Need Help with Nursing Home and Assisted Living Costs?

Need Help with Nursing Home and Assisted Living Costs?

Transfer Penalty Rules Different for those Seeking Medicaid Assistance at Home

Most people in need of care would prefer to stay at home rather than go to a nursing home. However, if you don’t have long-term care insurance or other ways to pay for the cost of care, the existing interpretation of the Medicaid rules regarding transfers makes it more difficult to obtain Medicaid eligibility at home than in a nursing home.

Notwithstanding the 5 year look back to determine if there have been any uncompensated transfers resulting in a transfer penalty, such penalty can often be reduced if applying for long-term care (nursing home) Medicaid (there are many different Medicaid programs and each program has rules that could be applicable to that program alone) since the transfer penalty has a start date and the penalty can be reduced by partial returns, etc. So, if one is in a nursing home and applies for Medicaid, there could be a transfer penalty of only a month or two or several years or more depending on the amount transferred. However, if one applies for a “waiver” home care Medicaid program such as Community Based Alternatives (“CBA”) or Community Living Assistance and Support Services (“CLASS”), then the state Medicaid Agency has interpreted that there will be no start date for a transfer penalty (no matter how small) until the applicant is admitted to a nursing home and then admitted to Medicaid Mason Manor (drug coverage only while there is a transfer penalty running). As a result of this interpretation, even if one just gave $200 within 5 years of applying for a waiver home care Medicaid program such as CBA or CLASS, then the applicant could be barred from the program for at least 5 years after the month of the transfer.

Apparently, the Center for Medicare and Medicaid Services “CMS” has strictly interpreted the rule which states that a transfer penalty start will only begin when one is “eligible for medical assistance”. If you are in a nursing home and apply for Medicaid but have made a transfer, you can be eligible for medical assistance such as drug coverage even though there may be no nursing home coverage. However, that is not the case for CBA or CLASS. CMS has interpreted that there is no start date for a penalty. Thus, there is presently disparity in the Medicaid programs which appears to discriminate against those who have made transfers and apply for the long-term care (nursing home) Medicaid and those who apply for waiver home care Medicaid. This is likely to be decided by the court system.

For more information on how to get help with nursing home or assisted living costs visit Dallas Elder Lawyer or call (214)247-6257 to schedule a consultation.

Skip to content