What is the PACE Program in Virginia?

PACE stands for the Program of All Inclusive Care for the Elderly. And this movement has gained a lot of momentum in recent months, particularly as it relates to concerns about care for the elderly and protecting them well into their later years in life. At its simplest definition, PACE is an alternative to nursing homes.

This is a Medicaid and Medicare program that helps to keep people in their own communities. In many cases, the programs are run with the support of in-home care providers at a nexus of community-based centers. This helps to complete an interdisciplinary care team for total comprehensive wellness. According to the national PACE Association, approximately 95% of people enrolled in the program live in the community and only 5% live in nursing homes.

Given that it is required to be eligible for nursing home care before enrolling in PACE, this is a substantial thing to take note of if you have a loved one who is in the process of figuring out the best care solution for them.

Most PACE participants are eligible for Medicaid and Medicare. The operators of these programs will receive specific monthly payments for each participant, meaning that some of it is paid by the payer and some is paid by the provider. COVID-19 played a significant role in increasing attention towards the PACE program. The general death rate in nursing homes across most of the pandemic was 11.8%, where it was only 3.8% in PACE locations.

If you have questions about qualifying for PACE in Virginia or discussing alternative care arrangements, schedule a consultation with an estate planning lawyer in your area to learn more.



What is Medicaid Expansion in Virginia?

Virginia undertook a program called Medicaid Expansion that now provides access to more residents than ever. Medicaid is a crucial program for low income residents, many of whom would not be able to afford things like nursing home care without support. But there are many misconceptions around how to get Medicaid coverage and support in Virginia.

Misunderstanding even just one of these could derail your long term care plans. When you need Medicaid coverage the most, you need to be prepared by understanding the qualification process. That’s where the support of a Virginia Beach VA Medicaid planning lawyer can make a big difference in giving you peace of mind. A 2018 budget bill called for the expansion of the program in Virginia, which now allows people earning up to 138 percent of the poverty level to tap into Medicaid benefits.

As a result of the expansion program, legislators expected a further 400,000 people to become eligible for benefits. But when COVID hit, that number was exceeded. Many people have been affected financially and have also needed recovery care if they were diagnosed with COVID.

Right now, Virginia allows the following groups to apply for and receive Medicaid:

  • Low income elderly residents
  • Disabled residents
  • Pregnant women with households at a maximum of 143 percent of the poverty level
  • Adults under age 65 with income under the 138 percent poverty level
  • Children under 18 where their households earn no more than 138 percent of the poverty level

When planning for the possibility of a nursing home stay in the future, you can’t afford to miscalculate. You need the support of an experienced Virginia Beach Medicaid lawyer to discuss a spenddown strategy that could protect a healthy spouse if you were to need a nursing home stay. Call today to set up a consultation.



When Does Medicaid Pay for My Virginia Nursing Home?

Does your loved one need to stay in a nursing home due to advanced medical care needs? This might raise a lot of questions from a financial perspective as you and other family members scramble to figure out what to do next.

Not every person in Virginia is automatically qualified for Medicaid so the sudden need for long term care or a stay in a nursing home can present significant financial challenges for you and your loved ones. Virginia’s Medicaid program provides payment for nursing home stays for those without appropriate assets or income and when those same people have been diagnosed for needing assistance with activities of daily living.

Since the cost of long-term care and stays in a nursing home are extensive, Virginia Medicaid is something that must be applied for by an applicant in order to receive payment from the government for these important services. Many people make the mistake of thinking that their private health insurance policy or Medicare will cover these stays. Medicaid is a common source of funding for long term care in Virginia, particularly when other assets have already been used up or sold to pay for long term care expenses.

Nearly 70% of residents inside nursing homes around the country use Medicaid to pay for their care. There’s no doubt that you will have many different questions about qualifying for Medicaid and how this financially impacts your spouse and other family members. Schedule a consultation with a Virginia Beach estate planning lawyer to discuss the specifics of your plan.



What Is Medicaid Spend Down in Virginia?

If you are trying to help a loved one apply for Medicaid in Virginia, you’ll discover many different terms and phrases related to this process. One of them is Medicaid spend down.

The term Medicaid spend down refers to families and individuals who would otherwise meet all of the necessary resource eligibility and non-financial requirements to get Medicaid in Virginia, but who have countable income that exceeds the needy income limit for their county or city of residence. It is helpful to think of a spend down as an insurance policy deductible.

For these purposes, you can insert spend down liability in place of the idea of a deductible. Your spend down period could cover you from anywhere from one to as long as six months. After a family or individual owes the amount or incurs the amount of spend down, they can become eligible for Virginia Medicaid services from the date they met the spend down.

If a person who has applied for Medicaid assistance in Virginia has been evaluated but full coverage is denied due to excess income, notification of the denial will be provided to the applicant. Resources will then need to be evaluated with the assistance of a Virginia Medicaid attorney to determine if the family or individual’s countable resources are below the maximum resource limit for their household.

If your countable resources are under the resource limit for your household, you could be considered eligible for a spend down, upon which you will be sent a notice of action regarding the spend down liability amount. These aspects can be confusing for you and your loved ones but having the support of a Virginia Beach Medicaid assistance lawyer can go a long way in answering your questions.



Understanding Virginia’s PACE Program

Seniors in the Commonwealth of Virginia may need support in the form of a health plan. The PACE Program, also known as the Program of All Inclusive Care for the Elderly, allows seniors to have a total health care solution that is separate from a nursing home.

This is especially popular with people who wish to age in place or stay at home and in their own community. Independence is one of the most important aspects for many aging seniors and PACE centers in Virginia allow these participants to still receive the medical care they need but live independently.

A team of doctors, personal care aides, nurses, social workers and rehabilitation therapists can provide coordinated care for each individual PACE participant. Only certain people are eligible to leverage Virginia PACE benefits. First of all, you must live in a PACE service area.

You must also be age 55 or above, able to live safely in the community with the support of PACE, not requiring any outside involvement and be approved for nursing facility care level through the state of Virginia assessment.

A variety of services are offered through this program, including social services, prescription coverage, transportation, speech therapy, physical therapy, meals, activities, and day centers.

Whether you’re looking to prepare for your own future or trying to help a loved one qualify for Medicaid, you’re not in this alone. The support of an estate planning attorney can be extremely helpful during this time.

For more information about planning for Medicaid in Virginia and how to determine the most appropriate estate plan for you, a consultation with a Virginia Beach estate planning lawyer should be your next step.



How Does Virginia Medicaid Evaluate Senior Applicants?

Every state has the responsibility of determining what parameters will allow a person to receive Medicaid payments. Since Medicaid is a government program designed to provide parties who have no other method of paying for their care, it is important to plan ahead with the support of a Virginia Medicaid lawyer.

Simply retitling or transferring all of your assets in the weeks or months before you apply for Medicaid may subject you to a penalty. It is far better to have a long term plan that considers the costs of long term care and your options to reach it. In 2021 the monthly income limit in Virginia is $2,382 for Medicaid home care benefits. There is no set income limit for nursing home care.

The asset limit is $2,000 but this does exclude the applicant’s interest in certain personal effects, household furnishings, a vehicle and equity in the home up to $603,000. Just having asset limits or income above this level does not mean that a person cannot qualify. There are numerous methods to shelter and protect assets and allow a senior to become eligible for Medicaid home care or nursing home care.

As you can see, there are many different complex facets of qualifying for Medicaid, and it is imperative to have the support of a qualified elder law attorney to guide you through. The cost of a nursing home in Virginia can range from $7,500 a month to nearly $12,000 per month. In the Virginia Beach, Norfolk and Newport area, the average cost for nursing home expenses is between $265 to $385 per day.

This could decimate your retirement savings and leave your without the money they need to take care of themselves. Don’t hesitate and don’t wait until a crisis occurs. Schedule a consultation with a Virginia Beach Medicaid planning lawyer.        


Do You Need Medicaid in Virginia for Your Long-Term Care?

At least 50% of healthy Americans above age 65 will need some form of long-term care in the future. This can come in the form of home care, assisted living or nursing home care. This kind of care might be necessary but regardless of the setting it can be very cost prohibitive.

There are five primary ways that you may be able to afford long term care in Virginia. These include:

  • Private pay; in which you write the provider a check directly from your own accounts.
  • Long term care insurance; which requires an active policy with regular premium payments. Only around 8% of Americans have bought LTC insurance.
  • Veterans’ Administration benefits, but these VA programs pays for less than 1% of all long term care services in the US.
  • Medicare; which is a common misconception since most people assume that Medicare would pick up the tab for long term care assistance. Medicare only pays for extremely limited benefits, such as a certain number of days in a nursing home if the person is receiving skilled care.
  • Medicaid; a low-income form of benefits payments that is responsible for more than half of all long term care expenses in the United States.

The Medicaid program is administered at the state level. The primary aspects for Virginia Medicaid eligibility include Virginia residency, membership in a covered group, medical and functional criteria, resource eligibility rules, asset transfer rules, and income eligibility rules.

To learn more about these complex aspects, schedule a consultation with an experienced Virginia elder lawyer today. Planning in advance and thinking through these options before a crisis situation emerges makes it easier for you and your loved ones.



What You Need to Know About Medicaid And Partners Entering Relationships with Different Assets

Getting married later in life raises a number of different confusing aspects associated with estate planning. An estate planning attorney might be the only person who can help you navigate the legal maze of health care and estate plans. If one party enters this late in life marriage with significant assets whereas the other does not, this can cause major issues when qualifying for Medicaid.
For example, if the wife in the marriage has ample assets when entering but the male partner does not have as many, Medicaid will evaluate the couple’s assets overall. Older adults face unique estate planning concerns such as guardianship, probate estate planning and Medicaid.
When you get remarried, you need to update your estate planning materials anyways because your estate planning tools can affect your children from previous marriages. However, you must also factor in Medicaid.
If you do not have long term care insurance policies, you essentially might be self-insuring yourself and a spouse. This is because Medicaid will look at all of the couple’s assets in determining whether or not if a person who needs assistance will qualify through Medicaid. A wife who brings in a great deal of assets to the marriage might have to use her own assets and spend down in order to pay for the care needed for a partner unless other financial plans, such as the purchase of a long-term care policy has been made.
Legal documentation is essential when it comes to Medicaid planning, and the further in advance you can show that this work has been done, the easier it will be to accomplish your various concerns and goals. Medicaid can be very complicated, but the support of an attorney is instrumental in outlining what you do and don’t need.
Don’t hesitate to schedule a consultation with an attorney who is highly knowledgeable about best protecting your interests.

It Won’t Be Much, But in Some Cases Caregivers Can Get Paid

Senior woman with her caregiver

Senior woman with her caregiver

The estimates vary between 66 and 70 million, when it comes to the number of people in the United States serving as unpaid caregivers for family members with disabilities.
The good news is that in some instances, these overworked and stressed out people may at least be able to get something for all the effort they spend on behalf of a loved one.
While the potential for being reimbursed for caregiver services varies widely from state to state programs do exist, according to articles on the websites Carepathways.com and Caring.com.
“Some states offer limited programs that pay family members to take care of an elderly parent,” the entry at carepathways.com states. “Budget cuts at the state level, however, have further reduced options. Programs within the 50 states vary as to what if any programs exist, who pays for them and even what they are called. ‘Participant and Consumer Directed,’ ‘Cash and Counseling’ are a few of names that refer to programs which allow folks to choose and pay a family caregiver. Many of these programs offer inadequate wages and strict income eligibility requirements including those compensated by Medicaid.”
“If you’re one of more than 70 million people who provide unpaid caregiving for a family member or friend, either in that person’s home or in your own, you know that the time and energy burden can be enormous, caring.com begins. “In fact, you may have cut back or given up your paying job. Your smaller, or now nonexistent, paycheck may be pinching you hard. If so, it might be possible for you to get a small but regular payment for your caregiving work.
“Here’s how: If the parent, spouse, or other person you’re caring for is eligible for Medicaid, its Cash and Counseling program, available in some states, can provide direct payments that could go to you. A few other states have similar programs for low-income seniors, even if the person receiving care doesn’t quite qualify for Medicaid. Also, if the person you’re caring for has long-term care insurance that includes in-home care coverage, in some cases those benefits can be used to pay you.”
The Caring.com entry goes on to advise that in instances where the family member receiving care is willing and able to pay the caregiver, “it may be a good idea, for both of you, to draft a short written contract setting out the terms of your work and payment.”

Half of seniors eligible for drug benefit don’t apply

A little Extra Help could do senior citizens a world of good, literally and figuratively.
That’s the name for a Medicare benefit that can greatly help low-income elderly people pay for their prescriptions, but one that far too many of those eligible for it don’t know exists.
“More than 2 million people on Medicare could be getting their prescription drugs nearly for free, but don’t,” according to a recent story by Mark Miller of Reuters news service. “That’s because they have not signed up for Extra Help, an important Medicare benefit that subsidizes drug costs for low-income senior citizens.
“Extra Help can pay nearly all of the prescription drug costs a senior incurs in a Part D drug plan. It is provided automatically to seniors receiving Medicaid or Supplemental Security Income benefits. In some states, Extra Help also is automatic for people receiving benefits through the Medicare Savings Program, which helps subsidize Medicare Part A (hospitalization) and Part B (outpatient) premiums.”
However, for those who qualify but just not automatically, less than half are enrolled in Extra Help, Jack Hoadley, a research professor at the Health Policy Institute of Georgetown University who tracks the program, told Reuters.
“The government reaches out with information on this from time to time,” Hoadley was quoted as saying. “What’s harder is to figure out how to reach out specifically to people who are eligible.”
“The benefit is substantial – annual savings can easily total $800 on premiums and deductibles, and can be much higher for seniors with high drug spending,” Miller wrote. “Two factors determine your eligibility for Extra Help: income and assets. Your income cannot exceed the federal poverty level guidelines. For seniors with incomes of 135 percent of the federal poverty level or lower, Medicare pays the entire annual premium, expected to average $480 next year, according to the Kaiser Family Foundation. Extra Help also covers deductibles, which typically run $310 for the year.”
Seniors who wish to learn more about Extra Help may do apply online at secure.ssa.gov/i1020/start or call 1-800-772-1213 to get the process started.