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.
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.
Mandatory Eligibility For Medicaid
States are required to provide Medicaid to recipients of federally matched cash assistance, either SSI or AFDC. The more relevant program to the issue of long-term care eligibility is SSI because virtually all long-term institutionalized persons are aged, blind, or disabled, and are not part of the AFDC-related population. Therefore, the following discussion generally does not consider AFDC rules or families.
The majority of elderly and disabled Medicaid recipients live in community settings and qualify for Medicaid by virtue of receiving an SSI payment requirements where applicable). Just the opposite is true of Medicaid recipients in institutions, the majority of whom establish Medicaid eligibility under other eligibility provisions because they have too much income to qualify for a cash payment. In 1986, Medicaid served a total of 6.2 million elderly and disabled persons of whom 4.1 million, or 2 out of 3, also received cash assistance. By contrast, a little more than 330,000, or 1 in 5, of the 1.5 million Medicaid recipients of SNF or ICF services were poor enough to qualify for SSI.
The reduced rate means that institutionalized persons with incomes from all other sources of $50 per month or more do not receive an SSI payment and cannot qualify for Medicaid assistance as members of this mandatory eligibility group.
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Nursing Home Care Vs Assisted Living
Not every nursing home resident actually requires nursing home care. It is important to recognize many assisted living communities now offer advanced care services that are almost on par with nursing homes. One option for reducing nursing home costs is to consider assisted living instead. Read about the key differences between assisted living and nursing home care.
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.
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Eligibility And Asset Transfer Rules
In the past, to avoid exceeding Medicaid’s income limits, some families would transfer a patient’s assets into the names of other relatives, such as the children. The Deficit Reduction Act of 2005 made such maneuvers much harder to manage. Now, when you apply for Medicaid, there is a five-year lookback at all asset transfers. If Medicaid finds money was transferred within the past five years, a penalty period is imposed, delaying the onset of Medicaid coverage.
Medicaid calculates the penalty by dividing the amount transferred by what Medicaid determines is the average price of nursing home care in your state.
For example, suppose Medicaid determines your state’s average nursing home costs $6,000 per month, and you had transferred assets worth $120,000. You will not be eligible for Medicaid assistance until you pay the cost of the nursing home for 20 months . There is no limit to the number of months for which someone can be declared ineligible. The penalty period begins on the day the patient enters a nursing home.
Not all transfers are counted in the lookback period. Arrangements that are allowed include transfers to:
Medicaid programs are paid for out of both federal and state funds.
How Much Is The Medicaid Copayment To The Nursing Home
The Medicaid program requires nursing home benefit recipients to share in the monthly cost of their care. This is called the Medicaid copayment or their applied income. In Texas, every nursing home Medicaid recipient is entitled to a personal needs allowance of $60 per month. But as explained in more detail below, Medicaid recipients can actually keep more of their income than the $60 allowance suggests. It is also important to understand that the Medicaid recipient still receives their income. Therefore, even if an individual is on Medicaid, the recipient will still be responsible for satisfying a monthly copayment to the nursing facility. If this copayment is not paid, the nursing facility can begin the process to discharge the resident for nonpayment.
As the payor of last resort, Medicaid encourages benefit recipients to keep their Medicare or other health coverage by reducing the monthly Medicaid copayment dollar for dollar by the premium paid to maintain health insurance. To be more specific, the Medicaid copayment will be reduced for incurred medical expenses not covered by a third party. These expenses are limited to Medicare and other general health insurance premiums, deductibles and coinsurance, and to medically necessary medical care and services that are recognized by state law but not covered under the Medicaid state plan.
Other Frequently Asked Questions
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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.
Adult Day Care / Adult Day Health Care
Medicaid in all 50 states through Medicaid HCBS Waivers and some regular Medicaid programs will cover adult day care and / or adult day health care for some beneficiaries. Interestingly, some states choose to only cover adult day care and not adult day health care and other states choose to do the reverse. Still other states elect to cover both options. Specific state policies and waivers are available here.
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Illinois’ Medicaid Program Pays For Nursing Homes Assisted Living And Home Health Care Services For Many Illinoisans
Long-term care services in Illinois are expensive, including nursing homes, assisted living facilities, and home health care. Private health insurance policies generally do not cover long-term care , and Medicare coverage for LTC services is quite limited. LTC insurance policies can help pick up some of the tab, but few people purchase it. This leaves Medicaid, which has become a very common source of funding for long-term care.
There are, however, strict rules for Medicaid eligibility for long-term care in Illinois. Besides qualifying financially, you also need to qualify medically for Medicaid to pay for any LTC service like a nursing home, assisted living facility, or home health care.
Eligibility For Medicaid In Florida For Nursing Home Care
If you have a loved one who may need nursing home care but would like government assistance in paying for it, you will need to make sure the candidate meets all of the criteria in Florida to receive Medicaid for nursing home care.
These criteria are as follows:
- Legal residency in Florida
- A need for nursing facility level of care
- At least 65 years old, OR between 18 and 65 years old and designated by the Social Security Administration as being disabled
- Meeting the financial requirements for Florida Medicaid
Nursing facility level of care
The phrase nursing facility level of care does not necessarily mean the person receiving care requires nursing. Instead, Florida has standardized degrees to which a person needs assistance or partial assistance for completing at least two activities of daily living, such as bathing, eating, mobility and personal hygiene.
Financial eligibility
The state will consider an applicants income and owned assets for Medicaid eligibility for nursing home care. As of 2020, the individual income limit is $2,349 per month, and double that for couples. The asset limit for a single applicant is $2,000 for an individual and $3,000 for a couple, but there are many assets that will be exempt from counting toward this eligibility standard.
For more information about Medicaid eligibility for nursing home care and how to apply for Medicaid in Florida, contact an experienced Tampa estate planning lawyer at BaumannKangas Estate Law.
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Three Ways Medicaid Attorneys Help You Plan For Nursing Home Care
Medicaid attorneys can provide invaluable help in making a plan for nursing home care. According to the Wall Street Journal, you have around a 40 percent chance of needing nursing home care if you have reached the age of 65, and a 25 percent chance of needing care in a nursing home for at least five years.
You dont want to have to make decisions about care in an emergency situation after you have decided you can no longer live alone. You also dont want your family to be forced to make care decisions in an emergency. And, in some cases, it would be too late to take the steps that you would have needed to take to protect yourself when you must go into a nursing home if you have waited until the time for care is imminent.
Instead of putting yourself and your family in a difficult situation by waiting too long to make a plan for nursing home care, you should reach out to Eghrari Wealth Training Law Firm today. Our legal team will work closely with you to help you in many ways to make your plans for your care and to make sure you can afford to pay for it. In particular, three key ways that Medicaid attorneys can help you to make a plan for nursing home care include the following.
The Best Nursing Homes In Cedar Rapids
- Find the best nursing homes in Cedar Rapids, IA, according to the Centers for Medicare & Medicaid Services . Learn more about your nursing home options and find out how you may be able to get help paying for qualified nursing care.
Its understandable for anyone looking for a nursing home to seek out the very best in quality care. There are approximately 30 nursing homes in Cedar Rapids, IA, so determining which one may be best for you or your familys needs can seem like a daunting task.
Fortunately, nursing homes in Cedar Rapids are rated for quality every year by the Centers for Medicare & Medicaid Services . The CMS uses a five-star scale to assess each nursing home on various quality measures like staff credentials and facility cleanliness.
Below is a list of nursing homes in Cedar Rapids sorted by their Medicare star rating. A five-star nursing home is considered the very best in quality, while three stars signals an average quality nursing home.
| Facility | |
|---|---|
| ST LUKE’S HELEN G NASSIF TRANSITIONAL CARE CENTER | 1420 UNITYPOINT WAY |
| THE GARDENS OF CEDAR RAPIDS | 5710 DEAN ROAD SW |
| 393-1447 |
This list includes only nursing homes in Cedar Rapids. There may be additional nursing homes just outside Cedar Rapids worth considering in your research. You may use the Medicare care compare search tool to look for more nursing homes around the Cedar Rapids area.
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Disposition Of Excess Assets
Many persons in institutions begin their stays as private-pay residents, paying their monthly expenses out of some combination of income and assets. If their stay is long enough to deplete assets to Medicaid levels, they may subsequently be able to qualify for assistance.
The process of asset depletion is also referred to by the term spend down, an unfortunate double use of a term that originally and more technically refers to the periodic use of excess income in medically needy cases. The two processesspend down of assets and spend down of incomeare quite distinct as regards the rules that govern them and their effect on individuals.
The Medicaid program does not dictate how the individual must use excess resources during the period preceding Medicaid eligibility. Common sense dictates that the individual use resources, in combination with available monthly income, to cover nursing home and other medical expenses. However, except for the Medicaid penalties against those who give away assets, there are no other constraints on how the person uses his or her resources, and they may be used without limits to purchase personal items, gifts, or they may be converted into exempt resources such as burial contracts.
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.
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Pennsylvania’s Medicaid Program Will Pay For A Nursing Home Or Home Care If You Have Limited Income And Assets And Your Doctor Certifies That You Need The Care
Nursing homes and assisted living facilities in Pennsylvania are expensive, and even alternative long-term care like home health care can be costly. In 2017, the median annual cost of a private room in a nursing home in Pennsylvania was $120,085. Private health insurance policies generally don’t cover long term care, very few people purchase private long-term care insurance policies, and Medicare coverage for long-term care services is limited.
When people can’t afford to pay the $5,000 to $8,000 per month of long-term care, they often turn to Medicaid, which has become a very common source of funding for long-term care. In 2017, approximately 60% of nursing home residents in Pennsylvania used Medicaid to pay for their nursing home care.
There are many different ways to become eligible for Medicaid in Pennsylvania, and there are specific eligibility rules for long-term care services like nursing homes, assisted living facilities, and home health care services.
Why You Need Medicaid To Pay For Nursing Home Care
Seniors who are covered by Medicare often believe they dont have to worry about the high costs of nursing home care, but this couldnt be further from the truth.
Medicare pays for some limited types of skilled nursing care for a very limited period of time. But, long-term care simply isnt covered under the Medicare program. Further, a lot of the help and care people need falls well short of skilled nursing care. For example, people who need help taking their medication, cooking, bathing, or have memory problems really need help, but may not need skilled nursing care. Sometimes, people with these needs end of squeezed into skilled nursing care because Medicaid will pay for this and there are no other options.
Because Medicare wont pay for care, seniors need to find an alternative. Buying long-term care insurance also isnt a viable option for most, in part because premiums tend to become prohibitively expensive with advancing age, and in part because of the fact that most long term care policies have daily payment limits or other restrictions that make them ineffective in fully covering the care seniors need.
The process of impoverishing yourself to get Medicaid can, however, be avoided or mitigated with help. Medicaid attorneys at Clarity Legal Group® will work with you to make certain you are able to protect as much of your wealth as possible while getting Medicaid to pay for the nursing home care you need.
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