Will I Lose Medicaid Coverage if I Bring a Claim for Nursing Home Abuse?

Victims of nursing home abuse and their families often have questions and concerns to consider when deciding whether and how to pursue legal action against people or facilities that may have been responsible for the abuse. One of those worries often involves the impact that a lawsuit would have on Medicaid eligibility. Legal claims can affect a Medicaid recipient’s benefits, so careful consideration and planning are necessary to ensure that nursing home residents are properly covered. The Jacksonville nursing home abuse lawyers at The Lawrence Law Group understand the complexities at issue in deciding whether to file a personal injury claim while also relying on Medicaid funds. If you have questions about pursuing legal action against parties responsible for nursing home abuse, contact our office today to learn more about your options.

If you obtain a settlement or judgment in a nursing home abuse claim that awards you an amount over $2,000, Medicaid coverage could be lost for a period of time until the funds run out. Medicaid benefits are based on a means test, which determines whether an individual qualifies for coverage by calculating his or her income and assets, which means that a significant damages award can affect eligibility. Florida requires Medicaid recipients to have under $2,000 in countable assets. A nursing home abuse or neglect settlement award is typically classified as a countable asset.

However, establishing a special needs trust avoids jeopardizing your Medicaid coverage. Special needs trusts are set up to ensure that a disabled individual can continue to receive necessary need-based governmental benefits, in the event that they receive a significant payment from an alternative source. These trusts can be established on behalf of a disabled person, who is named as the beneficiary. A person with a disability is defined under Florida law as an individual “unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment.” People who need the full-time care of nursing home facilities qualify under this standard.

Special needs trusts can be set up individually or by participating in a pooled trust. Individual special needs trusts name only one beneficiary, with assets usually originating from one source. Pooled trusts allow for many beneficiaries to receive contributions from different families. Pooled trusts must be operated by a nonprofit entity. Some advantages of pooled trusts include lower administrative fees, professional management of assets, and reduced costs in the establishment and maintenance of the trust.

Funds from a special needs trust can only be used toward the care and for the benefit of the named beneficiary. This includes using trust assets for certain living expenses, medical bills, utilities, and other quality of life services and purchases related to a beneficiary’s health, hygiene, and comfort. The assets in a special needs trust are exempt from inclusion as countable assets for the purposes of determining Medicaid eligibility. If you or your loved one is a Medicaid recipient who has suffered from nursing home abuse, it is important to seek advice from a knowledgeable injury attorney who can help determine the proper steps to take.

Nursing home abuse victims have rights to assert against their abusers, and they should not hold back from asserting their rights because they are worried about losing their means to live as a result. The nursing home abuse and neglect attorneys at The Lawrence Law Group are dedicated to making sure that victims are protected when pursuing legal claims against the parties responsible for their harm. Our firm offers experienced and compassionate legal representation to people throughout Duval, Clay, Nassau, Baker, Brevard, Union, Flagler, Suwannee, Hamilton, Putnam, St. Johns, Columbia, Jefferson, Volusia, and Alachua Counties. You can contact us online or at (904) 632-0077 to find out more about the legal options available to your loved one and your family.