- Medicaid Planning
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In the United States, Medicaid is the largest payee for Long Term Care Services. Medicaid will pay to provide long-term care services in a nursing home, assisted living, or for home healthcare. The eligibility rules are identical regardless of facility choice, but there are some differences in the process and application. There are generally three tests to establish eligibility: medical necessity for long term care, income, and resources.
- Medicaid Planning
Long-Term Care Medicaid
Long-term care Medicaid provides coverage for care and services in nursing homes, assisted living facilities, or at-home care. The eligibility criteria are the same for each living arrangement, but the process of qualifying is different. In general, there are three tests to establish eligibility: medical necessity for long term care, income, and resources. Since Medicaid is a needs based program, it is mandatory to meet certain income and resource requirements.
- Medicaid Planning
Medical Need
The process of evaluating medical need is determined differently depending on the type of living arrangement of the applicant. For example, a person in a nursing home will complete an evaluation upon arrival at the facility. This evaluation usually guarantees that the individual will qualify for LTC Medicaid. For a person who is in assisted living, or is seeking home healthcare, a nurse from the Regional Bureau of Long Term Care office visits the Medicaid applicant to determine if services are needed by the applicant. This evaluation is largely dictated by one’s ability to perform the activities of daily living (ADL’s), such as bathing, dressing, toileting, managing/taking medications, mobility, meal preparation, etc.
- Medicaid Planning
Income
Income guidelines change every year. These guidelines are set by each state, but correlate with the Federal Poverty Guidelines. Income is calculated based on Gross income prior to any deductions, insurance, Medicare Part B Premiums, or any other deductions. There are typically two methods to use if someone is over the income limit. First, if the applicant is married, then one spouse may choose to decline Medicaid in order for the other spouse to have a higher income limit. The is referred to as the community property method. The second is to use a Qualified Income Trust, otherwise known as a Miller Trust. Using this method allows an individual to transfer the amount of money that they are over income limits into the trust each month. The portion of the income moved into the trust then becomes outside of the Income limits for Medicaid’s purposes.
- Medicaid Planning
Resources Or Assets
Resource assessments are quite different depending on the household. If the Medicaid applicant has a spouse, a disabled child living in the home, or a dependent who is a minor then some resources are excluded in the resource method. The spouse who is not requesting coverage for care (commonly referred to as the community spouse) is allowed to keep a portion of resources in their name. This number changes every year, but is higher than $125,000.
For single applicants, Medicaid is $2,000 of countable resources. Resources that are not counted include the applicant’s home or primary residence, one vehicle, an irrevocable burial plan or designated burial funds, burial plots, IRAs or similar retirement plan (if the applicant is receiving required minimum distributions), resources needed for self-support, certain annuities, and property that is listed for sale. Other resources may be excluded as well, but are more complicated in nature and would depend on the facts involved in those assets.
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Our team is eager to help our clients call and talk to Medicaid in order to make sure that their issues are resolved. Many insurance agencies have a ‘come back when you have your Medicaid problems figured out’ mentality. We are proudly not like them.
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Whether you have Medicare Advantage or a Medicare Supplement Insurance plan for traditional Medicare Parts A and B (original Medicare) depends on your preferences and
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Whether you have Medicare Advantage or a Medicare Supplement Insurance plan for traditional Medicare Parts A and B (original Medicare) depends on your preferences and
Blog title Goes Here
Whether you have Medicare Advantage or a Medicare Supplement Insurance plan for traditional Medicare Parts A and B (original Medicare) depends on your preferences and