If I Have a Nursing Home or Personal Injury Claim and I am Receiving Medicaid, Will My Recovery be Considered an Asset Causing Me to Lose Medicaid Coverage?

Medicaid provides health coverage for persons of limited financial means. In Florida, eligibility for Medicaid is determined by the Department of Children and Families based on the following categories of potential recipients: children; low income families; parents and caretakers of children; pregnant women; former foster care recipients; and aged and disabled persons not currently receiving Social Security Disability Income.

In order to qualify for Medicaid, an adult must have limited assets. In Florida, a person must have less than $2,000.00 in “countable” assets in order to qualify. Exempt assets, such as a homestead, are not considered “countable” assets. To be eligible, a person must also receive less than $2,205.00 in gross monthly income.

With respect to nursing home injury claims, our clients are almost always on Medicaid. While Medicare pays for the first 90 days of a nursing home stay following an acute illness, Medicaid will pay for the remainder of the stay for those covered by Medicaid. Sometimes, people live in nursing homes for several years. We have had clients who, due to dire health needs, had to continue to live in a nursing home after our representation was complete.

When a recovery is made for a nursing home resident who receives Medicaid, precautions must be taken if that person wants to continue receiving Medicaid. This is because, as the net proceeds of a nursing home neglect or personal injury claim typically get paid to the client directly, the resulting funds are “countable assets.” If the net recovery is more than $2,000.00 (which essentially all are) then the client may lose Medicare coverage.

There are some methods that can be used to avoid this result; however, the first step is to determine whether keeping Medicaid is, indeed, the best course of action. With a very large recovery, the client may simply wish to return to home or a home environment and hire home nursing staff as may be required. If those funds are eventually depleted, the client can later reapply for Medicaid.

For clients that must remain in a nursing home due to health issues, losing Medicaid would be extremely disruptive. In these situations, upon making a recovery for our clients’ injuries, we can establish a pooled or special needs trust which allows the client to receive distributions for living, health, hygiene, comfort and other expenses without losing eligibility for future Medicaid benefits. For anyone with an injury claim who is on Medicaid, we strongly recommend you hire lawyers that are familiar with establishing pooled or special needs trusts.

Handling personal injury claims for Medicaid recipients can be a minefield for the inexperienced practitioner. Hiring an attorney experienced in resolving nursing home and personal injury claims without losing Medicaid coverage can prove essential to sound financial decision-making.

If you have any questions about the role of Medicaid coverage with respect to personal injury and nursing home claims, please contact one of our lawyers at (904) 632-0077.