Having a loved one in a nursing home is tough enough. And then being told your loved one doesn’t qualify for Medicaid and having very few resources to pay privately for that nursing home stay makes it even tougher. You wonder how you will survive. You’re no longer in the “working” age group. You’re retired. What are you supposed to do?

How One Car Accident Forever Changed the Lives of an Entire Family

On a September day in 2017, our client’s husband was in a serious car accident and was admitted to the emergency room in his hometown. Two days later, he was transferred to a hospital in another state where he would stay in their intensive care unit for the next three weeks. After being released from the ICU, he would be in the hospital's rehabilitation unit for the next two months. When this hospital realized he wasn’t improving, he was transferred to his second rehabilitation unit in yet another state. This man would stay there until finally being transferred to a nursing home in his home state in late April of 2018. All of this occurred over the course of eight months. How stressful for both this man and his family, especially when the moves for medical care took him too far from home for frequent visits from his beloved spouse and family.

How Could She Be Told No?

While our client’s husband received a settlement after the accident, most of the funds were used to pay for his medical bills and rehabilitation stays. It was determined that he could never live at home again due to his serious injuries. With medical bills looming for his continued care at the nursing home and having so few financial resources, his wife, our client, filed for Medicaid. But to her surprise, she was denied! How could this be?

You see, the North Carolina Division of Social Services (DSS) has a rule that says the non-institutionalized spouse can only keep half of the couple’s assets, known as the Community Spouse Resource Allowance, with a minimum amount of $25,728 and the maximum amount being $128,640, and still qualify for Medicaid. So, if your combined assets totaled $60,000, the stay-at-home spouse only gets to keep $30,000.

In addition, DSS would only let our client keep her Social Security and enough of her husband’s income to get her to the Minimum Community Resource Allowance allowed by DSS. How can one live on so little at this point in their lives where their own medical bills keep rising due to age-related health issues?

Luckily, There Is a Way!

We took our client’s case to court and asked the judge to allow her to keep her spouse’s income. This way, her husband’s payment to the nursing home, more commonly known as the PML, would become $0. In this case, the judge granted our request. It was a great relief for our client to know that her financial worries are over, and now she can just concentrate on what’s most important—caring for her husband and being his health care advocate.

The situation our client found herself in is not uncommon. If your spouse is in a nursing home, and you are struggling to support yourself and pay for their care, contact Legacy Lawyers to discuss your options. In the meantime, download our free book, You’ve Earned It, So Keep It!, and start getting the answers you need now.

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