Are You Applying For Medicaid Coverage?

Getting Started

There are three types of Medicaid: (1) Community Health Insurance (2) Custodial Long-Term Care and (3) Home-Based Care Waiver Programs. Most likely, you are interested in information about Custodial Long-Term Care or the Waiver Programs offered in the applicant's home state.

Medicaid is a public benefits program. The rules are very complicated, and for you or your loved one, there is a lot at stake. The costs of long-term custodial care are going nowhere but up, quickly approaching $120,000 per year. There are only three ways to pay for long-term custodial care: (1) private pay (2) long-term care insurance; or (3) Medicaid. If you are in a crisis situation, it is recommended that you consult with an elder law attorney familiar with Medicaid eligibility rules before you apply for Medicaid.

The Medicaid Program

Medicaid is a welfare program jointly administered by the federal government and the states. Each state administers the program subject to its own state agencies and Medicaid regulations. An applicant must satisfy three eligibility criteria to qualify for long-term care Medicaid: first, the applicant must be aged (over 65), blind, or disabled; second, the applicant must require a nursing home level of care; and third, the applicant must meet the financial requirements. If determined eligible, long-term care Medicaid will pay the nursing facility costs of the eligible individual.

Medicaid Waiver

Medicaid Waiver is a Medicaid benefits program offered to qualified applicants as an alternative to long-term custodial care in a nursing home. The eligibility criteria are very similar to those of long-term care, Medicade, with some variation by jurisdiction.

The Waiver Program allows an eligible individual to continue to reside at home, with support services provided and paid for by Medicaid. The concept of the Waiver Program is to allow an eligible individual to stay at home, rather than enter a nursing home. There are a variety of Waiver Programs in each state, all of which may vary in eligibility criteria. It is best to consult with an elder law attorney if you are considering the Waiver Program.

Eligibility: Medical

Medical eligibility for long-term care is determined on a case-by-case basis. An applicant must be aged (over 65), blind, and/or disabled, and must also be deficient in a number of Activities of Daily Living (transferring from bed to chair, dressing, toileting, eating, etc.). If your loved one is at home, the local social services office will do a medical assessment for eligibility. If he or she is in a nursing home, the facility will conduct the assessment.

Eligibility: Financial

Medicaid's financial eligibility rules encompass income and resources. Medicaid considers income to be funds received within a given month. For example, many Medicaid applicants receive monthly Social Security payments. Those payments are considered income to the individual.

Medicaid considers a resource to be anything owned by the individual. For example, real property, bank accounts, and life insurance with a cash value are considered resources.

Resources are divided into two groups: countable and exempt. A countable resource will be counted against eligibility, while an exempt resource will not affect eligibility. Exempt resources include the home, subject to certain restrictions; personal property; pre-paid funeral and burial; and an automobile. All resources that are not exempt are countable.

Income

The general rule, subject to variations among jurisdictions, is that if an applicant's income is less than the private pay rate of the nursing home, then he/she is income qualified. It is important to know that this general rule applies only to long-term care applicants residing in a nursing home. Some states have income limits for their home-based Waiver Programs

For couples, Medicaid follows the "name on the check rule;" that is, there is no commingling of income between spouses.

Medicaid eligibility rules provide for a shifting of income from the Institutionalized Spouse to the Community Spouse to assure that the Community Spouse has a base income. The maximum base income guaranteed the CS is $3,090 (2018). The minimum guaranteed amount, known as the Minimum Monthly Maintenance Needs Allowance (MMMNA), is $2,030.00 (2018).

Resources

The countable resource limit for a long-term care Medicaid applicant varies among states. In 2018, an applicant cannot have more than $2,000 in countable assets in Virginia, $2,500 in countable assets in Maryland, and $4,000 in countable assets in D.C.

Resource Eligibility for a Married Couple: The Community Spouse Resource Allowance

The individual in (or applying for) long-term custodial care is identified as the "Institutionalized Spouse " and the spouse at home is the "Community Spouse." All of their resources, regardless of whose name is on the title, are counted for purposes of Medicaid eligibility. This includes resources titled jointly with any third party, including children.

The Institutionalized Spouse cannot have assets exceeding the applicant's resource limit. The Community Spouse is permitted keep a portion of the couple's assets. In very basic terms, the Community Spouse is allowed to keep a Community Spouse Resource Allowance in an amount between $24,720 and $123,600 (2018). The amount of the Community Spouse Resource Allowance will depend on the value of the couple's total countable resources when the Institutionalized Spouse first became institutionalized for a period of thirty days or more.

The Application Process

Each jurisdiction has its own application process and specific requirements for documentation. See your state's Medicaid website to find out more about local procedures. The first step is to obtain and review a copy of the application of the jurisdiction where your loved resides. Eligibility rules are different for each jurisdiction, and planning strategies; and resource preservation, will vary depending on the state. Contact an elder law attorney in your loved one's jurisdiction prior to attempting to navigate the application process.

Lastly, please familiarize yourself with the Medicaid Myths to avoid any misinformation. For more information and skilled assistance, contact The Elder & Disability Law Center by calling us toll free at 866-399-4324 or locally at 202-452-0000. You may also send us an email.