Life Estates And Remainder Interest
The Texas Health and Human Services Commission counts both a life estate and a remainder interest in property as resources, except as described in paragraph of this section.
Life estates. A life estate provides a person, for the person’s lifetime, certain rights in a property, while transferring ownership of the property to another person. The duration of a life estate is measured by the lifetime of the owner of the life estate, or by the occurrence of some event. The contract establishing a life estate, however, may restrict one or more rights of the owner of the life estate. The owner of a life estate does not have fee simple title to the property nor the right to sell the entire property. In most situations, the owner of a life estate has the right to:
possess the property
get profits from the property and
sell his or her life estate interest.
Remainder interest. A remainder interest, which is created when a life estate is established, gives a person owning a remainder interest the right to ownership of the property upon the death of the owner of the life estate. A person owning a remainder interest in the property has the right to sell his or her remainder interest unless the person is prohibited from doing so by a legal restriction.
Exclusion for life estates and remainder interests. Life estates and remainder interests are not counted as resources if:
the property is the person’s home and can be excluded under §358.348 of this division
Reporting Unauthorized Inspection Or Disclosure Of Social Security Administration Provided Information
Staff who become aware of an incident of unauthorized access to, or disclosure of, restricted verified SSA information or confidential information must contact the immediately.
The HHS Privacy Office will report the incident by contacting the Chief Information Security Office .
If a person is responsible for a security breach or an employee’s employment is terminated, the user’s access to all information resources is removed. Supervisors must follow agency procedures for removing access for employees, contractors, vendors or trainees.
Whose Income Is Counted
We count the gross monthly income of the person applying for long-term care or waiver to decide if he or she is eligible. The eligible person is commonly expected to use their income to pay a share of the cost of services provided in a nursing home. Medicaid will pay the remaining amount owed for their cost of care.
To determine how much the person pays for their care, Medicaid uses the eligible persons gross monthly income and then deducts for personal care needs, Medicare and health insurance premiums, incurred medical expenses not covered by Medicaid, and contributions made to a spouse or dependents living at home. After the deductions are applied, any remaining income must be paid toward their care.
Recommended Reading: Texas Healthy Womens Medicaid Coverage
Read Also: Is Invisalign Covered By Medicaid
Reasons For Denial Of Aged Blind And Disabled Mao Applications And Cases
Reasons for denying applications or closing cases are classified into four major groups: death of applicant or recipient ineligible with respect to need ineligible with respect to requirements other than need and miscellaneous reasons.
Select the code reflecting the primary reason for denial. If a reason producing ineligibility with respect to need and reason producing ineligibility with respect to some requirement other than need occur at the same time, use the code for need. If several events occur simultaneously, none of which, alone, would produce ineligibility with respect to need, but collectively they do make the recipient ineligible, use the code for the reason having the greatest effect.
Although the applicant or recipient will receive a card explaining action taken on his/her case, the worker should make an adequate interpretation of the decision to the applicant or recipient.
Computer-printed reasons to the applicant or recipient will be initiated by use of the appropriate closing code and the computer will automatically print out the appropriate reason to the recipient corresponding to the code used.
The statements that are to be computer-printed to the applicant or recipient are listed after each closing code. The Spanish translations are to assist workers in completing FL-4 and Form h1801. The Spanish translation will not be included on the Form H1029 mailed by the State Office.
Seek Help With Medicaid Application And Spend
Medicaid is a very complex government program. Just because a seniors assets exceed the general limits listed above does not mean they are automatically ineligible for coverage. Different states implement slightly different rules and resource limits, and an elder can devise a personalized asset spend-down strategy to meet their states eligibility criteria.
In addition to asset limits, there are many other guidelines for calculating countable income and determining ones medical need for care and assistance. Furthermore, different financial rules apply for married couples. It is recommended to familiarize yourself with these eligibility requirements early on in case you ever need to help an aging loved one apply for Medicaid .
Working with a certified elder law attorney who has extensive knowledge of the unique Medicaid program in your state and is well versed in legal and financial Medicaid planning strategies is crucial. In most cases, handling the application process without any professional assistance can result in a determination of ineligibility and even a costly Medicaid penalty period.
Read Also: What Does Medicaid Family Planning Services Cover
How Does Dual Eligibility With A Medicare Advantage Plan Work
People that are eligible for Medicare and Medicaid can choose a Medicare Advantage plan as an option to original Medicare. In terms of which program provides the primary coverage, it is the same as with original Medicare. Your Medicare Advantage plan covers eligible costs first. Medicaid acts as the secondary insurance and covers costs after Medicare Advantage.
Treatment Of Trusts On And After August 11 1993
Introduction. The Texas Health and Human Services Commission follows §1917 of the Social Security Act ) regarding the treatment of trusts established on or after August 11, 1993, using a person’s assets. The trust provisions apply to a person receiving benefits under a Medicaid-funded program for the elderly and people with disabilities , whether the person is in an institutional or a noninstitutional setting. However, transfer-of-assets provisions apply only to a person in an institutional setting.
Limited partnerships.
A limited partnership is a “similar legal device” to a trust. In accordance with the definition of a trust in §1917 of the Social Security Act ), HHSC treats a limited partnership as a trust and applies the provisions of this section to a limited partnership. The general partners of a limited partnership act as trustee, and the limited partners are the equivalent of beneficiaries of an irrevocable trust. To the extent that the general partners can make each limited partner’s ownership interest available to him, that interest is a countable resource and not a transfer of assets. However, a transfer of assets has occurred to the extent that:
the value of the share of ownership purchased by the limited partner is less than the amount the limited partner invested and
the general partners cannot make the limited partner’s share available to the limited partner.
Qualified income trust .
Characteristics of a QIT are as follows:
The trust must be irrevocable.
Also Check: How Does Medicaid Work In Maryland
Treatment Of A Nonemployment
This section describes the Texas Health and Human Services Commission’s treatment of nonemployment-related annuities purchased or having a transaction date before February 8, 2006. In this section, a nonemployment-related annuity means a revocable or irrevocable annuity a person may purchase to provide income.
A nonemployment-related annuity is not a countable resource if the annuity:
is irrevocable
pays out principal in equal monthly installments and pays out interest in either equal monthly installments or in amounts that result in increases of the monthly installments at least annually
is guaranteed to return within the person’s life expectancy at least the person’s principal investment plus a reasonable amount of interest
names the state of Texas or HHSC as the residual beneficiary of amounts payable under the annuity contract, not to exceed any Medicaid funds expended on the person during the person’s lifetime, except as described in subsection of this section and
is issued by an insurance company licensed and approved to do business in the state of Texas.
If a person in an institutional setting is married and the spousal impoverishment provisions of §358.413 of this subchapter apply, the requirement in subsection of this section does not apply to a nonemployment-related annuity purchased by or for a community spouse.
A nonemployment-related annuity that does not meet the requirements of subsection or of this section is a countable resource.
How Did The Affordable Care Act Change Medicaid
Medicaid plays an even more important role in insuring low-income Americans due to the Affordable Care Act. As noted, the ACA provides coverage for poor and low-income adults by expanding eligibility for Medicaid to 138 percent of the poverty line. As of April 2020, 35 states plus the District of Columbia have implemented the Medicaid expansion to serve poor and low-income adults. By 2029, 14 million more low-income adults will have enrolled in Medicaid and gained access to affordable comprehensive health coverage due to the ACA, CBO estimates.
The expansion is a very good financial deal for states. After picking up all expansion costs for the first three years, the federal government now pays 90 percent of expansion costs on a permanent basis. And by greatly reducing the number of uninsured, the expansion will save states and localities substantial sums on uncompensated care for the uninsured. Some expansion states have also experienced savings in mental health programs, criminal justice systems, and other budget areas.
Don’t Miss: How To Get A Medicaid Card Online
Are You Eligible For Medicaid
Wondering if you could qualify for Medicaid? One of the main criteria used to determine eligibility is your level of income. If you don’t have income over the federal poverty level and have limited assets, depending on your specific circumstances and the state in which you reside, you may qualify for some level of Medicaid coverage.
Keep in mind, however, that there are different categories of eligibilityâand each category has its own unique set of requirements. For example, the eligibility requirements for a pregnant woman may not be the same as that of a disabled person.
Can You Have Both
People who qualify for both Medicare and Medicaid are considered dual eligible. In this case, you may have original Medicare or a Medicare Advantage plan , and Medicare will cover your prescription drugs under Part D.
Medicaid may also cover other care and drugs that Medicare doesnt, so having both will probably cover most of your healthcare costs.
Don’t Miss: Does Medicaid Pay For Wisdom Teeth Removal
Community To Nursing Facility Or Home And Community
If an active MEPD Medicaid or Medicare Savings Program recipient enters a facility for a long-term stay or requests waiver services, before completing a program transfer, staff must address all factors that may impact eligibility or co-payment. Staff must explore transfer of assets and substantial home equity and provide required information about annuities, estate recovery and long-term care options.
Reductions In Maximum Exclusion
The burial fund exclusion allows a person to designate up to $1,500 of various kinds of resources as burial funds. The burial fund exclusion works in conjunction with the life insurance exclusion described in Section F-4223, Life Insurance, because the $1,500 set aside for burial must be reduced by the face value of:
- any life insurance policy that is already being excluded by the life insurance exclusion
- any burial insurance policy for the burial expenses of the individual
- any amount held in an irrevocable trust, burial contract or other irrevocable arrangement for the individual’s burial expenses, except to the extent that it represents excludable burial spaces or
- any life insurance policy for which a funeral provider has been made the irrevocable beneficiary, if the life insurance policy owner has irrevocably waived his right to, and cannot obtain, any cash surrender value the life insurance policy may generate .
To be excluded, the person’s funds must be:
- liquid resources ,
- specifically designated for burial expenses.
Read Also: Pain Management Doctors That Accept Medicaid
What Is Medicaid And Who Qualifies For It
Medicaid is a state and government program designed to provide the elderly, the disabled, pregnant women, and low-income families with health insurance. To qualify for Medicaid, the recipient must be below the national poverty line or enrolled in other governmental programs, like Social Security, foster care, or Medicare.
Medicaid, like other governmental programs, can be incredibly complex for those not used to navigating programs to find the benefits or how to apply. However, this program is an excellent resource for the elderly, those with low income, those with disabilities, and those pregnant while living below the poverty line. Read below for details about what Medicaid covers, how to qualify, and how to appeal if an application is denied.
Understanding Medicaid: What You Need To Know
Are you living below the poverty line? Does your current income prevent you from being able to afford reliable health coverage? If so, then you may want to apply for Medicaid, a government health-care program designed to help low-income families and individuals receive the medical care they need. You may also qualify through disability.
The Centers for Medicare & Medicaid Services reports that as of February 2015, over 70.5 million people nationwide were enrolled in Medicaid or the Children’s Health Insurance Program . CHIP and Medicaid are closely related CMS programs. CHIP provides health care to children who qualify for the program like Medicaid, it’s run by both the federal and state governments.
According to a 2015 article on the CMS website*, people on Medicaid can generally get the care they need just as well as those who have private insurance plans. The article reports that Medicaid’s costs per person are considerably lower than under private insurance, for both children and adults.
Medicaid may cover a variety of health-care needs. While benefits vary from state to state, Medicaid programs in all states must cover certain benefits, such as :
- Inpatient hospital care
- Lab work and x-ray services
Also Check: How To Get Medicaid Certified
How Do Medicare And Medicaid Work Together
Medicare and Medicaid work together to cover medical costs for an individual who qualifies for both programs. First, Medicare pays for Medicare covered services then, Medicaid pays once all Medicare and any other health insurance expenses have been paid. The coverage provided depends on the persons specific health needs.
Other Sources Of Data On Medicaid Enrollment
National Survey Data
Current Population Survey : Provides demographic detail but cannot provide estimates of state-level coverage.
National Health Interview Survey : Estimates both coverage status and length of time with coverage at time of interview but states must be combined to produce reliable annual estimates.
Medical Expenditure Panel Survey : Contains detailed information covering two full calendar years that can be broken down into census regions .
Survey of Income and Program Participation : Includes health care coverage status as well as disability status but cannot provide annual estimates.
Aggregate-Level Administrative Data
Medicaid Budget and Expenditure System : Aggregate enrolled data available quarterly, can be linked to claims data but lacks demographic detail.
Centers for Medicare & Medicaid Services Performance Metric Data: Updated monthly and includes details by state and program.
Individual-Level Administrative Data
Medicaid Statistical Information System : While not publicly available, can link enrollment and spending but lacks demographic characteristics.
Census Bureau, Health Insurance
Moving Medicaid Data Forward, Forum: Medicaid EnrollmentOverview and Data Sources
Medicaid Pocket Primer
Read Also: Does Medicaid Cover Hearing Aids In Ohio
Treatment Of A Medicaid
A Medicaid-qualifying trust is a trust that a recipient, the recipient’s spouse or guardian, or anyone holding the recipient’s power of attorney establishes using the recipient’s money. The recipient is the beneficiary of an MQT. A trust meeting this definition that was established between June 1, 1986, and August 10, 1993, is an MQT. A trust meeting this definition that was established before June 1, 1986, is treated as a standard inter vivos trust.
Except as described in §358.338 of this division , the Texas Health and Human Services Commission counts potential distributions from an MQT as resources available to a person, whether or not distributions are actually made.
The amount available to the person is the maximum amount the trustee could distribute under the terms of the trust.
If distribution is not made, the maximum amount the trustee may distribute under terms of the trust is considered an available resource.
If a trust does not specify an amount for distribution, and if the trustee has access to and use of the principal, then HHSC counts:
the corpus of the trust as a resource and
payments from the trust to or for the benefit of the person as income only if the payments would ordinarily be counted as income in accordance with 20 CFR §416.1102.
Cost Of Care Responsibility
If you are eligible for Medicaid in a nursing facility, ICF/IID facility, IMD or for waiver program services, you may have to pay toward the cost of your care. This is referred to as your copayment. From your total income, you are allowed to keep a standard personal needs allowance. The amount of this allowance is different for different programs. Certain medical expenses you may pay, such as general health insurance premiums, Medicare premiums, deductibles and coinsurance, certain dental fees or prescription drug costs, may also be deducted. HHSC staff will calculate your copayment and notify you and your case manager or your service provider of the amount. The arrangement for your portion of the payment is between you, your case manager or the service provider. Medicaid payments for your care will be made directly to the service provider.
To access the Medicaid eligibility rules on the Internet, follow the steps below:
- Under Points of Interest, select View the current Texas Administrative Code.
- A menu will appear entitled Texas Administrative Code: Titles. Select Title 1, Administration.
- Select Part 15, Texas Health and Human Services Commission.
- Select Chapter 358, Medicaid Eligibility for the Elderly and People with Disabilities.
- Select the subchapter you desire.
You May Like: Federal Income Guidelines For Medicaid
