Paying for Eldercare without Losing Your Assets

NEW YORK (MainStreet) —You probably already know that there’s a five-year look-back period for giving away assets before being able to qualify for Medicaid nursing home coverage. But what if you want to stay at home, keep your investments, and continue trading?

In some states, if you’re married, you may be able to get Medicaid to pay for in-home unskilled care or at least get the care at the negotiated rate Medicaid pays, which is a 50% to 60% of savings, according to Anthony J. Enea, an elder law attorney at Enea, Scanlan & Sirignano, in Westchester, New York.

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To do this, you must transfer your assets to your spouse, and your spouse must say she or he refuses to use the assets to support you, Enea says. It’s called “spousal refusal.” There’s no look-back period for homecare, he notes. (Of course, if you use the strategy and continue investing, you’ll be investing your spouse’s assets.)

Enea warns that Medicaid can sue your spouse for support, but he says lawsuits are not common. More typically, what happens is the spouse will end up paying some portion of the bill, he says. Medicaid can only recover what it pays out, he says.

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If you’re homebound but only need rehabilitative care, you should know that Medicare covers skilled medical care in the home on a part-time basis, if it is prescribed by a doctor and you are unable to leave home unassisted. In this case, there’s no need to protect your assets.

Nate Purura, director of eHealthMedicare.com, suggests working with your doctor to make sure that a skilled medical professional is handling as many services as possible.

Another option Purura suggests: concierge medicine. For a few thousand dollars, these doctors not only give you their cell phone numbers for direct access around the clock, but also will make house calls. That may be an investment worth making.