Almost certainly, you have heard of Medicaid or know someone who receives Medicaid benefits. However, for many the Medicaid world can seem cryptic and be difficult to understand. We thought it was time to share some information on the subject.

Medicaid is a combined federally- and state-funded benefit program, administered by each state, which can pay for the cost of a nursing home if certain asset and income tests are met. There are two general types of planning to consider, pre-need and crisis planning.

In advance of needing nursing home care, while you are still healthy, you can undertake pre-need planning. One the other hand, if a spouse or a parent has entered, or is about to enter, a nursing home and is not expected to return home,crisis planning may be undertaken.

There are four main eligibility prerequisites for Medicaid recipients, including: Medical Eligibility; Resource Eligibility; Income Eligibility; and Transfer Eligibility (relative to the penalty period).

To be “Medically Eligible,” the applicant must generally be “medically needy.” This determination is based on a comprehensive needs assessment, which must demonstrate that the proposed Medicaid recipient requires nursing facility services.

To establish “Resource Eligibility,” an applicant may have no more than a small amount of “countable assets” or “resources” in his name. This is considered the applicant’s “Resource Allowance.” The Individual Resource Allowance is $2,000. A married couple with both spouses applying for Medicaid long-term care assistance has a Resource Allowance limit of $3,000. The patient is also allowed a “Monthly Maintenance Needs Allowance” of $1,966.23 to $2,980.50.

A number of resources are deemed exempt assets, with a primary residence being the best example. Consulting an attorney about how your particular assets may be characterized for Medicaid purposes is advised, especially since assets that become part of the recipient’s estate after death may become subject to Nevada’s Medicaid Estate Recovery Program.

A Medicaid applicant will be “Income Eligible” if his gross income is less than Nevada’s “income cap” of $2,199. Because of this limitation, an Income Only Trust (a.k.a. a “Miller Trust”) may be needed if the Medicaid applicant’s income exceeds the cap. The patient assigns the right to receive income from social security and pension benefits to the trust, thereby avoiding receipt of excess income. There is a Community Spouse Resource Allowance ($23,844 minimum in Nevada) which a Medicaid recipient may be able to pay to the spouse who continues to live at home.

“Transfer Eligibility” determines whether an uncompensated transfer of assets results in a period of ineligibility known as a “penalty period.” There is a 60-month (five-year) look-back period. The penalty period generally begins when the applicant files for benefits and is receiving care. The patient must privately pay for care throughout the penalty period.

We strongly urge you to weigh your options regarding Medicaid benefits, to pre-plan whenever possible and to act immediately in a crisis. Our office can explain the options, so please call for your consultation.

When someone close to you passes away, the initial reaction is usually shock. Even when the death was expected, the actual event may leave you feeling unprepared. Often, when you receive this news, it is because you are the “responsible” person—the surviving spouse, the “in charge” child, or the executor. In any event, there are important decisions to be made and actions to take. Having a sense of what to do will help you move forward despite the fog of grief and uncertainty you may feel.

The first action step depends on where and how the person died. If the death occurred in a care facility, the staff will generally help with some arrangements. An appropriate person can make a legal pronouncement of death, which is necessary for obtaining a death certificate. If someone dies at home and without hospice care, you will need to notify the authorities. This generally means calling 911, and you will want to have the decedent’s Do Not Resuscitate document on-hand to show to the paramedics, if one exists. Without this document, the paramedics may be required to initiate life-saving procedures. The paramedics will take the person to the emergency room where a physician can pronounce death. If the person dies at home, but was receiving in-home hospice care, you should contact the hospice organization instead of calling emergency services.

If an autopsy is not needed, a mortuary or funeral home can remove the body and help with making burial arrangements. It is easiest when the decedent pre-arranged funeral and burial plans. If you are unaware of any such plans, it is important to know that a mortuary is required to provide price information over the phone when requested. In this situation, it may be helpful to ask family and friends for advice and a referral to a trusted funeral director.

After the immediate reporting of the person’s death and arrangements for the body, you will need to contact family members, friends, and clergy. In making these calls, consider asking key people to call a few other relatives and friends. This will lessen the burden on you while making sure the news is spread to those who need to be informed. If possible, ask someone to stay with you during this time—it will help you stay on track and give you moral support during the first few hours of dealing with this difficult news.

Other key persons to contact promptly are the decedent’s physician and the decedent’s employer. If you do not know the physician’s name, you can check prescription bottles or medical bills for identifying information. An employer should be able to give you information on any salary or wages due to the decedent as well as any benefits owing.

Within a few days, you should obtain death certificates and start looking at the decedent’s important papers. Whether the person died with a will, trust, or intestate, an estate planning attorney can help you plan the transfer of assets and assist with any probate matters. The decedent’s accountant or tax preparer can help with the details of a final tax return, and a financial advisor can provide information on investment accounts and holdings. You should also contact the life insurance company to inquire about benefits and to file a claim. The Social Security Administration and other agencies from which the decedent was receiving benefits must also be contacted about stopping payments and providing survivor benefits (if applicable).

If the deceased person maintained a home, you also need to secure the residence. The local police department may offer property checks, and utilities should be changed over to the executor’s name or stopped. If the decedent had pets, the animal and its belongings should be removed so it can be placed in a new home.

Undoubtedly, the death of a loved one is a difficult and grief-filled time. Knowing how to handle the person’s affairs after death can help relieve some of the stress. If we can help you navigate the loss of a loved one, please contact our office for a consultation.