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.

Client Reviews
I have known Mr. Lawrence for several years and in my opinion he is the most professional and trustworthy lawyer I have ever known. I have had dealings with other lawyers but they were not as good as Mr. Lawrence. I would highly recommend him. Carla
I was referred to Greg by a coworker after I received a bad injury from an auto accident and was so pleased with Greg, and staff. They literally took care of everything for me while I was healing and kept me updated every step of the way. Calls and emails were always accepted and returned promptly and they were extremely patient and helpful with any questions and concerns that I had. Should I ever need legal assistance again I will definitely be calling him and referring him to family and friends. Amie M.
I had a difficult disability case, and was referred to Greg by a judge. As an experienced lawyer myself, I was apprehensive about using someone I didn't know. As it turned out, however, I could not have been more pleased. Greg mastered the case in no time, and was nothing short of brilliant in getting me a substantial settlement. He's a lawyer's lawyer, and I recommend him highly and without reservation. Steve
I would like to take a moment to say thanks to Greg, and his staff for doing an excellent job with my deceased mothers nursing home case. After hiring two other law firms my brothers and I decided to hire Greg. This was the best decision that we made regarding this case. Greg took the time to get to know who our deceased mother was, and the important facts involving our claim. As a result Greg was successful in resolving our claim to our satisfaction. Greg is the best attorney that I have ever met! I would highly recommend hiring Greg for any nursing home, or any other claims. Falsario Arnold
Of all the things that pleased me about Greg was that he was always available to me. If I called or emailed, I spoke to him and wasn't pushed off to one of his paralegals or assistants (although they were very helpful as well). I felt like I had a lawyer - not a factory. Scott