How To Qualify For Medicaid In Pennsylvania

Sep 6, 2022 | Elder Law

There’s no denying that health care in America is expensive, and Pennsylvania is no exception. Seniors in Pennsylvania are at a higher risk for health problems than others and often have to liquidate their retirement money to afford their medical bills, or to afford the cost of long-term care. One of the ways to avoid this, if you cannot afford expensive medical bills or the cost of a nursing home, is to apply for Medicaid.

Medicaid is a federal and state-funded program that assists low-income citizens with health care fees. Seniors over the age of 65 in Pennsylvania are eligible for Medicaid benefits –  specifically long-term care programs – if they qualify. Pennsylvania Medicaid programs fund nursing home care and assisted living services along with other support services that allow infirmed seniors to remain at home or in the home of a family member and still receive the care they need.

Pennsylvania’s Department of Human Services runs the Medicaid program, also known as Medical Assistance (MA), in this state. If you want to know whether you or a loved one can qualify for Medicaid in Pennsylvania, the answer may not be as simple as you’d like. Fortunately, Daly Law Offices is experienced with Medicaid planning – our lead attorney cares about your needs and concerns and can equip you with all of the information and legal guidance you need to ensure you don’t lose everything to nursing home costs!

What Are The Qualifications For Medicaid In Pennsylvania?

To qualify for Medicaid coverage in Pennsylvania, you must require health care or health insurance assistance and be one of the following:

  • A Pennsylvania state resident
  • A citizen
  • A U.S. national
  • A legal alien
  • A permanent resident

You also need proof that your financial standing is in a low to very low-income bracket for the fiscal year and that you’re at least one of the following: 

  • A pregnant woman
  • 65 years of age or older
  • Guardian to a child 17 years of age or younger
  • Are disabled or live with a disabled family member

If you’re unsure whether you qualify for Medicaid in Pennsylvania, contact your local County Assistance Office (COA).

30% of people on Medicaid in Pennsylvania are elderly or disabled, yet they make up 78% of state Medicaid costs. While Medicaid expansion under the Affordable Care Act (ACA) has made health care accessible to more citizens in PA, most seniors cannot take advantage of this statute because they do not meet income limits or because their age or disability does not grant them eligibility for Modified Adjusted Gross Income (MAGI) methodology.

How Do I Get Medicaid Coverage If I Am Over The Income Limit?

While many seniors in Pennsylvania need assistance to pay expensive medical bills, the system often makes it difficult for them to qualify. The income limits for Medicaid eligibility often leave seniors and their families stuck in limbo – they don’t have enough money to pay for healthcare, but they currently have too much income to qualify for assistance. This catch-22 leaves elderly adults and their caretakers stuck between a rock and a hard place when trying to procure the healthcare they desperately need.

At Daly Law Offices, Joshua N. Daly works to help seniors from all walks of life live their best lives during the last decades of their lives with the least amount of stress. There are many strategies and income planning techniques he can employ to help you qualify for Medicaid benefits that would be too complex for you to navigate on your own without legal help. Mr. Daly will also provide assistance to protect your home from the Medicaid estate recovery program

Some helpful techniques he uses to help seniors with Medicaid enrollment include the following:

Medicaid Asset Protection Trust (MAPT)

A MAPT is an irreversible trust that keeps allocated holdings out of consideration in the calculation of Medicaid resource limits. Putting a home into such a trust protects the asset as an inheritance for family members, so the Medicaid applicant no longer has to claim property ownership. Mr. Daly will help with the application process to confirm proper paperwork filing.

Irrevocable Funeral Trusts (IFT)

IFTs benefit the Medicaid applicant and their family as assets in the trust are set aside for funeral costs; this helps the applicant meet Medicaid income limits and unburdens loved ones from the financial strain of expensive funeral and burial costs. IFTs can decrease calculable holdings by $15,000 for single applicants or $30,000 for those in a marriage. These terms will never change and are not susceptible to cancellation.

Daly Law Offices can help prepare your IFT and file necessary documents thoroughly, ensuring completion of the process to meet eligibility requirements to qualify for Medicaid in Pennsylvania.

“Half a Loaf” Medicaid Planning

With a half a loaf strategy, a Medicaid applicant would gift roughly 50% of their assets to family members and use the rest to procure a Medicaid-compliant annuity. While the annuity would disqualify the applicant from enrollment for a period of time, the income it creates would finance long-term care until the period of ineligibility is over. Daly Law Offices can assist those who need Medicaid planning assistance with this strategy to confirm legal compliance every step of the way.

Medicaid Spend Down

Medicaid spend down is a strategy wherein an applicant reduces assets by purchasing medical equipment that insurance won’t cover, such as installing a chair lift or other apparatus in their home or paying off credit cards or a mortgage. By doing so, the applicant can reach the Medicaid holdings limit in a way that doesn’t disqualify them from eligibility. Applicants should not attempt this technique without the oversight of a qualified attorney to ensure they don’t accidentally disqualify themselves from Medicaid enrollment.

Other legal techniques Daly Law Offices can use to assist clients who wish to qualify for Medicaid include:

  • Annuities
  • Spousal asset transfers
  • Sibling exception
  • And more

Why Choose Daly Law OfficesIf you or a loved one need assistance to qualify for Medicaid in Pennsylvania, Attorney Joshua N. Daly can help. As a member of the Pennsylvania Bar Association- Elder Law Section and the Pennsylvania Association of Elder Law Attorneys, he is a dedicated servant to the Commonwealth of Pennsylvania and well suited for Medicaid planning, nursing home finance issues, estate planning, and more. Tomorrow isn’t guaranteed, and none of us know what the future will hold. Call today to book your free consultation and get started!

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