Pennsylvania Medical Assistance and the Pre-Arranged Funeral
Medical Assistance, also known as Medicaid, is a federally-funded, state-administered program that, amongst other things, provides for Skilled Nursing Care for individuals that meet certain qualifications. Skilled Nursing Care is a very specific term. It means care provided for in a Skilled Nursing Facility. This does not include Assisted Living facilities nor Government-Subsidized housing for the elderly. Most commonly, it is for elderly Pennsylvanians that require long-term care for chronic conditions which require them to stay in a Nursing Home, and that the nursing home stay itself has exhausted the persons assets to a "spend-down" point where Medical Assistance begins to pay for the person's Nursing Home Stay.
When a facility accepts Medical Assistance as a mode of payment, they must, by law, provide the same care to a patient who pays privately for the care as they do to the person on Medical Assistance. Notwithstanding certain planning that only a lawyer may help the person with, a person must spend down mostly all of their assets before qualifying for Medical Assistance. However, there are certain "exempt" assets that do not count against a single person filing for Medical Assistance. Rules are different for a person whose spouse lives independently and does not require Medical Assistance; you should consult an elder law attorney to go over these differences. Exempt assets are:
- $2,000.00 in any form (usually a bank account) or $8,000.00 if person's monthly income is below a certain amount which changes by year
- Term Life Insurance, any amount
- Whole Life Insurance totaling a face amount value of $1,500.00 or less
- Prepaid funeral expenses
With prepaid funeral expenses, there are certain items that are separate and can be prepaid individually by a person facing a long term stay in a nursing home. These items are:
- A burial plot
- A prepaid funeral
The prepaid funeral must meet certain qualifications. Firstly, it must be irrevocably assigned. This means that once the funeral is prepaid, the money cannot be removed by anyone for any reason. Neither the funeral director nor the person making the pre-arranged funeral can take the money out of whatever investment device (Certificate of Deposit, Life Insurance Policy, Annuity) that money was invested in. This does not mean that the money cannot be moved to another funeral home; it can. However, once the money is prepaid, Medical Assistance requires that the money stay there to pay for the person's burial. The second requirement for the funeral is that it must be under a certain dollar amount. In Pennsylvania, the limit for a qualified prepaid funeral is calculated by taking the average funeral in each county and adding 25% for "Extraordinary Costs."
For our geographic area, the 2021 limit for Allegheny County is $22,029.41, Westmoreland County is $18,624.85, and Washington County is $18,088.75.
At A.J. Bekavac Funeral Home, we feel that pre-arranging a funeral for a person facing Medical Assistance is a very beneficial step that can be taken by a family facing a loved one's long stay in a nursing home. As explained above, a person who receives Medical Assistance receives the same level of care as a person who pays privately. However, for most people to qualify for Medical Assistance, they must "spend-down" all of their assets to qualify. If the funeral is not prepaid for that person, when that person passes away, their family is faced with paying for the funeral, but now without any assets of their loved one, who had to spend it all to pay for his or her nursing care.
When a funeral is pre-paid at A.J. Bekavac Funeral Home for either Medical Assistance purposes or personal reasons of the individual, we guarantee that all of our costs will be taken care of by the funds set aside.* Pre-arrangement and pre-payment of a funeral makes sense by taking advantage of one of the few allowances Medical Assistance permits for an individual facing a long term stay at a nursing home and a spend down of all of their assets. Why not pay for the funeral now, with money that must be spent down for the nursing home care, instead of leaving it for your family at the time of death?
*Note: Guarantee does not include any cash-advanced items (payments to other providers advanced by the funeral home). This includes, but is not limited to, grave-openings, grave plots, newspaper obituaries, mass offerings or clergy offerings, donations to churches or church employees, flowers, caterers or restaurants, shipping or travel providers, or any other third parties who provide services to a family at the time of a funeral.