How Do Elderly Qualify For Medicaid


How Can My Elderly Parent Qualify For Medicaid

Do I Qualify For Medicaid?

In order to qualify for Medicaid, a single individual cannot have more than $2,000 in countable assets, and a couple cannot have more than $101,540. Any excess must be either spent down until it’s gone , gifted , or converted to a non-countable asset. One example of a non-countable asset is known as a “Medicaid annuity.”

Who Qualifies For Medicaid

Medicaid qualification is different in every state. You must be a resident of the state in which you are applying for benefits and must be a U.S. citizen or otherwise qualified non-citizen such as a lawful permanent resident.

Federal law requires every state to provide Medicaid to the following mandatory eligibility groups that meet certain income and asset requirements:

  • Low-income families
  • Pregnant women
  • Children
  • Individuals receiving disability benefits
  • As you can see from the federal guidelines, the only reference to age is in regards to children. Each state governs its own Medicare program in adherence to federal regulations. Some states may have an age requirement in order to qualify for its Medicaid program while other states may not.

    You can find your states Medicaid eligibility requirements to learn more.

    How Much Does Dementia Care Cost

    Dementia, as a general term for a variety of memory-loss illnesses, is not inexpensive to diagnose, treat, or manage. This is one of the reasons why so many people are concerned about the overall cost and whether Medicaid would pay it.

    The average lifetime treatment cost is roughly $350,000, or $4,500 per month for basic care.

    This is a significant sum for many low-income families, and it is heartening that Medicaid is willing to cover the expenditures.

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    Another type of Medicaid program is Early and Periodic Screening, Diagnostic, and Treatment . This program is available to individuals under the age of 21 who live in households that meet certain financial criteria. This type of Medicaid also has an age restriction and could therefore also be considered age-based.

    ABD and EPSDT are required by federal law to be included in all state Medicaid programs. But as long as certain federal requirements are met, state Medicaid programs are free to offer their own Medicaid benefits and eligibility guidelines to people who might not otherwise be eligible for these two programs. Age may or may not play a role, depending on where you live.

    For example, Medicaid in North Carolina is only available to those age 65 and over or 21 and under unless you are pregnant, are responsible for a child age 18 and under, disabled or require long-term care.

    But in North Dakota, Medicaid is available to all low-income adults, regardless of age.

    It could be said that Medicaid is age-based in some states and for some programs, but it is not universally age-based.

    What Is A Medicaid Waiver

    What Are The Asset Limits In Order To Qualify For Medicaid?

    The Medicaid waiver program is a federal government plan that allows each state to waive rules that usually apply to Medicaid. These waivers allow individuals that would otherwise not be covered by Medicaid, such as the elderly or pregnant women, to receive care. The Medicaid waiver can also allow seniors to receive care at home instead of a long-term care facility.

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    Can Elderly Have Medicare And Medicaid

    There has always been some confusion between Medicare and Medicaid, and who exactly qualifies for what under which plan. Oftentimes they are used as interchangeable terms, and are thought to be the same thing but they actually are not.

    For those who know that there are two different programs, they also usually think that coverage under these programs is mutually exclusive. That is to say that Americans can only receive health benefits under one or the other but not both.

    The truth, however, is that there are some seniors who do qualify for coverage under both of these programs. When that happens, they are considered to be a dual-eligible beneficiary and are therefore added to both plans.

    In short, yes there are some elderly citizens who can have both Medicare and Medicaid. It is still important to understand the difference of each program, and how to qualify for each one.

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    What If I Think A Decision You Make Is Unfair Incorrect Or Made Too Late

    You have the right to appeal the Medicaid decision. There are several ways to request an appeal. You can write the reason you disagree with the decision on the back of the decision letter and then mail or fax it to Medicaid as directed on the letter. You can also fax the decision letter to the Division of Administrative Law at 225-219-9823 or mail it to the Division of Administrative Law, Department of Health Section, P. O. Box 4189, Baton Rouge, LA 70821-4183. You can request an appeal by phone by calling Medicaid Customer Service at 1-888-342-6207 or the Division of Administrative Law at 225-342-5800.

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    Can An Individual Receive The Necessary Care At Home Or In The Community

    Individuals who need the type of medical care usually available in facilities, but who can be successfully and cost-effectively treated in other settings, may be allowed to receive the necessary care at home or in the community. Home and community-based services provide help to qualified individuals who can safely remain in or return to the community as an alternative to placement in a facility. HCBS does not provide 24 hour per day supports. Home and community-based services are available through the following programs:

    • Community Choices Waiver
    • Adult Day Health Care
    • Children’s Choice Waiver
    • New Opportunity Waiver
    • Program for All-Inclusive Care for the Elderly
    • Long-Term Personal Care Services

    Individuals who are aged, blind, or disabled and eligible for Medicaid outside the facility may qualify to receive long-term personal care services in their homes even without being in one of the waiver service programs.

    Except for LTPCS, the Medicaid financial and non-financial requirements for waiver are the same as for nursing or ICF/IID facility care.

    For information about the OAAS CCW, ADHC, PACE, or LTPCS programs or to request services, call

    1-877-456 -1146 Monday through Friday between the hours of 8 a.m. and 5 p.m. The call is free.

    For information about the OCDD CCW, NOW, SW, or ROW programs or to request services, call the Office for Citizens with Developmental Disabilities at 1-866-783-5553 or your local Human Services District and Authority.

    Whose Income Is Counted

    Medicaid for Older Adults- Do you qualify?

    We count the gross monthly income of the person applying for long-term care or waiver to decide if he or she is eligible. The eligible person is commonly expected to use their income to pay a share of the cost of services provided in a nursing home. Medicaid will pay the remaining amount owed for their cost of care.

    To determine how much the person pays for their care, Medicaid uses the eligible persons gross monthly income and then deducts for personal care needs, Medicare and health insurance premiums, incurred medical expenses not covered by Medicaid, and contributions made to a spouse or dependents living at home. After the deductions are applied, any remaining income must be paid toward their care.

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    Medicaid Vs Medicare: What Is The Difference

    Medicare is a federal program that is run by the federal government. It mainly focuses on and provides coverage to individuals who are 65+ or have a disability, no matter what their income.

    Medicaid is an assistance program run by both state and federal governments and provides health coverage if you have a very low income. Medicaid does not pay money to you instead, it sends payments directly to your health care providers. Eligibility is largely determined by income level. Medicaid programs offer a wider range of health care medical services compared to Medicare.

    How Do I Apply For Medicaid

    Medicaid sends the Ways to Apply letter when a person is admitted to a nursing home or offered a waiver opportunity. Be sure to apply for Medicaid using one of the following ways:

    1.) Apply online by visiting the Medicaid Self-Service Portal.

    2.) and print an application. Then mail or fax it to Medicaid as directed on the form.

    3.) Call Medicaid Customer Service toll free at 1-888-342-6207 to apply by phone.

    4.) Apply in person at your local Medicaid office.

    You must answer all of the questions on the application form and give the needed proof so we can see if the person who needs long-term care services is eligible for Medicaid. If you do not apply, Medicaid cannot decide if the person is eligible for benefits.

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    What Changes Were Made To Medicaid In Response To Covid

    Older adults and those with serious chronic medical conditions are considered to be at higher risk for contracting the virus. While the number of cases skyrocketed in 2020 it was important to protect our seniors from getting COVID-19. The following changes were made to Medicaid in response to the virus:

    • Federally Enhanced Funding States meeting certain criteria are able to access funding to help people obtain and maintain coverage.
    • Telehealth Services Telehealth services are medical or health services that generally occur in person. These services can now be performed by a doctor or other health care professional that is located elsewhere. The visits can be done via telephone or video. Due to the pandemic, some states expanded their services to include telehealth visits. This includes doctor visits and behavioral health counseling.
    • Prescription Drugs During the pandemic, several states adopted a pharmacy cost-containment strategy to keep prices down. Several states are continuing to implement prescription drug cost containment.

    Plans may have changed since the emergency first started. Applicants should contact their state agency directly to learn about which services are covered due to Coronavirus and those that are not.

    State Expanded Medicaid Eligibility

    Medicaids Role for Medicare Beneficiaries

    As of August 2021, 38 states had expanded Medicaid to cover all low-income adults whose household incomes are below a specified threshold. If your state has expanded Medicaid, you are eligible for coverage based on your income alone. Typically, your household income shouldnt exceed 138% of the federal poverty level.

    In Idaho, for instance, the monthly income limits for expanded Medicaid range from $1,482 for one member to $5,136 for a household with eight members. The income limit is $523 for each additional member beyond eight. Check this page to understand your states Medicaid profile.

    You should still fill out a marketplace application if your state hasnt expanded Medicaid and your income level doesnt qualify you for financial assistance with a . States have other coverage options if youre pregnant, have children, or live with a disability.

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    How Does The Medicaid Planning Process Work

    Most Medicaid planners start the process with a free consultation in which they will discuss the health status and financial resources of the individual who is applying, or will someday apply, for Medicaid. They establish the likelihood of success, as well as the positive impact they can have on preserving a clients assets. They use this information to determine whether to accept the prospective client and to provide a cost estimate for their services.

    Once engaged with a client, several weeks are typically required for the collection of information and formal analysis of the familys assets. A plan is built, discussed, and modified as needed. Putting the plan into action can take longer. Depending on the strategy, it can take several weeks or months, even up to 6 months in some cases. In situations where there is an immediate need for Medicaid care, the Medicaid application documentation can be prepared concurrent with the execution of the plan. In some cases, Medicaid coverage can even be made retroactive.

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    Can Our Law Firm Help

    Regardless of where you are in the state of Florida, our law firm may be able to help protect assets and apply for Medicaid. We have been protecting assets to benefit the elder and their family for over 20 years and we have successfully completed thousands of Medicaid applications. We charge $200 for an hour long consultation with an elder law attorney who is glad to review your family’s situation to see if we can help.

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    Can Seniors Get Medicare Medicaid

    While many people believe that participation in these programs is mutually exclusive, the truth is that some seniors do qualify to receive both Medicare and Medicaid coverage. When a Medicare beneficiary also qualifies for Medicaid , they are deemed a dual-eligible beneficiary and are entitled to enhanced benefits.

    Medicaid And Nursing Homes: A Quick Guide To The Rules

    Medicaid program allows sick, elderly to hire family members as caregivers

    Many seniors rely on Medicaid to pay for long-term nursing home care. To be eligible for Medicaid, you must meet certain income and asset requirements. Medicare covers nursing home costs up to a certain point. For example, if you are admitted to a skilled nursing facility for a three-day inpatient hospital stay, Medicare pays for the first 20 days.When you apply for Medicaid, the state performs a five-year lookback on all asset transfers. If Medicaid discovers money was transferred within the last five years, a penalty period is imposed. There is no limit to the number of months someone can be declared ineligible. Medicaid is funded by both federal and state funds.

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    Reduced Coverage / Medicare Cost Sharing Or Premium Payment

    Qualified Medicare BeneficiariesCovered group: individuals covered by MedicareIncome limits: Income cannot exceed 100% of the federal poverty level. For more information, view the Guidelines for Medicare Cost-Sharing Programs brochure.Age: Medicare beneficiaries of any ageQualifications: Individuals must be eligible for Medicare Part A hospital insurance.

    Specified Low-Income Medicare BeneficiariesCovered group: individuals covered by MedicareIncome limits: Income cannot exceed 135% of the federal poverty level. For more information, view the Guidelines for Medicare Cost-Sharing Programs brochure.Age: Medicare beneficiaries of any ageQualifications: Individuals must have Medicare Part A

    Qualified IndividualsCovered group: individuals covered by MedicareIncome limits: Income cannot exceed 135% of the federal poverty level. For more information, view the Guidelines for Medicare Cost-Sharing Programs brochure.Age: Medicare beneficiaries of any ageQualifications: Individuals must have Medicare Part A

    What Is A Medicaid Lookback Period

    The Medicaid lookback period is a period of time in which any transfers of assets to family members may be subject to scrutiny for Medicaid eligibility. If it’s determined that you specifically transferred assets during the lookback period in order to qualify for Medicaid, this can affect the benefits for which you’re eligible.

    Also Check: Florida Medicaid In Home Care

    How To Apply For Medicaid

    Here are some important things to know about applying for Medicaid:

    CHIP is Medicaid for children. The Children’s Health Insurance Program is for children whose parents do not qualify for Medicaid. CHIP is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.

    You may qualify even if you did not before. Since needs and income can change you may qualify now for CHIP or Medicaid when you did not before. You can apply any time of year and if you qualify your coverage can start right away.

    Fill out an electronic or paper application through the Health Insurance Marketplace. If anyone from your household is eligible, the Health Insurance Marketplace will send your personal information to your state agency. Your state agency will then contact you about enrollment.

    Apply directly to your state Medicaid agency. Once you input your state on the site it will direct you to your Medicaid agencys contact information.

    Contact the Centers for Medicare & Medicaid Services. The Centers for Medicare & Medicaid Services is part of the Department of Health and Human Services . The organization is there to help people to apply for Medicare,Medicaid/CHIP or enter the Marketplace to build their health care plans around the Affordable Care Act . The ACA makes it possible for affordable health insurance to become available to more individuals.

    How To Get Medicaid To Cover Dementia Care Costs

    Seniors Solutions

    One of the biggest difficulties with dementia is that people with it typically dont have enough clear judgment to appraise a situation, thus family members must make all of the decisions.

    This is why, as soon as you receive a diagnosis, you should establish a power of attorney or seek court permission.

    This will help with all of the documentation that will be required in the future for appropriate treatment and convergence by Medicaid.

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    How Many Elderly Women Vs Men Apply For Medicaid Nursing Home Assistance

    Its a sad day for womens health care in American with the reversals of Roe vs Wade. This got me thinking about Medicaid and how families must hire attorneys at thousands of dollars so their family member can get health care at the end of life. Given that men out live women, are women second class citizens in America and being denied health care in the Medicaid system because of all the complications with Medicaid assistance? How many elder women can hire an attorney, and an honest one at that, given their declining health? How many women in the future will even have someone to advocate for their health as many couples decided not to have children? How many women apply for nursing home care vs men?

    Our Medicaid system application needs to be simplified where elders should not have to hire attorneys. Is our Medicaid for elders so hard to achieve because most of the applications are from women and our America does not care? I hope this gets women thinking.


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