and held that it constituted the unlicensed practice of law for a non-lawyer to engage in Medicaid or VA planning. http://www.floridasupremecourt.org/decisions/2015/sc14-211.pdf

Furthermore, in order to assist with VA planning or claims an attorney must be specifically accredited with the VA. Every attorney at Murphy & Berglund, PLLC is VA Accredited and can assist you with your VA Benefits Analysis.