Special Assistance is a complicated program with many pitfalls. Careful planning with a professional is essential.
There is a myth that if you are poor and destitute that you can get government assistance for any health care need. This is not true! It is important to know that if your income is above the cap, you will not be eligible for public assistance in an assisted living facility even if you are destitute without assets of any kind. This creates a big hole in the safety net, because a deserving person with Social Security income of $1,200 each month, even without assets of any kind, will not qualify for assistance. You will not be able to find an assisted living facility to care for you for $1,200 per month—the facilities generally cost much more. Hence, there is a large number living alone who can’t get the assistance they need for activities of daily living, who must depend on the limited help provided by Meals on Wheels and other charities to survive.
If you need Skilled Care or Intermediate Care in a Nursing Home Facility, a middle class family can plan for and receive “Adult Medicaid” to protect the family legacy. Adult Medicaid allows provides many ways for a knowledgeable attorney to plan for your needs and protect your loved ones.
Assisted Living Care
If you need Assisted Living care, sometimes called Custodial Care, or Domiciliary Care, Adult Medicaid is NOT an available option. The program that provides for Custodial Care is called “Special Assistance.” This program gives you fewer options for planning but can still provide important benefits.
There is one big limiting factor for the Special Assistance program—the income cap.
The Income Cap
If you are in an Assisted Living facility and your gross monthly income exceeds $1,247.50, you are NOT eligible for the Special Assistance program. If you are in a special care unit (sometimes called an Alzheimer’s or dementia care unit) at an Assisted Living facility, your gross monthly income must not exceed $1,580.50. Importantly, a spouse’s income is not counted toward the cap, but the limit is so low, generally only people who have worked solely at home or in low-income cash jobs, such as farmers, are eligible.
If the person in need has low income (under these caps), and the spouse is healthy, good planning will result in quick eligibility, regardless of the spouse’s income or assets.
As a result, Special Assistance is not an option for many families without proper planning. While options are limited compared to Medicaid, good planning makes a significant difference in getting approved. Our focus at W.G. Alexander & Associates is on getting you qualified quickly while protecting your hard earned assets.