Medicaid Eligibility Pa Over 65

Income Requirements For Pennsylvania Medicaid

Household size, the total of outgoing bills, and eligibility requirements help determine the income requirements for each family applying for Medicaid in Pennsylvania. The amount varies for everyone based on these details. Single adults between the ages of 19 and 64 must have an income that falls below 133% of the federal poverty guidelines to be eligible. A maximum income of $15,800 per year, or roughly $1,317 per month, is designated to an individual.

Gifts Can Create Ineligibility

The Medicaid Gifting Problem. Parents sometimes help their children financially. Grandparents give money to their grandchildren. Unfortunately, if that parent or grandparent is admitted to a nursing home within 5 years of such gifting and needs to apply for Medical Assistance long-term care benefits there could be problems, sometimes big problems. Specifically, the application for benefits could be denied for a period of time. This is known as the Medicaid transfer penalty. Large gifts can create long periods of ineligibility for Medicaid long-term care benefits. Read more about the Pennsylvania Medicaid gifting rules.

Asset Limits For Pennsylvania Medical Assistance Long Term Care Benefits

Disclaimer: This article has been posted for general information purposes only, and applies only to Pennsylvania residents. You should not act upon the information in this article without first retaining legal counsel.

By Robert C. Gerhard, III, Esquire

We are commonly asked about the Medical Assistance long-term care resource limits. In order to qualify for benefits the applicant must be resource eligible. This commonly involves a spend-down of excess resources to below the applicable limit. The problem is that there is a great deal of misinformation out there about how far one must spend-down before becoming eligible for benefits to cover nursing home costs.

This article will attempt to clear things up a bit as you begin your research. This article is not a substitute for legal advice, if legal advice is needed please reach out, but should help you better understand the topic. You will generally do better navigating the Medicaid application process if you have an experienced elder law attorney help you along the way.

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Medicaid Income Limits For Seniors And People With Disabilities

Medicare recipients can be “dually eligible”eligible for both Medicare and Medicaidinwhich case Medicaid will help cover Medicare premiums and some other out-of-pocket medical expenses.The eligibility criteria for these specific Medicaid pathways can be complicated,both in terms of how income is counted and what income needs to be under in order to be eligible.For all pathways below, there are significant deductions to your income that may apply, includingignoring half of your earned income. For a more accurate estimate use our Medicaid eligibility calculator.For more information, view our Medicaid for Seniors guide.

Aged, Blind, Disabled Medicaid Pathway

The Aged, Blind, and Disabled pathway to Medicaid eligibilityis the most common pathway to eligibility for those with a disability or over 65 years old.

Medically Needy Medicaid Pathway

The Medically Needy pathway to Medicaid eligibility allows people who spend a significantamount of their income on medical expenses to “spend down” their income to receive Medicaid.Like ABD Medicaid, there are significant deductions to your income that may apply,including ignoring half of your earned income.Additionally, your monthly medical expenses are subtracted from yourincome to get the final income that’s used in the eligibility calculation.The medically needy spend down pathway to Medicaid eligibility is available for children, people over 65, people with a disability, parents to children under 18, and pregnant women.

If Your Income Is Low And Your State Hasnt Expanded Medicaid

If your state hasnt expanded Medicaid, your income is below the federal poverty level, and you don’t qualify for Medicaid under your state’s current rules, you wont qualify for either health insurance savings program: Medicaid coverage or savings on a private health plan bought through the Marketplace.

Find out why

• When the health care law was passed, it required states to provide Medicaid coverage for all adults 18 to 65 with incomes up to 133% of the federal poverty level, regardless of their age, family status, or health.
• The law also provides premium tax credits for people with incomes between 100% and 400% of the federal poverty level to buy private insurance plans in the Health Insurance Marketplace®.
• The U.S. Supreme Court later ruled that the Medicaid expansion is voluntary with states. As a result, some states havent expanded their Medicaid programs.
• Adults in those states with incomes below 100% of the federal poverty level, and who dont qualify for Medicaid based on disability, age, or other factors, fall into a gap.
• Their incomes are too high to qualify for Medicaid in their states.
• Their incomes are below the range the law set for savings on a Marketplace insurance plan.

States are continuing to make coverage decisions. They could expand Medicaid in the future.

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How Much Does Medicaid Cost In Pennsylvania

The federal government, partnered with the state of Pennsylvania, spends a total of more than $27 billion per year on Medicaid costs. Thirty-seven percent of the states budget is allocated to these funds. Plans to expand the program are in the works, meaning even more people will get access to some of the funds for medical coverage.

Apply For Medicaid Coverage Even If Your State Hasnt Expanded

Even if your state hasn’t expanded Medicaid and it looks like your income is below the level to qualify for financial help with a Marketplace plan, you should fill out a Marketplace application.

Each state has coverage options that could work for you particularly if you have children, are pregnant, or have a disability. And when you provide more detailed income information you may fall into the range to save.

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Medicare Vs Medicaid: Compare Benefits

In the context of long-term care for the elderly, Medicares benefits are very limited. Medicare does not pay for personal care . Medicare will pay for a limited number of skilled nursing days following hospitalization no more than 100 days for a minimum of 3 days. Medicare will also pay for some home health care, provided it is medical in nature. In recent years, some Medicare Advantage plans started offering long-term care benefits. These services and supports are plan-specific. But they may include:

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If I Lose My Job Or Find A New Job Will I Lose My Medicaid Coverage How About My Family Members

No. Unlike employer-sponsored plans, Medicaid is not tied to your job. Youll still have it even if you lose your job because of COVID-19 or for any other reason. If you find a job, your new financial situation will determine whether you qualify for Medicaid. Your eligibility is based on income, age, residency, citizenship, ability, pregnancy, family size and the role you play in your household.

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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

Medicare Savings Programs For Dual Eligible Beneficiaries94

States must offer Medicare Savings Programs through which low-income Medicare beneficiaries receive Medicaid assistance with some or all of their Medicare out-of-pocket costs.95 Medicare beneficiaries include seniors as well as nonelderly people with disabilities receiving Social Security Disability Insurance, generally after a 24-month waiting period. Medicares out-of-pocket costs, including premiums, deductibles, and other cost-sharing, can be high. For example, Medicare Part A, which covers inpatient hospital services, has an annual deductible of $1,340 in 2018.96 Medicare Part B, which covers outpatient services, requires a monthly premium of $134 for most beneficiaries in 2018.97 Part B also requires an annual deductible of $183 in 201898 and co-insurance of 20% of the Medicare-approved cost of services after the deductible is met.99 Box 4 describes the MSP pathways.

Box 4: MSP Pathways

To help low-income enrollees afford Medicares out-of-pocket costs, state Medicaid programs must offer three MSPs:

Qualified Medicare Beneficiaries generally have incomes up to 100% FPL .100 Medicaid pays Medicare Parts A and B premiums and cost-sharing for QMBs.

Specified Low-Income Medicare Beneficiaries have slightly higher incomes and receive help with Medicare Part B premiums only.101 Most states set their SLMB income limits at 120% FPL .102

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Pennsylvania Medicaid Income Limit

The PA Medicaid eligibility income limit charts are divided by groups.

For example, the first chart is focused on income limits for children who qualify for Medicaid.

Similarly, the second chart below focuses on the Medicaid income limits for adults in Pennsylvania who qualify for Medicaid.

Pennsylvania Medicaid Income Limit for Children

Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.

How to Read the Pennsylvania Medicaid Income Limits Charts Above

You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.

Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.

For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 215% of the Federal Poverty Level which for a family of two is $37,453 as shown in the chart above.

Modified Adjusted Gross Income

Your modified adjusted gross income is your AGI with excluded foreign income, non-taxable portions of your Social Security income, and tax-exempt interest.

Essentially, this adds back certain deductions from the AGI. For most people, the AGI and MAGI will be the same.

When it comes to Medicaid eligibility, however, MAGI has two components. The first is your household income, and the second is the size of your household.

If you are on your own, in a family of two, or in a family of five, you will have different qualifying MAGI levels to become eligible for these programs. Each state will have different MAGI levels too, depending on whether or not they enacted Medicaid expansion.

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Funeral And Burial Funds

The government allows some dignity when it comes to death and dying. Funds used to pre-arrange a funeral or memorial are excluded from your Medicaid assets. This includes pre-purchased burial plots, not only for you but for your immediate family.

If no preparations are made in advance, a bank account up to $1,500 can be reserved for funeral expenses and not be counted towards your Medicaid qualifying assets.

Case Study #: Single / Widowed

Jerry, a widower, has two daughters. His daughter Nora was born with Down syndrome and currently resides in a group home. His daughter Laura quit her job three years ago to move in with Jerry and care for him full-time. If not for Lauras care, Jerry would have had to reside in a nursing facility.

Now Jerrys immobility and dementia have both progressed to the point that Laura can no longer safely care for him at home. Laura arranges Jerrys admission to a nursing home 10 minutes away from Jerrys residence.

When Jerry had full mental capacity, he signed a durable power of attorney that named Laura as his agent. The POA gives Laura broad authority to act on Jerrys behalf, including the power to make unlimited gifts to family members and create trusts.

Upon admission, Jerry owns the following assets:

Jerry receives $2,150 a month from Social Security, and $950 a month from his pension.

Laura is exhausted from recent round-the-clock care that Jerry needed before his nursing home admission. After resting for a week, Laura books an appointment with an elder law attorney to see if he can help with Medicaid qualification.

The attorney reviews Jerrys power of attorney and confirms the exact amounts of his assets and income. He gathers evidence, including a letter from Jerrys doctor, to verify that Laura meets the definition of a caregiver child for purposes of making an exempt transfer of Jerrys residence to Laura.

Jerrys transfer and spend-down of assets looks like this:

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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.

State Options To Expand Medicaid Ltss Financial Eligibility

All states elect at least some options to expand financial eligibility for people who need Medicaid LTSS. Medicaid LTSS includes nursing home and other institutional services as well as home and community-based services . Medicaid remains the primary payer for LTSS, as Medicare does not cover long-term care, private insurance coverage is limited, and out-of-pocket costs often are unaffordable.55 Medicaid also is an important source of federal funds to support states in meeting their community integration obligations under the Americans with Disabilities Act and the Olmstead decision.56 State policy choices about key financial eligibility rules for Medicaid LTSS are described below.

Special Income Rule

Nearly 85 percent of states allow people with functional needs that require an institutional level of care to qualify for Medicaid institutional and/or home and community-based LTSS with income up to 300% SSI under the special income rule .58 Forty-one of these states use the federal maximum of 300% SSI. Delawares limit is 250% FPL, and the income limit in Missouri varies by program. States also apply an asset limit under the special income rule, usually the SSI amount of $2,000 for an individual and $3,000 for a couple.

Figure 8: State Options to Expand Financial Eligibility for Medicaid LTSS, by Care Setting, 2018

Qualified Income or Miller Trusts

Supplemental Needs and Pooled Income Trusts

ABLE Accounts for Disability-Related Expenses

Home Equity Limits

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Because Medicaid Is A Joint Endeavor With The Federal Government And The States The Requirements To Qualify For Medicaid Vary From State To State In Pennsylvania Ma Recipients Must Spend Down Their Assets To No More Than $2400 If Their Income Is Equal To Or Greater Than $2205 Per Month A Pennsylvania Ma Recipient Whose Income Is Less Than $2205 Per Month Is Permitted To Keep Up To $8000 In Assets Certain Assets Are Not Included As Countable Resources Such As One Residence And One Car

The spouse of an MA recipient must be left with assets of at least $24,180, but cannot retain assets in excess of $120,900, in addition to assets of such spouse which are not countable as a resource under the law. The determination of exactly how much a spouse can keep is determined by dividing the couples countable resource assets by two. Fifty percent of the couples countable resource assets must fall between $24,180 and $120,900. If the value of fifty percent of the couples assets is more than $120,900, then not only does the MA applicant spouse need to spend down to $2,400, but the spouse remaining in the community must spend down to $120,900.

Individuals who do not have long-term care insurance but do have sufficient assets to live on and to cover payment for skilled nursing services for at least five years can take action to protect certain assets by proactively planning for long-term care with a qualified Elder Law attorney. Absent proactive planning, the family often ends up in crisis planning, like in Jacks case.

Just as estate planning is critical to ensure that your assets pass to your intended beneficiaries with as little death tax due as possible, long-term care planning is critical if your goal is to ensure that your beneficiaries receive some part of what you worked a lifetime to build. Being proactive in your long-term care planning will produce the best possible results if your goal is to protect your assets.

Prescription Drugs With Medicaid In Pennsylvania

Medicaid in Pennsylvania does not cover all prescription drugs. It does, however, cover some of them, allowing people to pick up the prescriptions they need for free. Adults may have a small copay of $3 to pick up their prescriptions. This price is for brand-name medicines. Generic versions often cost just a dollar.

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Can I Get A Ca Id Without Ssn

Application Requirements You may not start a noncommercial Class A, B, or C driver license application or an ID card application without providing an SSN to DMV. You do not need to show your SSN card or any other visual verification of your SSN to apply for a noncommercial driver license or an ID card.

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