Medicaid Planning

Pennsylvania Medicaid Planning Attorneys

Medicaid, a federal program providing public health insurance for people with low income, is the principal source of long-term care coverage in the United States. Becoming eligible for Medicaid includes specific health and financial requirements, among other factors. In Pennsylvania, the Department of Human Services administers Medicaid and its associated rules.

Knox Law’s Elder Law group can help clients determine their Medicaid eligibility (now or potentially in the future), provide advice, and even help clients through the Medicaid application process. We often implement this planning into a client’s overall estate plan, striving to preserve assets and provide peace of mind for them and their family.

The Importance of Medicaid Planning

Long-term care (nursing home) costs are significant. In Pennsylvania, the average monthly cost of a private room in a nursing home facility for 2024 was nearly $13,000, or $156,000 annually. Especially for retirees on a fixed income, this amount could wipe out all or most of one’s lifetime savings.

Also, Baby Boomers are aging at a fast clip: every day until 2030, 10,000 Baby Boomers will turn 65. The statistics also show that individuals 65 and older have a nearly 70% chance of needing some kind of long-term care services, with women needing care longer than men. 20% of today’s 65-year-olds will need care for longer than 5 years. These numbers are staggering and show a need for strategic planning, including a focus on Medicaid eligibility.

Finally, Medicaid qualification limits the nursing homes’ rights to collect from other adult family members for services rendered to a nursing home resident (based on Pennsylvania’s conditions for receiving Medicaid funding). See more about Pennsylvania’s Filial Support Law. 

How to Know if You Are Eligible For Medicaid

A number of rules and requirements must be met to become eligible for Medicaid to pay for one’s long-term care. They include requirements pertaining to an applicant’s categorization, citizenship, state of residence, health status, and financial state. Among the most important of these requirements are those pertaining to an individual’s medical condition and financial circumstances.

Medical Eligibility

An applicant will qualify for Medicaid when they require ongoing skilled nursing care; are mentally impaired with Alzheimer’s disease or dementia; or are unable to care for themselves.

Financial Eligibility

The financial eligibility for Medicaid depends on whether the applicant is single or married.

• A single person will qualify (financially) for Medicaid when they own less than $2,400 in countable assets, unless their income is less than $2,329 monthly, in which case the applicant can keep $8,000 in assets. These assets do not include excluded assets - see more below.
• A married person will qualify (financially) for Medicaid when they (the spouse going into the nursing home, or Institutionalized Spouse) owns less than $2,400 of countable assets in their name. The spouse not going into a nursing home, or Community Spouse, keeps one-half of the couple’s total assets, capped at $128,640. If total assets are less than $25,628, the Community Spouse can keep all assets. Anything over these caps needs to be spent down or converted to an excluded asset or income.

What Are Excluded vs. Countable Assets?

Excluded assets are not counted toward an individual’s financial Medicaid qualification. Examples include their primary residence (with some rare exceptions and limits); household goods and personal effects, such as clothing, jewelry, recreational equipment, musical instruments, and hobby items; one motor vehicle; burial spaces and irrevocable burial reserves; life insurance policies (up to a maximum face value of $1,500); and property essential to self-support.

Countable assets are counted towards an individual’s financial Medicaid qualification. Generally, they are assets which can be easily reduced to cash. Examples include real estate (other than principal residence), all types of bank accounts and deposits, most types of investment securities, all types of retirement accounts, other types of investments held jointly with others or through a revocable trust, and the cash surrender value of life insurance policies in excess of certain (very low) limits.

Read more about asset types and details for each: Demystifying Medicaid Planning.

How Does Medicaid Planning Work?

Our Elder Law team works to understand each client’s individual circumstances and uses several tools to help expedite financial Medicaid qualification. These strategies include, but are not limited to:

• Asset depletion and spend down
• Conversion of countable assets to excluded assets
• Asset transfer strategies
• Trust planning
• Family caregiver contracts
• Long-term care insurance
• Maximizing retirement assets (of Community Spouse, for married couple)
• DRA-Compliant annuities

These planning strategies require a comprehensive evaluation of a client’s financial situation. The most efficient planning meeting at our law office requires clients to bring their financial information, existing estate planning documents, insurance policies, legal documents, and more. See our full list of recommended items to bring to an elder law appointment. 

Why Do You Need a Medicaid Planning Attorney?

We have merely scratched the surface of Medicaid regulations and planning techniques. Knox Law’s experienced Elder Law attorneys can help determine how the complex Medicaid rules affect your unique circumstances, including eligibility issues, asset evaluation (and protection), and estate planning strategies. No “one-size-fits-all” solution exists: blended families, unexpected deaths, and other circumstances can complicate planning.

How Our Attorneys Can Help With the Medicaid Planning Process

Many of the techniques listed above are generally known by estate planning attorneys or other practitioners. Our Elder Law team has the benefit of significant and specific experience with Pennsylvania Medicaid rules, eligibility, and effective asset protection strategies.

You do not have to navigate this journey alone. In addition to “know-how,” our team has the compassion to help individuals and families plan for the future and gain peace of mind.

Secure Your Future With Help From a Pennsylvania Medicaid Planning Attorney

Contact us today to learn more about how we can help you and your family secure your legacy, protect assets, and help you gain peace of mind. 

Download Medicaid Planning PDF