What Qualifies You To Get Medicaid
Medicaid beneficiaries generally must be residents of the state in which they are receiving Medicaid. They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. In addition, some eligibility groups are limited by age, or by pregnancy or parenting status.
How Do You Calculate Your Medicaid Income Eligibility
Follow these steps to calculate whether or not your income may qualify you for Medicaid:
- Find the FPL for your household using the chart above
- Multiply that number by your states Medicaid income limit found below, and then divide by 100
For example, if there are two people living in your household and you live in Arizona, you would multiply $17,420 by 138 and then divide by 100. That equals $24,039.60.
You may also multiply $17,420 by 1.38.
Michigan’s Medicaid Program Will Pay For Long
Long-term nursing home care in Michigan doesn’t come cheap. In 2018, the average daily cost of a private room in a nursing home in Michigan was $300. For people with few assets, including those who have already used up all of their own assets to pay for care, Medicaid is a common source of funding for long-term care. Those with too many assets often have to pay for their own care outright, because private health insurance policies generally do not cover long-term care, and few people purchase private long-term care insurance policies.
There are many different ways to become eligible for Medicaid, and there are specific eligibility rules for long-term care services like nursing homes. To apply for Medicaid in Michigan, contact your local office of the Michigan Department of Health & Human Services. You can also apply online.
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Can I Get Emergency Fap Benefits
Certain households are eligible for expedited or emergency FAP benefits. You are probably eligible for expedited FAP benefits if any of these are true:
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Your gross monthly income is $150 or less and you have less than $100 in cash or savings
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Your gross monthly income plus all of your cash and savings are less than your monthly housing and utility bills
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You are a migrant or seasonal worker who is between jobs and you have less than $100 in cash or savings
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You are homeless
If your application alone shows that you are eligible for expedited FAP benefits, MDHHS must review and make a decision on your application within seven days. This is true even if you dont have all the papers and proof of income that MDHHS asks for. You will have to give MDHHS all of this information in order to continue getting FAP.
The benefits should be issued on the seventh day, though delays are common. If you dont receive your benefits shortly after the seventh day, try calling your caseworker. If you cant get a hold of your caseworker, your local legal services office may be able to help you. Use the Guide to Legal Help to find a legal services office near you.
Michigan Medicaid Eligibility Guidelines
To qualify for Medicaid in Michigan, an individual must meet the eligibility requirements of the program.
There are several Medicaid programs that people in Michigan can be eligible for. Each program has its own income and asset requirements.
However, all applicants must meet the general requirements below in order to qualify for Michigan Medicaid.
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More Ways To Qualify For Medicaid If You Have A Disability
There are other ways to qualify for Medicaid if you have a disability. You might qualify for SSI-related Medicaid if:
- You get Supplemental Security Income benefits.
- You make more money at work than income-based Medicaid allows. In that case, you could apply for Freedom to Work.
- You also get Medicare. Usually, Medicaid doesnt cover people getting Medicare, but SSI-related Medicaid does. It may even help pay your monthly Medicare premiums.
- You are 65 years old or older.
You might qualify for income-based Medicaid, even though you have a disability, if:
- Your disability does not meet Social Securitys definition of disability. SSI-related Medicaid is only for people who have disabilities meeting this standard.
- You have more resources than are allowed by SSI-related Medicaid.
- You make enough money that you would have to pay a monthly premium for Freedom to Work.
Learn more about SSI-related Medicaid andFreedom to Work.
Transfers Not Labeled As Divestments
There are certain transfers that MDHHS wont label as divestments. These types of transfers can be complicated. Here are some examples:
- An income transfer that is not countable income for SSI related to TM
- A transfer from one spouse to another, or a transfer solely for the benefit of the spouse not getting one of the services listed above
- A transfer to a blind or disabled child, regardless of that childs age
- A transfer totally for a purpose other than to be or stay eligible for TM
There are other types of transfers that MDHHS will not label as divestments not listed here. If you have questions about whether MDHHS will count a transfer as a divestment, you can speak with someone at MMAP. Your local legal services office may also be able to help you. Use the Guide to Legal Help to find a legal services office near you.
You can also contact a local FQHC. They often have patient advocates who can help answer questions about Medicaid. Use the locator tool to find a FQHC near you.
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What Is The Healthy Michigan Plan
The Healthy Michigan Plan is run by the Michigan Department of Health and Human Services . It covers ten essential health benefits:
- Ambulatory patient services
- Mental health and substance use disorder treatment services, including behavioral health treatment
- Prescription drugs
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Some health plans offer extra benefits to Healthy Michigan Plan members like transportation services, care management and virtual care. Find what extra Priority Health offers here.
When To Apply For Medicaid
The best time to apply depends on your medical situation, your marital status and the complexity of your finances. If your finances are straightforward, the state may be able to process your application faster. If you find that you need long-term care, you should apply as soon as possible because it may take some time for the state to process your application and make an eligibility determination. For the most part, the date you become eligible is based on the date you apply, assuming you meet all of the eligibility requirements when you apply. The longer you wait to apply, the later your date of eligibility will be.
The Medicaid agency usually has 45 days to process your application. If the application requires a disability determination, the agency can take up to 90 days. But, it may take longer for the state to determine your eligibility if you do not provide the required documents on time. If Medicaid thinks that you are not cooperating, it can deny your application for failing to cooperate. If this happens, you may have to start your application over again once you have your documents in hand. This will delay the date you become eligible for Medicaid even longer.
Michigan Medicaid Attorneys at The Elder Law Firm PC& Associates provide assistance in protecting your assets and protecting your family through Medicaid planning. Contact us by calling 877.960.5233 or completing our free online Medicaid planning form here.
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Learn About Medicaid Expansion In Mi
What are the Medicaid application guidelines regarding expansion? The Medicaid program is referred to as the Healthy Michigan Plan.
In order to understand who is eligible for Medicaid expansions in MI, recipients ought to familiarize themselves with the plan and how it is helping newly eligible adults. Income up to 138 percent of the Federal Poverty Level can be earned by newly eligible adults who may be wondering how to qualify for Medicaid.
The reformed Healthy Michigan Plan saw 497,000 beneficiaries meet the Medicaid eligibility requirements by January 2015 and by September, more than 100,000 newly eligible recipients enrolled. It was on September 16, 2013, that the law came into effect.
Now that the number of people able to achieve Medicaid benefits eligibility in Michigan has broadened, the coverage gap is getting smaller.
Timelier healthcare can be offered as a result of broadening the application guidelines for Medicaid and peoples minds can be put at rest. The road to expansion has had some speed bumps though, with the process taking almost eight months to activate.
Financial Resources For Michigan Medicare Enrollees
As a Medicare beneficiary, your state of residence may have a significant impact on the care that you receive and how you pay for that care during your golden years. This page explains how Michigans regulations and policies are likely to affect your bottom line.
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Michigan Medicaid Health Plans
Most people with Michigan Medicaid will have to select a health plan. Plans are different in every county. The benefit of choosing a plan is that your care will likely be much more coordinated and run more smoothly. Your doctors and specialists are more likely to work well together. Aside from the county health plans, Michigan has four eligibility group plans:
What Is The Income Limit For Medicaid In Michigan
The Michigan Department of Human Services determines eligibility through the Modified Adjusted Gross Income methodology. Under those guidelines, enrollees between the ages of 19 and 64 are eligible for Michigan Medicaid if their annual income does not exceed $16,000 for a single person or $33,000 for a family of four.
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How Much Is The Federal Poverty Level
The federal poverty level in 2021 is equal to an income of $12,880 per year for an individual adult, plus $4,540 for each additional household member. Alaska and Hawaii have different benchmarks because of their differing costs of living.
2021 Federal Poverty Level by State|
Number of people in home |
48 states and Washington D.C. |
Alaska |
|---|
What Happens After I Apply For Medicaid In Michigan
After you submit your Michigan Medicaid application, you may be required to attend an interview with a Department of Health and Human Services caseworker.
Whether you will be required to attend an interview depends on your situation:
If you are applying for Medicaid for your child alone, then no interview will likely be required.
If you are applying for any other benefits at the same time, then an interview will likely be required.
During this interview, you will be required to bring documents that prove the information that you provided on your initial Michigan Medicaid application.
Once you complete this interview, you will receive a call or a letter in the mail that will tell you whether you were approved or denied.
If you are denied benefits, you have the right to appeal but that appeal must be filed within a certain timeframe. As your caseworker for details.
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Michigan Home Help Program
Seniors who prefer to age-in-place and receive care services in their own home may consider the Michigan Home Help Program, which operates similarly to the MI Choice Waiver. Seniors who require assistance with their activities of daily living may participate in the Home Help Program to receive Medicaid coverage for in-home personal care and housekeeping services.
Individuals who currently reside in nursing homes may not qualify for the Home Help Program. The program is designed to help seniors remain in their private residences for as long as possible without being institutionalized, therefore a nursing home resident may not use the program to relocate from their facility into a residential setting.
The Home Help Program operates using Michigans Cash and Counseling model, allowing participants to select their caregivers. They may select anyone to provide their care, including family members or close friends. The person who is selected to provide care may be paid for their services through the Home Help Program, although they may not be paid as much as a caretaker working for a facility. However much a caretaker is paid depends on the county in which they provide service.
Additionally, an applicant must meet the asset and income requirements for Medicaid to qualify for the Home Help Program.
When A Nursing Home Is Medically Necessary
Medicaid will pay for a nursing home only when it is medically necessary. You must show that you require a “nursing home level of care,” meaning that you have a physical or mental condition that requires nursing supervision and assistance with activities of daily living .
Within the first two weeks after you are admitted to a nursing facility, Medicaid requires that you have a “Level of Care” determination. In Michigan, nursing facility staff do the LOC determination using an online state system.
To determine the level of care you need, nursing facility staff will ask you questions to determine how much assistance you need with your ADLs. The ADLs that Michigan uses to determine whether you meet the nursing home level of care are: bed mobility, transfers, eating, toileting, short-term memory, cognitive skills for decision-making, and making yourself understood. For each, the assessor will decide how much assistance you need and assign you a functional level. The levels are: Independent, Supervision, Limited Assistance, Extensive Assistance, Total Dependence or Activity Did Not Occur. For example, if you usually cannot get up from a chair without someone helping you, then the assessor may say that you need limited assistance with transfers.
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Earned Income Tax Credit
The Earned Income Tax Credit gives money to low- to moderate- income workers and families. Even people who dont make enough to owe income taxes may qualify for this tax credit.
To qualify, you must have income from employment, self-employment, or employer-paid disability benefits and you must file your taxes! The amount of your EITC depends on your family size and income and can range from $2 to $6,728. Note: If your income is too high, you dont qualify for the credit.
To get the Earned Income Tax Credit, you need to file your taxes, even if you owe nothing. Make sure to complete the Schedule EIC as well. Lots of people dont get the EITC because they dont know they could.
If you need help filing your taxes, get in touch with a Volunteer Income Tax Assistance center. With VITA, certified volunteers help prepare your taxes and make sure you get any credits you qualify for. Most sites also offer free electronic filing . Find a local VITA center or call 1-800-906-9887.
How Much Income And Assets A Spouse Can Keep
If you have a spouse who is going to continue to live independently, then Michigan will allow you to keep more income and assets to support that spouse. This is called spousal maintenance.
Your spouse will be allowed to keep some income each month. The amount will depend on how many dependents and expenses he or she has. In 2019, the minimum amount your spouse can keep is $2,057.50, and the maximum is $3,090. If your spouse needs more than the Department of Health & Human Services decides to allow, then you can go to court and ask a judge to order more.
You will also be allowed to keep more than $2,000 in resources if you have a spouse who will remain in the community. The Department of Human Services does a complicated calculation to determine how many assets your spouse can keep.
When you are admitted to a nursing home, you will complete a form called an “Assets Declaration,” and the staff will do ask you about all of your assets in an “Initial Asset Assessment” . Michigan assumes that half of your IAA should belong to your spouse, subject to a limit that changes annually. In 2019, the minimum “Protected Spouse Amount” is $25,284, and the maximum is $126,420. When you apply for Medicaid, your PSA is subtracted from your countable assets at the time of your application.
EXAMPLE
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Who Is Eligible For Medicaid In Michigan
You qualify for Medicaid in Michigan if your household income is below the following limits :
- 195% of the federal poverty level for infants under 1 year old
- 160% of FPL for children 1-18 years old children with slightly higher household income up to 212% of FPL, qualify for the Childrens Health Insurance Program, which is called MICHILD in Michigan
- 195% of FPL for pregnant women
- 133% of FPL for parents and other adults
While these are the main groups covered by Medicaid, other people such as those who are blind or disabled may also qualify. See the Department of Community Health website for more information on covered groups and eligibility guidelines.
Who Qualifies For Medicaid
In all but 13 states, adults who make below a certain income may qualify for Medicaid. In all states, Medicaid is available to people who make a low income and also meet other criteria such as being at least 65 years old, disabled, pregnant or other qualifications.
Each state runs its own Medicaid programs with its own set of qualifying criteria.
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