Medicaid is a joint state and federally funded program that was established by the Social Security Act in 1965. Although it sounds similar, it is separate from the Medicare program. Medicaid and Medicare have separate and very different criteria. The intent of the Medicaid program is to provide assistance to persons who qualify based on financial and medical needs. It is a welfare program and eligibility is determined by a means test.

At the Federal level, the Medicaid program is administered through the Health Care Finance Administration (HCFA). In the Commonwealth of Pennsylvania, the Medicaid program is known as Medical Assistance and it is administered through the Department of Public Welfare’s local County Assistance Offices (CAO). The CAOs review the medical assistance applications, manage the applicants’ files and make determinations of eligibility.

Once you are qualified for Medicaid, the program then pays for your skilled nursing care and most of your related expenses.

The first step is for the family to meet with a qualified elder law attorney to receive a comprehensive overview of the programs which may be available and to fully evaluate the needs and resources of the person in need of care.

The second step is for the attorney and family to verify the assets, income, expenses and medical need of the applicant.

The third step is to determine if the assets of the applicant should be reallocated or gifted in order to hasten the qualification period.

The fourth step is the completion of Form PA 51 through the County Office of Aging. In this form, the treating physician must certify a need for skilled nursing facility care.

The fifth step is the Resource Assessment, which is done by the completion of Form PA 1572. The Resource Assessment form requires the reporting and documentation of all of the applicant’s assets as of the date of admission. This serves as a “snap shot” of the assets. The purpose of the Resource Assessment is to determine what assets must be spent down to become Medicaid eligible. If an applicant is married, this form is also used to determine the spousal share.

The sixth step is the receipt of a determination letter from the County Assistance Office which specifies whether Medicaid benefits are available for the institutionalized individual, and if not, how much of the assets must be “spent down” to qualify.

If the institutionalized individual is not eligible for the receipt of benefits, the seventh step is the reallocation of assets to reduce the necessary spend-down amount and the actual spend-down of excess assets.

The eighth step is the qualification of the institutionalized individual for Medicaid benefits.

At Beauchat & Beauchat, LLC, it is our goal to pre-plan and to advise our clients regarding the legal reallocation of assets to reduce the available resources and shorten the private pay period. We engage in the lowest risk techniques in order to preserve our clients’ assets and to ensure that our clients are comfortable with the actions we are taking.