Selling A Home While Receiving Medicaid Benefits
Some individual circumstances may require that individuals sell their house while they are receiving care under Medicaid. These situations will likely disqualify the individual from Medicaid because the proceeds from the sale of the home are not exempt from Medicaids assets calculations. The money received from the sale of the house becomes a countable asset.
Although you may be disqualified from Medicaid, this can be a temporary situation until you can spend down your assets and be reconsidered for Medicaid. However, it is crucial to follow the spend-down rules and ensure that you do not do anything that would violate the look back rule. Generally, you can spend money on the cost of your long-term care.
Understanding The Reason Why One Was Denied Medicaid Benefits
Medicaid programs for Long Term Care include Nursing Home Medicaid and Home and Community Based Services waivers. If one goes through the long and detailed process of applying for services through these programs, a letter of approval or denial should come back within 90 days.
A Medicaid denial letter should state the exact reason an applicant was not approved for benefits. Those reasons could be due to the following: being above the financial limits having physical/functional needs that arent severe enough for approval a mistake on the application.
Mistakes are common on Medicaid applications! These are complicated documents that take a long time to fill out correctly.
It is common for one to immediately appeal a denial, but that is not necessarily the correct next step to get Medicaid to change its mind.
How To Appeal:
How To Become Eligible For Dual Health Plans With Medicare And Medicaid
It is possible to be eligible for both Medicare and Medicaid simultaneously. You are termed dual eligible if you
- Qualify for Medicaid in your state
- Qualify for Medicare Parts A and B
- Live in a dual-eligible plans coverage area
In that case, you will be enrolled in a dual health plan. This plan is a sort of Medicare Part C that is unique. Medical, prescription and hospital care are combined in dual health plans, and you preserve all of your Medicaid benefits.
Private insurance firms provide dual health plans that allow you to choose the best coverage for you and your health care needs. For persons who are enrolled in both programs, Medicaid may pay some costs of Medicare premiums, copayments, and deductibles.
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Medicaid Application Processing Timeline
In most cases, Medicaid applications are handled within 45 days of receipt or 90 days if a disability assessment is required. However, in order to collect the necessary paperwork for the application process, a family needs to add several weeks to that estimate. It can be challenging to reapply for Medicaid in a different state, whether for oneself or a family member.
B: Investigate Alternate Pathways To Eligibility For Nursing Home Medicaid
Medically Needy MedicaidMedically Needy Medicaid is available in 36 states, and Washington D.C., and is for getting Medicaid benefits to people who spend a significant amount of their income on care costs, even if their monthly income is above the Medicaid income limit. Another way of describing Medically Needy Medicaid is to say that an applicant becomes eligible if the difference between their monthly cost of care and their monthly income is less than a specific amount set by the state.
For example, if the Medically Needy Income Limit in your state is $600, someone who makes $3,000 per month would need to spend more than $2,400 on medical expenses to be eligible for Nursing Home Medicaid despite earning more than the monthly income limit for Medicaid.
Miller Trusts or Qualified Income TrustsAnother option is Miller Trusts or Qualified Income Trusts , which can get complicated but would be described basically as special accounts for someone to deposit income that put them over the Medicaid limit. Money in the trust would not count toward eligibility and would only be accessible by the applicant for specific purposes. The trust is managed by someone who is not the Medicaid applicant and can be used to pay for medical expenses not covered by Medicaid. Not every state allows for Miller Trusts or QITs.
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How To Apply For Long
For those applicants who are already at or below the income and asset levels, it is very typical that the nursing home does the application for you/the resident. Typically, the business office and/or social worker can do this when the resident’s income and assets are already below the applicable limit. If you/the elder is at home and looking to apply for Medicaid, then you would call your local Aging Resource Center to get placed on the long-term care wait list. There is no waitlist for nursing home Medicaid but there is a very long waitlist for assisted living and in-home Medicaid assistance.
If the elder’s assets are above the minimum level, then it is highly likely that the family will want to consult a good elder law attorney to learn legal ways to protect assets. Here, the elder law attorney would do the application for the elder after assets are legally protected, when appropriate.
How To Chek If You Qualify For Medicaid
You can only find out if you qualify for Medicaid by filling out an application. However, before you do, talk to a Certified Medicaid Planner to ensure youre on the right track. The CMP Governing Board is in charge of certifying CMPs. Attorneys, accountants, social workers, financial advisors, and geriatric care managers are among those that operate in this field. Medicaid is one of the governments most complicated bureaucratic processes. Therefore, hiring a professional is a good idea, just like hiring an accountant to file your taxes or consulting a lawyer for legal advice.
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Personal Care Services Are For Recipients Under 21 Years Old
Personal Care Services provide medically-necessary assistance with activities of daily living and age appropriate instrumental activities of daily living that enable the recipient to accomplish tasks that they would normally be able to do for themselves if they did not have a medical conditional or disability.
What Is Medicaid Understanding The Basics
Medicaid is a health-insurance program for low-income people of all ages that are jointly supported by the state and the federal government. Medicaid covers medical treatment, such as physician visits, as well as non-medical support services, such as in-home personal care, through the state plan. The state program also pays for nursing home care. As a result, Medicaid may cover virtually all of a seniors long-term care costs if he or she is financially and medically eligible.
Medicaid programs must adhere to federal regulations. The federal government contributes a share of the expenditures, but each state manages Medicaid independently. As a result, coverage and expenses may vary depending on your states demands and economic goals. One of the most perplexing aspects of this system is that most states offer several programs aimed at different groups of people. In California, for example, Medicaid is known as Medi-Cal. And the waiver program that pays for assisted living services is called ALW.
In addition to the regular Medicaid, there are also special and different poverty-level programs for the Aged, Blind or Disabled people. In this guide, well focus on institutional Medicaid, which is one of the more relevant programs for older persons.
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Home Protection Strategies When Applying For Medicaid Long Term Care
There are several Medicaid planning strategies that can be used to protect ones home from Medicaids estate recovery program. When implementing a strategy, one has to proceed with caution. Some of these strategies are complicated and often the rules governing them are state specific. Furthermore, many strategies violate Medicaids look back rule. With this rule, Medicaid checks all asset transfers within 60 months of long-term care Medicaid application to ensure no assets were transferred for under fair market value. If this has occurred, Medicaid assumes it was done to meet Medicaids asset limit and the applicant is penalized with a period of Medicaid ineligibility. While not all strategies violate Medicaids look back rule, many do.
Medicaid Asset Protection Trusts
A ladybird deed is a life estate deed that is a form of co-ownership that allows a Medicaid recipients primary home to automatically transfer to a beneficiary following their death. With a ladybird deed, the Medicaid recipient continues to be the home owner and maintains control over it. The beneficiarys ownership does not begin until the Medicaid recipients death. Since ownership does not change until the Medicaid recipient passes away, a ladybird deed does not violate Medicaids look back rule.
Caregiver Child Exemption
Consult a Medicaid Planner
Medicaid Benefits And Services
The services covered by Medicaid vary from program to program and from state to state. What follows are general Medicaid benefits which are typically available in most states.
The Affordable Care Act does not significantly impact Medicaid long term care benefits for the elderly. Therefore, repeal by the Trump administration will have limited impact.
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Costs Associated With Medicaid And Applying For Medicaid
Once an individual has been accepted into the Medicaid program, generally speaking, there are no monthly payments. And co-pay amounts are non-existent or very minor. However, applicants may incur some costs during the Medicaid application process if they elect to use certain types of assistance.
There are Area Agencies on Aging that have case managers and benefits counselors who can help with the application process for no charge. There are also private Medicaid Planners who have a much stronger incentive to ensure a seniors acceptance into the program. Private Medicaid planning fees are typically several thousand dollars. It is worth noting that private Medicaid planners can very quickly pay for themselves if they are able to help a family retain some of their assets or get the candidate into the Medicaid program sooner. This is because even one month of out-of-pocket long term care costs can greatly exceed any Medicaid planning fees.
Help us improve this webpage. What questions about Medicaid and aging care have we left unanswered? Tell us.
Reasons For Medicaid Long Term Care Denials & What To Do About Them
SummaryIf one applies for Medicaid Long Term Care and is denied, it is still possible to receive Medicaid benefits. There are several reasons a person might receive a denial, and while Medicaid is different in every state, there is usally a process for someone who is initially denied Medicaid benefitsincluding Nursing Home Medicaid and Home and Community Based Services waivers for long term careto nonetheless receive those services.
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How To Apply For Ny Medicaid
You may apply for Medicaid in the following ways:
- Enrollment Assistors offer free personalized help.
- To speak with the Marketplace Customer Service Center call 355-5777
- Through a Managed Care Organization
- Call the Medicaid Helpline 541-2831
- Through your Local Department of Social Services Office
Where you apply for Medicaid will depend on your category of eligibility, which might be single, childless couples, pregnant women, parent and caretaker relatives with dependent children, elderly, and/or disabled. Certain applicants may apply through NY State of Health while others may need to apply through their Local Department of Social Service . For more information on determining where you should apply read on
The Marketplace determines eligibility using Modified Adjusted Gross Income Rules. In general, income is counted with the same rules as the Internal Revenue Service with minor variations. Applications may be completed online, with an Enrollment Assistor, by mail, or by phone.
The following individuals should apply through the Marketplace :
- Adults 19-64 years of age and not eligible for Medicare,
- Pregnant Women and Infants,
- Children 1 – 18 years of age, and
- Parents and Caretaker Relatives.
The following individuals should apply with their Local Department of Social Services :
Medicaid Innovation Accelerator Program
The Medicaid Innovation Accelerator Program , a collaboration between the Center for Medicaid and CHIP Services and the Center for Medicare & Medicaid Innovation, was administered by the Centers for Medicare & Medicaid Services from July 2014 until September 2020. . IAPs mission was to improve Medicaid beneficiaries health and care while also lowering costs by assisting states with ongoing payment and delivery system improvements. In addition, by providing focused technical assistance, tool creation, and cross-state learning opportunities, the Medicaid IAP assisted Medicaid agencies in strengthening capacity in the key program and functional areas.
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Simplify The Medicaid Process
A Medicaid planner can help you with the heavy lifting of determining what documentation youll need for your application, obtaining the documents youll need, and double-checking your application before submitting it. In addition, Medicaid planners are program experts who can help their clients understand any eligibility rules or coverage terms that they are unsure about.
The Basics Of Medicaid Denial & Next Steps
At a basic level, this is what you need to know about being denied for Medicaid programs including Long Term Care, and what to do next. If one receives a Medicaid denial letter, it is most often due to assets or income above the limits. Another possible reason is human error. One has three options upon a denial of Medicaid:
1) Request a reversal2) Appeal3) Re-Apply
Now, lets get a little more in-depth on the process of becoming Medicaid-eligible after a denial of benefits.
Who May Receive Nursing Facility Services
NF services for are required to be provided by state Medicaid programs for individuals age 21 or older who need them. States may not limit access to the service, or make it subject to waiting lists, as they may for home and community based services. Therefore, in some cases NF services may be more immediately available than other long-term care options. NF residents and their families should investigate other long-term care options in order to transition back to the community as quickly as possible.
Need for nursing facility services is defined by states, all of whom have established NF level of care criteria. State level of care requirements must provide access to individuals who meet the coverage criteria defined in federal law and regulation. Individuals with serious mental illness or intellectual disability must also be evaluated by the state’s Preadmission Screening and Resident Review program to determine if NF admission is needed and appropriate.
Nursing facility services for individuals under age 21 is a separate Medicaid service, optional for states to provide. However, all states provide the service, and in practice there is no distinction between the services.
In some states individuals applying for NF residence may be eligible for Medicaid under higher eligibility limits used for residents of an institution. See your state Medicaid agency for more information.
Complete And Submit The Application For A Medicaid Waiver
Because there are so many types of Medicaid, you should find your local Medicaid office at this link, and then find the application for the specific eligibility group you want to apply underin this case its likely the Home and Community Based Services waiver, also known sometimes as 1915 waivers.
In most states an application can be submitted three ways: in person, by traditional mail, or online. Applying online is generally faster than submitting physical documents through the mail or in person.
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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.
How To Get Qualified For Medicaid When Income Exceeds The Limit
Medicaids long-term care applicants income level must not exceed the allowable limits. The excess income can be directly allocated to a restricted funds account if it goes beyond that limit. They are referred to as Qualified Income Trusts or Miller Trusts. These funds can be used only to pay for specified costs like medical bills, nursing home bills, and Medicare premiums. The total process is quite complicated. Therefore, consulting a Medicaid Planning professional about qualifying for this benefit is highly recommended.
As Medicaid qualifications vary from state to state, not all states allow these trusts. They ask to spend-down the excess monthly income on medical-related care to be approved.
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Medicaid Coverage Of Residential Senior Care
Long-term Medicaid care is available in nursing facilities as well as in the home or community, which includes services like home care, adult daycare, adult foster care, and assisted living. HCBS means Home and Community-Based Services. Home and Community-Based Services can be delivered through Medicaid Waivers or the standard state Medicaid program.
Medicaid And Nursing Home Care
Medicaid covers long-term nursing home care for seniors who meet the programs criteria. It is an entitlement program. But to be eligible for Medicaid coverage, seniors must be financially and medically eligible. Medicaid will then pay practically all associated costs, including a seniors room and care services.
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A Daytime Program In Your Community
Whether you live alone or stay by yourself when your family goes to work, you do not have to be lonely. If you go to a daytime program, also called adult day care, you can have fun, learn and be with others. You also may get help with some tasks, such as taking medicine.
- Find out about Your Rights in HHS Community Programs .