Allowable Medicaid Spend Down Items

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Medicare Flex Cards Vs Flexible Spending Accounts

Though superficially similar to flexible spending accounts , Medicare flex cards differ in where they are offered and how they are funded. Medicare flex cards carry a prepaid balance that cardholders can use to pay for specific healthcare services. They are offered by some private insurance companies through Medicare Advantage plans. Keep in mind that these cards are not associated with government-run programs such as Original Medicare, so any ads indicating that its possible to obtain a government flex card for seniors are false.

Flexible spending accounts , meanwhile, are offered through employer-sponsored healthcare. They are non-taxed accounts that are used to pay for certain medical expenses not covered by employer plans. You can make contributions to your FSA through payroll deductions for as long as you are employed.

While both FSAs and flex cards may be used to cover the cost of health services, FSAs have set contribution limits. In 2022, this amount is $3,050 per year. Money on Medicare flex cards, meanwhile, is disbursed according to a schedule set by Medicare Advantage providers. For example, money may be added in a lump sum each year or in smaller amounts each quarter.

What Are The Asset Limits To Qualify For Medicaid In New York

The amount that you can own in assets will vary depending on whether youre single or married. There are also some assets that are exempt from being counted towards your countable assets for Medicaid eligibility.

There are also different levels of services that you can get through Medicaid, and your asset limits will be different based on what you need.

Here are the three types of Medicaid.

• Institutional / Nursing Home Medicaid Living in a nursing home.
• Medicaid Waivers / Home and Community Based Services Living at home but requires help with daily activities. This program has limited space and is not an entitlement.
• Regular Medicaid / Aged Blind and Disabled No long term care required.

For detailed information about your specific asset limits based on your individual circumstances and medical needs, you can also contact the Medicaid representatives in your county.

Or, you can also call New York Medicaid at 1-800-541-2831 for more individualized information depending on your circumstances.

Below, well list the asset limits based on your marital status, as well as the level of care you require.

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Calculating The Spend Down Amount

While one may know its necessary to spend-down some of their countable assets to qualify for Medicaid, the exact amount that needs to be spent down may be unclear. This is because the asset limit varies by state, as well as if one is single or married, and if married, if one or both spouses are applying for Medicaid. While the preceding factors are relatively simple to calculate, states also vary in the way they calculate the amount of countable assets a healthy spouse can keep. This adds to the complexity of the calculation.

IndividualsThe asset limit for a single elderly individual for long-term care is $2,000 in most states. However, there are some exceptions. For example, as of 2022, the asset limit for a single individual in Connecticut is $1,600, in Nebraska it is $4,000, and in Minnesota it is $3,000.

When a couple is married, all assets are considered joint assets. Learn more about joint assets here. In most states, the asset limit for a couple where both spouses are applying for Medicaid is $3,000. Again, there are exceptions to this rule. For instance, in 2022, the asset limit in this situation for long-term care is $4,000 in Arizona, $6,000 in North Dakota, and $24,600 in New York.

How Does Medicaid Work

Medicaid was created in 1965 by Title XIX of the Social Security Act. This program was designed to provide health coverage to individuals who have significant medical needs but minimal assets and inadequate income to cover their care costs.

Some people with very few financial resources qualify for Medicaid immediately. However, most people have too much income and/or assets to qualify initially, but they know that paying out of pocket for long-term care will eventually cause them to run out of money. In such scenarios, applicants must carefully spend down for Medicaid. In other words, they must use up their own money to meet the programs financial eligibility requirements and trigger Medicaid coverage as soon as possible. Below, I will explain the Medicaid spend-down strategies we used to ensure my aunt qualified for long-term care coverage without impoverishing my uncle.

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Allowable Medicaid Spend Down Items As Of 2022

On Behalf of Brothers & Henderson, P.S. | Mar 8, 2022 | Elder Law |

For many individuals, qualifying for long-term care Medicaid is difficult for the sole fact that they do not meet the programs asset limit. More specifically, the value of their assets greatly exceeds the set limit which, as of 2022, is $2,000 for single applicants and $3,000 for a married couple applying together.

Understandably, many aspiring Medicaid recipients have assets that far exceed the $2,000 limit. In an attempt to qualify for benefits, they may try to get rid of their assets by spending them down, gifting them, donating them or getting rid of them via other means. To prevent applicants from doing this, The Centers for Medicare and Medicaid Services developed the lookback period.

What Is A Medicaid Spend Down

As you know, to qualify for Medicaid, you need to meet certain income and asset requirements, among others, depending on your state of residence.

If you meet all the other requirements, but dont meet the income or asset limits, then you can qualify for Medicaid through an income and/or asset spend down.

In New York, Medicaid spend down is also known as the surplus income or excess income program.

The way it works is this.

If you accumulate medical bills that exceed your excess income above the eligibility for Medicaid, then you can spend your excess income on your medical bills to qualify for Medicaid for the rest of your medical expenses.

In other words, you spend your income or assets that exceed the Medicaid eligibility requirements on specific medical or wellness expenses to bring your income/assets down to the level where you would qualify for Medicaid.

As with all things Medicaid, your specific requirements may vary based on your state, but the general idea remains the same.

It might sound a bit convoluted at first. So, lets look at a couple of examples of how Medicaid spend downs might work to further clarify the concept for you.

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Utilizing The Spend Down Option To Maintain Ssi And/or Medicaid Eligibility

The Voice is the e-mail newsletter of The Special Needs Alliance. This installment was written by Special Needs Alliance member Carol S. Battaglia, Esq. of San Diego, California. She is one of the authors of Special Needs Trusts: Planning, Drafting and Administration, published by the State Bar of California. Carol also serves as counsel to the Special Needs Trust Foundation of San Diego, a charitable pooled special needs trust. Her practice is limited to the creation of estate plans using special needs trusts and assisting trial lawyers in implementing special needs trusts and other strategies to receive an injured party’s settlement funds while maintaining eligibility for government assistance.

People with special health care needs and limited funds of their own often rely on public benefits for their well-being. Some of the most common public benefits include Supplemental Security Income , administered by the Social Security Administration, and Medicaid, administered separately in each state. To be eligible for SSI and/or Medicaid, an individual usually is limited to $2,000 in resources . For SSI, there also is a very low income ceiling.

Medicaid Planning Is Not A Do

Although I had been a financial planner and advisor for years, I had not had any previous personal or professional experience with the Medicaid program until my uncle asked for help. However, I had learned through reading and seminars that planning before acting is VERY important and that eligibility requirements vary from state to state.

The most important piece of advice I have to offer is that professionals who specialize in this area, such as elder law attorneys, medical social workers and state-employed case workers are an applicants greatest resource. These people will help avoid delays and creating periods of ineligibility that require reapplying and recertification. Professionals with Medicaid-planning experience can also keep you from running afoul of the more stringent divestiture rules, including the five-year look-back period during which transfers or gifts of assets are not allowed.

Because this matter is so complex and can have such serious consequences if handled incorrectly, I decided that my uncle and I had to meet with an elder law attorney to help us map out a Medicaid planning strategy first. The attorney carefully reviewed both the asset and income requirements with us for the Medicaid program in our state. After that consult, we got to work on pulling all my aunt and uncles fiscal information from the previous five years to compare their financial status with the requirements.

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Spending Down Assets To Qualify For Medicaid

When it comes to Medicaid, whether in the state of New York or elsewhere in the country, there is usually a limit on the assets you can own to qualify for Medicaid.

But just like income limits, you can spend down assets on qualified expenses to meet the requirements for Medicaid.

For example, if you prepay for funeral services, youre taking part of your cash assets and spending it towards a service that qualifies for asset spend down. Now, youve reduced the value of your assets, and youre closer to meeting the limits for Medicaid.

Before we delve into all of the specific ways you can spend down assets, lets first examine the asset limits in New York to qualify for Medicaid.

If you dont live in New York, then you should check with your states Medicaid agencies for the asset limits. But the general idea of spending down assets will be the same.

Understanding The Difference Between Exempt And Countable Assets

Assets are a persons financial resources, including cash, money in bank accounts, and the value of ones home. When applying for Medicaid Long Term Care programs, including Nursing Home Medicaid and Home and Community Based Services waivers, one needs to divide their assets into two groups: countable and exempt.

No one applying for Medicaid benefits needs to worry about spending down exempt assets, because they dont count toward eligibility. It only makes sense to spend down countable assets, because countable assets are considered when Medicaid offices determine whether an application should be approved.

List of Countable Assets

The application for Medicaid must include documentation of ones countable assets. Countable assets are also called non-exemptand include the following: Cash Vacation homes or properties other than the applicants primary home Mutual funds Bonds Most life insurance policies

List of Exempt Assets

The value of exempt assets, or non-countable assets, does not get considered as part of Medicaids asset limit. An example of an exempt asset is the applicants primary home, so the value of that home does not matter when figuring out whether someones assets exceed the states Medicaid limit.

Other assets that do not count toward the asset limit include: Personal vehicles Term life insurance policies valued below $1,500 Furniture Personal items including wedding/engagement rings Prepaid burial and funeral expenses

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If Youre Single And Applying For Medicaid

When it comes to Medicaid qualification, there are two kinds of assets countable and exempt.

The countable assets are the ones that count towards your asset limits when determining eligibility for Medicaid. Exempt assets are assets you can own but wont count towards your limit.

Lets look at both types of assets in further detail.

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Pay Off Debt Or Purchase An Annuity

You can use your excess assets to pay down debt, whether its towards your mortgage, childrens student loans, credit cards, or anything else.

If you dont have any debt, you can also purchase an annuity. You pay down a lump sum of money, and either you or your spouse will receive monthly income for a set period, depending on the plan.

When purchasing an annuity, be sure to consider how that might affect your income when it comes to qualifying for Medicaid.

Avoid Taking Advice From People Who Have A Financial Interest In Your Purchase

Its not just online that you have to be careful, either. You also have to be wary of in-person advisors with an agenda. Be especially careful with people who approach you without you asking or who push particular plans.

In our community, we have a so-called advisor who lurks around our local food banks. He is what is known as a captive agent because he only works with one insurer in this case, its United Healthcare. He does not make any commission on any other plans, so he steers everyone toward United Healthcare even if it isnt in their best interests.

If you must work with someone who has a financial interest in getting you to sign up, then at least make sure they offer plans from many different providers so that youre more likely to get a good fit. Independent agents work with a wide variety of providers, whereas captive agents work with only one or two providers. Avoid captive agents whenever possible.

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How Much Will You Receive

The amount of financial aid you receive from OSAP will depend on your assessed financial need. OSAP calculates the financial need as the difference between your cost of education and the contribution that you are expected to make:

Financial Need = Allowable Educational Costs Expected Financial Contribution

Your allowable educational costs include items such as tuition, books, living costs, transportation costs, etc. The expected contribution consists of your income and assets, you parents income, and your spouses income and assets . Any difference between these amounts will result in a financial need. This value will vary greatly from student to student so its difficult to predict exactly how much you will receive. There is a student financial aid estimator located on the OSAP website that can give you a general idea of the assistance.

The maximum amount of financial aid that a single student can receive is $350 per week . Married students or sole support students can receive up to $545 per week .

If you feel that you did not receive adequate financial assistance then you can request a review of the OSAP application by contacting your financial aid office. If your request is denied then you can file an appeal with the OSAP Appeal Board. Attach any supporting documentation that will allow you to receive an appropriate reassessment.

Income Limits For The Community Spouse

Unlike assets, Medicaid looks at a couples income separately. Therefore, the community spouse is allowed to keep all income they receive up to a certain point. Additionally, if the community spouses monthly income falls below a certain threshold , then the institutionalized spouses income can be redirected to the community spouse to make up the difference.

This payment is referred to as the Minimum Monthly Maintenance Needs Allowance and ensures that the community spouse is left with sufficient income to live on. Because of these spousal impoverishment rules, my uncle was allowed to keep both his own income and a portion of my aunts income, which amounted to more than half of their combined monthly income.

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Richmond Hill Seniors Transportation Services

It can be difficult when your loved one can no longer drive themselves around. Whether its traveling to the store, a social event, or to a doctors appointment, finding safe and reliable transportation can be a hassle.

With Affinity Health, your loved ones dont have to miss out on any of the activities they adore. Well provide safe transport and enjoyable companionship at their favourite events, arts and cultural programs, social and charity functions, religious services, and more.

Our caregivers can also provide transportation to and from the hospital, doctors office, or treatment center, as well as services and support while there. In addition, we will help your loved one pack for visits and run errands on the way.

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