Be Patient When Waiting
This is less of a tip on how to be approved and more advice on how to survive the waiting process. It can take weeks for this process to go from start to finish, frustrating some Medicaid patients and worrying others. Thats why its important to remain patient – oftentimes, nothing is wrong with your application other than the fact that its making its way through a large bureaucracy!
Using An Annuity For Medicaid Planning
An annuity is a regular stream of payments back to you, in exchange for a lump sum of money. It can be either a private arrangement or commercial . Medicaid only allows commercial annuities.
For example, if you are a male, age 70, you could transfer $50,000 to an insurance company in exchange for a monthly annuity payment of $400, guaranteed for your life, no matter how long you lived. But what if you died unexpectedly after two years? The annuity payments would stop. Most people do not like that, and therefore will typically purchase the annuity with a “guarantee period” of at least a certain number of years.
According to the Medicaid rules, a male age 70 has a life expectancy of 12.8 years. So you cannot purchase an annuity with a guarantee period that exceeds 12.8 years without causing a period of disqualification from Medicaid. So let’s stick with 12.8 years to be safe. Because you are guaranteed payments for the longer of your life expectancy or 12.8 years, the monthly payments will be lower. In this example, they drop from $400 to $354 per month.
So if the Medicaid “bill” is for two years of Medicaid coverage, it could easily be in the amount of $96,000 . Since that exceeds the value of the annuity, the state will receive all of the remaining payments and your family will get nothing.
- How much money is there to invest in the annuity?
- What is the age of the nursing home resident?
- What is the expected life expectancy of the resident?
Will This Cover All Of Your Medical Expenses
The short answer to this question is no. Federal regulations mandate that certain healthcare measures are fully covered. Other procedures are left up to the states to decide whether they are fully covered, partially covered, or not covered at all. Mandatory coverage includes services such as inpatient hospital services, physician service and x-ray services. Non-mandatory coverage includes things such as prescription drugs, physical therapy and personal care services. You will need to check with your state to find out exactly what is and isnt covered for your program
How Does Medicaid Check Income
Documentation of income might include any of the following: Most current pay stubs, award letter for Social Security, SSI, Railroad Retirement, or VA, pension statement, alimony checks, dividend checks, a written statement from ones employer or from a family member who is providing support, an income tax return, or a Mar 2, 2020.
Medicare Lift Chair Reimbursement
Here are additional details about the doctor evaluation and prescription needed to receive reimbursement for your lift chair. Your doctor will write the prescription if they feel that without it you may be confined to the chair or bed.
Lift chairs are typically approved for patients with muscular dystrophy, severe arthritis and neuromuscular diseases. However, your doctor will help you determine whether you are eligible for this benefit.
Your doctor will fill out the relevant sections of CMS-849, the same form you need to complete and file to receive the reimbursement.
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Can The Eligible Person Give Some Of His Or Her Income To A Spouse And/or Children
An eligible person may give some of their income to a legal spouse and/or to children under age 18 living in the eligible persons home. There are limits to how much can be given to the spouse and children. To decide how much can be given, we need income information about the spouse and/or children.
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Can You Get Dental Insurance As Part Of Medicaid
Because it is a partially state run program, the answer to this question depends on where residents call home. Some states offer dental programs as part of the comprehensive package while others offer it for a fee. Unfortunately, there are some states that do not offer dental coverage of any kind. For exact answers, it is best to contact your state authority on the matter.
How To Get A Lift Chair Through Medicaid
Do you find it difficult or impossible to get out of a chair unassisted due to a physical limitation? A lift chair can help you stand up or sit back down without assistance. In some cases, Medicaid may help you pay for this important mobility tool.
Remember that Medicaid varies drastically from Medicare. For example, Medicaid is a state-run program, whereas Medicare is a federal government program administered by individual states. For Medicare, this means that your eligibility can vary widely depending on where you live.
The easiest way to determine your eligibility is by visiting your state’s Medicaid website. Refer to the Medicaid State by State Directory for the relevant contact list. This list has the contact information as well as the telephone number for you to get the information you need. When you speak to someone, let them know that you want to apply for lift chair reimbursement.
If you schedule an appointment, make sure to bring proof of income, a photo ID and a copy of your insurance policy. You will also need a letter or prescription from your doctor indicating that a lift chair can help you retain independence. Since procedures vary for every state, it’s important to write down all the paperwork you’ll need to complete the application and receive partial or full reimbursement for a lift chair.
It’s important to ask all the questions that you may have at the meeting. For example, find out how long the application and approval process typically takes.
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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.
What Are The Income Requirements For Medicaid
The income requirements will depend on whether you get Supplement Security Income . Medicaid eligibility requirements for people who do not get SSI will be based on the MAGI system . The MAGI system includes earn and unearned income like alimony and child support payments, pensions and veteran benefits. During the application process, officials will take a look at your earnings and qualified deductions as well as the size of your household to decide if you meet the income requirements to get coverage. Households with more family members can have higher earnings than individual applicants and still qualify for coverage. The maximum amount that a household can earn and still qualify depends on the federal poverty level, which considers the number of family members the income must cover. If you do get SSI, then the income Medicaid eligibility requirements tend to be lower than the ones estimated by the MAGI system. This allows more seniors to access Medicaid.
To learn more about how to qualify for Medicaid coverage, download our guide.
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What Is Medicaid Learn How To Get Started With This Comprehensive Overview On Medicaid For Seniors
How Medicaid plays into an overall healthcare plan doesnt have to be complicated. In this article you will be helped to understand all of the viable plans at your disposal.Many Americans rely on Medicaid every year in order to visit a doctor when necessary. So what are the most important things to understand before looking into it for yourself? A quick and easy to understand overview of the program is as follows:
- What Is The Program?
- Who Can Take Advantage Of The Program?
- How Do You Apply?
- Can You Use It If You Are Also Enrolled In Medicare?
- Can You Get Dental Insurance As Part Of Medicaid?
- Will This Cover All Of Your Medical Expenses?
State Option To Adopt Streamlined Renewal Procedures For Pathways Based On Old Age Or Disability
Nearly all states have adopted at least one of the ACAs streamlined processes for Medicaid beneficiaries renewing coverage through an age or disability-related pathway, and over 60% have adopted both options . Aside from the Medicaid expansion, the ACA introduced other reforms that simplify and modernize Medicaid eligibility and enrollment processes. All states must adopt these reforms for poverty-related coverage pathways, and states can choose whether to apply them to age and disability-related pathways.105 Streamlined renewal polices can facilitate continuous coverage among eligible individuals, which helps prevent gaps in care and protects individuals from out-of-pocket costs that might be incurred if they experience a break in coverage. We surveyed states about whether they opt to send pre-populated eligibility renewal forms and whether they offer reconsideration periods for eligibility renewals in pathways related to old age or disability. The states that have not adopted either of these options are Alaska, New Hampshire, and Oregon.106
Figure 11: State Adoption of ACA Streamlined Renewal Options for Age and Disability-Related Pathways, 2018
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What Happens When A Long
When a long-term care recipient dies, Estate Recovery provisions require that we take steps to recover the cost of certain Medicaid payments from his or her estate. These costs include the total amount of payments for facility or waiver services, hospital care, and prescription drugs the person received at age 55 or older.
How Does The Medically Needy Spend
Medically Needy provides Medicaid eligibility to qualified individuals and families who may have too much income to qualify for regular Medicaid programs. Individuals and families who meet all Medicaid program requirements, except that their income is above those program limits, can spend-down or reduce their income to Medicaid eligibility levels using incurred medical expenses.
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What Medicaid Covers For Medicare Enrollees
Medicare has four basic forms of coverage:
- Part A: Pays for hospitalization costs
- Part B: Pays for physician services, lab and x-ray services, durable medical equipment, and outpatient and other services
- Part C: Medicare Advantage Plan offered by private companies approved by Medicare
- Part D: Assists with the cost of prescription drugs
Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid . Medicaid also covers additional services beyond those provided under Medicare, including nursing facility care beyond the 100-day limit or skilled nursing facility care that Medicare covers, prescription drugs, eyeglasses, and hearing aids. Services covered by both programs are first paid by Medicare with Medicaid filling in the difference up to the state’s payment limit.
How Medicaid Can Help With Medical Expenses For Seniors
Larryâs elderly father is struggling to make ends meet. After moving into a senior apartment complex after the death of his wife and living largely off of his Social Security income, his fatherâs finances are tight. Larry is helping to find ways to pay the monthly rental fee, buy groceries, and cover co-pays for his heart medications and his Medicare coverage. His father needs assistance beyond Medicare to cover his growing medical expenses, and Larry has heard about Medicaid, but heâs not sure where or how to find out if his father is eligible.
His fatherâs situation is faced by many seniors the Kaiser Family Foundation reports that one in four Medicare beneficiaries spent 30% or more of their income on health expenses in 2006. Making sense of Medicaid can be difficult for seniors and their caregivers. In the midst of an already confusing time, family caregivers often find confusion in the midst of Medicaid forms and filings. However, there are resources available to navigate Medicaid.
- The Area Agency on Aging in your area is a good first stop to learn more about the process for applying for Medicaid. To find your local agency, you can look on the National Association of Area Agencies on Aging website, which lists agencies alphabetically by state.
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What Does Medicaid Cover In Florida
The amount and type of services that will be covered by Medicaid will depend on things like how old the beneficiary is, which program the beneficiary is actually enrolled in, and even the type of services that will be necessary medically. These services might include community behavioral health, prescription medications, visual, dental, transportation, hospice, nursing home, home health care, family planning, hospital, doctor visits, and more.
How Do You Apply
Applying for Medicaid is relatively easy. There are two main ways to gain access to the program. The first is through your state run program if you feel that your income level makes you eligible. The second way to find out is through the Health Insurance Marketplace. It is here that you will find out whether or not you are truly eligible for the program.
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How Is Resource Eligibility Determined
Resources are cash money and any other personal property or real property that could be converted to cash and used for support and maintenance. Resources include checking and savings accounts, mutual fund shares, certificates of deposit, stocks, bonds, life insurance, real estate, annuities, trust, and more. The value of the resource is counted as of the first moment of the first day of the month, less encumbrances.
Countable resources cannot be worth more than $2,000 for an individual or $3,000 for a couple. Under Spousal Impoverishment rules, a married individual with a spouse living at home can have a certain amount of the couples countable resources protected for the spouse living at home. All resources owned separately by either spouse and owned jointly by the couple are used to determine the total countable resources.
Some resources do not count toward the resource limit. These resources usually include the home property, one vehicle, cash surrender value of life insurance policies with a combined face value of $10,000 or less, paid burial spaces, and irrevocable burial arrangements.
Individuals may not qualify for payment of LTC or HCBS waiver services, if the value of the home property is greater than the home equity limit or a transfer of resources for less than fair market value occurred during or after the 60 month look-back period.
What Happens If The Person Applying Transfers Resources For Less Than Fair Market Value
Medicaid must look at any transfer of resources made by the applicant or applicants spouse which occurred during the 60 months before the application date or at any time after application. Transfers for less than fair market value are presumed to have been done to qualify for Medicaid, unless the applicant provides convincing evidence that the transfer was done exclusively for another purpose. If it is determine that resources were transferred to qualify for Medicaid, the person who needs long-term care will not be eligible for payment of facility care or waiver services for a specified period. Medicaid uses the difference between the value of the transferred item and what the person received in return to determine how long the person will not be eligible for payment.
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Where Can I Find Information About A Nursing Home’s Health Or Fire
Health and fire-safety inspections with detailed and summary information about deficiencies found during the three most recent comprehensive inspections and the last three years of complaint investigations are found on the Medicare.gov Nursing Home Compare website.
Nursing Home Compare allows consumers to search for a nursing home based on location and compare the quality of care they provide and their staffing. Nursing Home Compare has detailed information about every Medicare and Medicaid-certified nursing home in the country.
For information about Louisiana nursing homes or any other nursing home inquiry, contact the LDH Health Standards Section, Nursing Home Program Desk at 225-342-0114 or visit the Louisiana Nursing Home Association website. Nursing home providers are required to post the results of their most recent inspection in the facility.