Advance Planning for the Nursing Home Decision

By Deb Miller, West Virginia Senior Legal Aid Contributor

All too often, a person or their family ends up making a rushed decision about going into a nursing home for long-term care.

In addition to health issues, there are financial concerns at such a time.

Planning ahead, one or two years out, can be the smartest option to get over these hurdles well in advance.

Many will face out-of-pocket payments for the entire cost of their care because traditional Medicare and Medicare Advantage will not pay for long-term nursing home costs.

Other West Virginians can receive long-term care coverage for a nursing home stay through the federal Medicaid program based on their income and assets.

Confusion about the Medicaid qualification process and not being aware of what’s needed next can increase a person’s stress and risk for financial exploitation. For example, others may suggest gifts or property transfers, often to themselves, that should not be done.

Plus, there is always the possibility of losing the capacity to gather such information and to make such decisions coherently. Handling this evaluation for Medicaid eligibility on a preliminary basis now is also a way to protect your spouse, family, and property as permitted by federal law.

The evaluation process starts with a listing of all types of assets and their current value. Income amounts must also be listed. A standard form at www.wv.dhos.gov is available for this purpose.

To qualify for Medicaid long-term care, a person may own a certain amount of assets, including a home (maximum equity in 2025 of $730,000), a car, personal property, an irrevocable prepaid burial plan, and up to $2,000 in other non-countable assets.

Completing the qualification form on a proactive basis does not require hiring a lawyer. Counselors with the WV SHIP program can help at 877-981-4463.

Further, the SHIP counselor can explain the process of nursing home admission and reduce concerns about doing this.

Many facing the nursing home decision think that the government will take their home to pay for their care. They think that if they give away their house to their children or add their childrens’ names to the property deed while they continue to live there, they will be fine.

The opposite can be true.

The reason for that is the long-term care Medicaid eligibility process involves listing any transfer of assets or property made within the previous five years, including those for which you didn’t receive full compensation.

If you gave your home or partial ownership in it to your children, a friend, or any others within that five years without full compensation, there will be a period of ineligibility for coverage.

In Medicaid lingo, that gift of your home causes an uncompensated transfer of assets penalty.

The penalty is losing out on Medicaid coverage of the nursing home costs for a period of time, based on a formula, equal to the value of the property given away. During the penalty period, you will have to pay the nursing home bills on your own.

An option to protect your home is a transfer on death deed. It changes nothing about your current ownership for Medicaid eligibility and lists the after-death recipients. Automatic transfer of the property occurs after death and avoids probate.

For free legal assistance with a non-criminal matter, West Virginia residents age 60 or older may contact West Virginia Senior Legal Aid at 800-229-5068 or info@seniorlegalaid.org.