Frequently Asked Questions (FAQs) About Elder Law in Connecticut

(1) What is the difference between Medicare and Medicaid?

Both Medicaid and Medicare offer access to health services, but they are very different in key areas. While Medicare is not predicted upon the assets of the beneficiary, (in general) Medicaid is a "needs-based" program for those individuals 65 years or older, or blind, or disabled (or who fall into another category of eligibility) and those who do not have sufficient income and assets to pay for their long term medical treatment. Medicaid also covers custodial and skilled long-term care and has no limits to the length of said care while Medicare will only cover a specified period of time spent in a nursing home.

(2) Will Medicare cover my medical costs if I need to stay in a nursing home?

Yes and No.

Medicare will cover a percentage of the costs associated with your stay in the skilled nursing facility for a maximum of one-hundred (100) days. To receive Medicare benefits in skilled nursing facility you first must be hospitalized for three (3) successive days (not counting the day of discharge), a physician must indicate that skilled care is needed on a daily basis, the care must be provided in a Medicare-certified skilled nursing facility and the need for care and services care must be due to a condition that was treated in the hospital. Once eligibility has been determined, Medicare will pay for the entire cost incurred for the first (20) days, but for days twenty-one (21) through one-hundred (100) there will be a co-payment required of the patient. In other words, Medicare will require that the patient staying beyond the twenty (20) threshold and provide payment to the facility through private means.

(3) If I apply for and accept Medicaid benefits, will my spouse be forced to sell our home and liquidate our remaining assets?

No.

Medicaid allows the "community spouse" (the non-nursing home-bound spouse) to keep the home (so long as he or she is living in the home or there is an intent to return to the home) and a modest amount of "disregarded" or "exempt" assets from the marriage. There is a cap on such assets and it is imperative that anyone seeking to obtain Medicaid eligibility speak with an elder law attorney prior to navigating the rules and regulations of Title 19. Failure to do so can result in ineligibility and potentially an assessment of a penalty period by the Department of Social Services (DSS).

(4) Can I give away some or all of my assets to my kids and still be eligible for Medicaid?

Maybe.

As part of your Medicaid application the Medicaid rules allow for the Department of Social Services to look back at your financial records. A determination of ineligibility in this circumstance can often depend on whether the gift was made prior to or after February 8, 2006. If you have transferred assets for less than valuable consideration at any point in the past five (5) years, the transfer should be evaluated by a skilled elder law attorney to determine how the transfer will be treated by DSS. Again, if you know you will need state medical assistance and you're considering gifting away some or all of your property, please consult with an elder law attorney prior to transferring assets to family or friends.

(5) What does "Spend Down" mean?

Individuals who meet all of the requirements necessary to qualify for Medicaid, but whose incomes or asset levels are above predetermined levels set by DSS are permitted to "spend-down" their income over six-month periods of time in order to qualify for Medicaid services. A spend down is very similar to a deductible in an insurance policy, and in the case of a Medicaid spend down, the individual is allowed to use their available income to pass for their medical bills. It is very important, therefore, that you keep copies of all medical bills, prescription receipts, and records of other medical expenses. When you accumulate enough bills to meet your spend-down, you can then submit copies of the bills to your caseworker in the local DSS office.