The Miller Law Firm creates personalized plans addressing both estate planning and Medicaid qualification issues.

Peace of Mind

The Miller Law Firm creates personalized plans addressing both estate planning and Medicaid qualification issues.

By Aaron R. Miller, Collin County LIVING WELL Magazine 

When faced with the unexpected cost of long-term care for the first time, people are often concerned about their ability to pay for care for themselves or for their parents. Typically, there are three ways one can pay for long- term care: private pay, insurance, or a government option, such as Medicaid. Frequently private pay isn’t an option, or you can see the writing on the wall that the money will not last. Although insurance with a long-term care component is a great option, many people do not have it. This leaves a government option, such as Medicaid.

Medicaid is a benefit available to seniors to offset the cost of long‑term nursing home care. Frequently confused with Medicare, this benefit is often misunderstood, resulting in uncertainty and concern about whether or not a loved one will qualify for assistance.

Medicare is a federal health insurance program currently available to seniors 65 and over who qualify for Social Security. Although there are many types of Medicaid, this particular benefit is a federal nursing home payment program that insures that our seniors who cannot afford nursing home care are provided for. Since the average monthly cost of nursing home care in our local area is now almost $5,000, this is an especially important program that every senior should know about.

A common misconception is that nursing homes that accept Medicaid payments are substandard or that the quality a Medicaid patient will receive will be less than a patient who private pays. A nursing home is not required to participate in the Medicaid program, and may choose not to do so. However, many top-rated nursing homes participate in the Medicaid program in order to fill empty beds and improve their profit margin.

Why might a nursing home not want to participate in Medicaid? As with any contracted service, the government reimburses the nursing home at a lower rate than a patient not on Medicaid would pay for that same service. If a nursing home is able to fill their beds to capacity at a higher private-pay rate, then that nursing home will be less interested in contracting with Medicaid.

It is in a nursing home’s best interest to have a patient self-pay as long as possible before applying for a Medicaid bed. This may not always be in the patient’s best interest, however.

It is in this circumstance that an elder law attorney can protect the patient’s best interest by helping the patient qualify for Medicaid sooner rather than later.

There are three criteria for Medicaid qualification:

  1. You must show medical necessity for nursing home care.
  2. You cannot have income in your name over a certain monthly amount.
  3. You cannot have countable assets in your name over a certain amount.

The Medicaid applicant must:

  • Be admitted to a nursing home that accepts Medicaid payments
  • Be in a Medicaid allocated bed in that nursing home
  • Be able to show medical necessity for nursing home care
  • Not have income in his or her name over a certain amount*
  • Not have countable assets in her or her name over a certain amount.*


*or work with a qualified elder law attorney to become qualified.


Gifts made in the past five years could affect the benefit, but not the eligibility.

A Medicaid-experienced elder law firm knows the ins and outs of the Medicaid process and can avoid common pitfalls. Qualified staff members maintain ongoing relationships with Medicaid caseworkers, ensure paperwork is not misplaced or lost in the Medicaid maze, and respond to any additional requests made by Medicaid caseworkers.

There are two types of Medicaid counseling––pre-planning and crisis planning.

If you are pre-planning, then you are anticipating the possible need for Medicaid assistance down the road and need help to protect as many of your assets as possible, while still making sure you are qualified when the time comes.

If you (or a loved one) need crisis planning, then you have already been admitted to nursing home care or are packing your bags. We can help.

As with most situations, pre-planning puts the family in a better position to protect assets and provide care. At the Miller Law Firm we offer a private Medicaid Qualification Analysis consultation where we sit down with the family and create a personalized plan addressing both estate planning and Medicaid qualification issues.

Perhaps you are concerned about the declining health or mental capacity of a loved one. In addition to the natural concern over the loved one’s decline, you are also stressing over how you will be able to afford care. We can help.

The stress of a loved one’s declining health and life event change is more than enough for a family to cope with; working with an experienced and knowledgeable elder law attorney can provide needed peace of mind, in addition to possibly saving tens of thousands of dollars.

Call us today to schedule your complete Medicaid Qualification Analysis at 214-292-4225.