West Virginia Medicaid Planning/Asset Protection Attorney

For many seniors in West Virginia, the rising costs of long-term care can quickly deplete a lifetime of savings. Medicaid, a joint federal and state program, offers a solution by covering nursing home expenses for those who meet eligibility requirements. Navigating the complex Medicaid rules and regulations can be challenging, however.

At Hewitt Law PLLC, we have an in-depth understanding of the essential issues that seniors have to deal with, and our extensive experience with elder law is a major reason why many West Virginians choose us to help them with Medicaid planning.

Medicaid Eligibility in West Virginia

To qualify for Medicaid coverage of nursing home care in West Virginia, seniors must meet both financial and level of care requirements.

Financial Requirements

• Income Limits: As of 2024, the income limit for West Virginia Nursing Home Medicaid is $2,829 per month for a single applicant.
• Asset Limits: Medicaid classifies assets as either countable or exempt resources. For a single applicant, countable assets must be below $2,000. For married couples with both spouses applying, the limit is $3,000. If only one spouse is applying, the asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse. Exempt resources, like a primary residence (up to $688,000 in equity) and one vehicle, do not count towards the asset limit.

Level of Care Requirements

• Medical Necessity Criteria: To qualify for nursing home Medicaid, seniors must demonstrate a need for a level of care that cannot be provided in a less restrictive setting, such as their home or an assisted living facility.
• Pre-Admission Screening: Before entering a nursing home, seniors must undergo a pre-admission screening to assess their medical and functional needs.

Spousal Impoverishment Protections

West Virginia Medicaid offers spousal impoverishment protections to help prevent the community spouse (the spouse not entering a nursing home) from becoming impoverished.

• Community Spouse Resource Allowance: The community spouse can keep a portion of the couple’s joint assets, known as the Community Spouse Resource Allowance (CSRA). As of 2024, the maximum CSRA in West Virginia is $154,140.
• Personal Needs Allowance: For Nursing Home Medicaid recipients, they are permitted to keep $50 per month as a Personal Needs Allowance.

Medicaid Spend-Down Strategies

For seniors whose assets exceed Medicaid’s limits, spend-down strategies can help them become eligible while preserving some of their wealth.

Spending Down on Non-Countable Assets

• Home Improvements and Repairs: Investing in home improvements, such as wheelchair ramps or bathroom modifications, can reduce countable assets while enhancing the senior’s quality of life.
• Prepaying Funeral Expenses: Seniors can prepay funeral expenses through an irrevocable burial trust, which removes the funds from their countable assets.

Converting Countable Assets to Exempt Assets

• Purchasing a Medicaid-Compliant Annuity: Seniors can convert countable assets into an income stream by purchasing a Medicaid-compliant annuity, which is an exempt resource.
• Buying a Larger Home: Seniors can invest excess countable assets into a more expensive primary residence, as long as they stay within West Virginia’s home equity limit of $688,000 (as of 2024).

Medicaid Asset Protection Techniques

Here’s an expanded discussion of the Medicaid asset protection techniques, with two paragraphs for each technique:

Long-Term Care Insurance Partnership Program

West Virginia participates in the Long-Term Care Insurance Partnership Program, which allows seniors who purchase a qualifying long-term care insurance policy to protect a portion of their assets from Medicaid’s spend-down requirements. This program provides a dollar-for-dollar asset protection benefit, meaning that for every dollar the partnership policy pays out in benefits, a dollar of assets can be protected from Medicaid spend-down.

The Partnership Program offers significant advantages for seniors planning for long-term care. Not only does it provide insurance coverage for care needs, but it also offers a safety net if the policy benefits are exhausted. Seniors can apply for Medicaid under modified eligibility rules that include a special feature called an ‘asset disregard.’ This allows them to keep assets that would otherwise not be allowed if they need to apply and qualify for Medicaid to receive additional long-term care services.

Caregiver Agreements and Personal Care Contracts

Seniors can pay family members for providing care services through a caregiver agreement or personal care contract, which can help reduce countable assets while ensuring the senior receives needed assistance. These agreements formalize the caregiving relationship and allow seniors to compensate family members for their time and effort in providing care.

By using caregiver agreements, seniors can effectively convert countable assets into exempt care expenses. This strategy not only helps to reduce the senior’s countable assets for Medicaid eligibility purposes but also provides financial support to family caregivers who may have had to reduce work hours or quit their jobs to provide care. However, it’s crucial that these agreements are properly structured and documented to withstand Medicaid scrutiny.

Gifting Strategies and Medicaid’s Look-Back Period

Seniors can give away assets to family members, but they must be aware of Medicaid’s 5-year look-back period. Gifts made within this timeframe may result in a penalty period of ineligibility. The look-back period is designed to prevent individuals from giving away their assets just to qualify for Medicaid.

When considering gifting as a Medicaid planning strategy, it’s essential to carefully time any transfers. Gifts made more than five years before applying for Medicaid will not be subject to penalties. However, gifts made within the look-back period will be scrutinized and may result in a period of Medicaid ineligibility. The length of the ineligibility period is calculated based on the value of the gifts made and the average monthly cost of nursing home care in the state.

Life Estate Deeds

West Virginia allows enhanced life estate deeds, which are similar to Lady Bird deeds. These allow seniors to transfer their homes to beneficiaries while retaining the right to live in and control the property during their lifetime. This strategy can help protect the home from Medicaid’s estate recovery program.

By using an enhanced life estate deed, seniors can effectively remove their home from their countable assets for Medicaid eligibility purposes while still maintaining control over the property during their lifetime. This includes the right to sell, rent, or mortgage the property. Upon the senior’s death, the property passes directly to the named beneficiaries without going through probate, potentially avoiding Medicaid estate recovery. However, it’s important to note that this strategy should be implemented well before the need for Medicaid arises, as it may be subject to the five-year look-back period.

Medicaid Estate Recovery in West Virginia

After a Medicaid recipient passes away, the state can seek to recover the funds it spent on their long-term care through the Medicaid estate recovery program.

Assets Subject to Recovery

In West Virginia, assets subject to estate recovery include real and personal property, such as the deceased recipient’s home, vehicles, and bank accounts.

Exceptions and Hardship Waivers

Certain exceptions and hardship waivers may protect assets from estate recovery, such as when the deceased recipient is survived by a spouse, a child under 21, or a child who is blind or disabled.

Strategies to Avoid Estate Recovery

Creating a life estate deed with retained powers allows seniors to transfer their home to beneficiaries while keeping the right to sell, rent, or mortgage the property during their lifetime.

Navigating the Medicaid Application Process

Applying for Medicaid can be a complex task, but understanding the process can help ensure a smoother experience. The main steps in the application process include:

• Gathering Necessary Documents: Seniors should collect essential documents, such as proof of income, bank statements, insurance policies, and property deeds, before beginning the Medicaid application process.
• Submitting the Application: As of 2024, West Virginia allows Medicaid applications to be submitted online through the WV PATH system, by mail, or in person at a local Department of Health and Human Resources (DHHR) office.
• Responding to Information Requests and Denials: After submitting the application, seniors may receive requests for additional information or face denials. It’s important to respond promptly and accurately to these requests and to consider seeking the assistance of a Medicaid planning attorney if faced with a denial.
• Appealing Medicaid Decisions: If a Medicaid application is denied, seniors have the right to appeal the decision. The appeal process involves a fair hearing before an impartial administrative law judge.

Work with Our Knowledgeable West Virginia Medicaid Planning Lawyer

Navigating West Virginia’s Medicaid system can be complex, but proactive planning can help seniors and their families make the most of available resources while ensuring quality long-term care. By understanding Medicaid eligibility requirements, spend-down strategies, asset protection techniques, and the application process, seniors can take steps to secure their financial future and receive the care they need.

For those seeking personalized guidance, consulting with an experienced West Virginia Medicaid planning attorney can provide valuable insight and peace of mind. With a deep understanding of West Virginia’s unique Medicaid landscape, Hewitt Law PLLC can help seniors and their families develop tailored strategies to meet their long-term care needs while preserving their hard-earned assets.

Contact us today for a personalized consultation to get started.