Long Term Care Medicaid Eligibility Criteria

To qualify for Long Term Care Medicaid, you need to meet the following requirements:

  • General Requirements
  • Financial Eligibility Requirements
  • Functional Eligibility Requirements

General Requirements:

  • Colorado resident; and
  • 65 or older or permanently disabled or blind; and
  • US citizen or qualified non-citizen

Medicaid’s Financial Eligibility Requirements:

An income and resource test will be performed in order to determine an applicant’s financial eligibility.

Income

Income is any item an individual receives in cash or in-kind that can be used to meet his or her need for food or shelter. Some income is considered countable, while other income may be considered not countable when determining eligibility. The 2010 income limit for Long Term Care Medicaid is $2022 (3 times the current SSI income limit).

Applicants in a nursing facility or in need of Home and Community Based Services (HCBS) who have income over $2022 but under the regional private pay rate for which they live may establish an income trust to meet the income requirements. Without the use of an income trust, eligibility can not be established; therefore, the income trust must be set up for eligibility to begin. Additionally, it must be properly funded each month by income over $2022. If the excess income is not transferred into the trust, eligibility may be terminated.

Resources

Resources are defined as cash and any other personal or real property that the applicant has the right, authority, or power to convert to cash (if not already cash); and is not legally restricted from using for her support and maintenance.

Medicaid resource limits vary depending on your circumstances:

o   Single Individual: $2000

o   Married Couples: $3000

o   Married Couples Sharing a Room  in a Institution: $4000 ($2000 per individual)

o   Spousal Impoverishment: $109,560 (If one spouse lives in an institution and the other spouse is still living in the community and not receiving Medicaid)

Some of your assets are considered, while other assets are excluded, and not counted. Exempt assets include but are not limited to a primary residence, personal items, one vehicle, life insurance policies with a face value under $1,500, and certain burial policies. Almost all other real or personal property and funds held with a financial institution owned by you or your spouse are counted toward the resource limit.

Transfer of Assets

Transfer of assets occurs when an individual, or spouse of such individual, disposes of assets for less than fair market value within the 5-year look back period. If you transfer assets, Medicaid may not pay for your long term care services during the penalty period. The penalty period is the amount of time during which the individual will be ineligible for Medicaid and depends on the amount of assets transferred.

Functional Eligibility Requirements:

In order to receive long term care Medicaid, the applicant must be assessed and determined in need of long term care services. This evaluation is done by the Single Entry Point agency in the area in which you live. The need for long-term care services is generally determined by the applicant’s ability to perform activities of daily living. Examples of these activities include bathing, dressing, using the toilet, transferring, and eating.

Getting Help:

Helping Hands Consulting, LLC is Colorado’s premiere Medicaid consulting group. We can assist you and your family navigate through the complexities of rules and regulations involved in obtaining Long Term Care Medicaid. We will streamline and simplify this process while working to maximize your eligibility. Call 303-717-6082 or Toll Free (888) 849-4346 for a free phone consultation or visit www.helpinghandsconsultingllc.com for more details on how we can assist you.

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Long Term Care Medicaid-Transfer of Assets Without Fair Consideration

Introduction

As mentioned in previous articles, Long Term Care Medicaid has many eligibility requirements, making it difficult for the individual to understand if they qualify. One of the most complex eligibility criteria is transfers without fair consideration (TWOFC).

Transfer of Assets Defined

A TWOFC occurs when an individual, or spouse of such individual, disposes of assets for less than fair market value within the 5-year look back period. For example, if grandmother has a vehicle worth $7000 and transfers title of that vehicle to her grandchild without receiving payment she has made a transfer without fair consideration. The same holds true if the item being transferred is cash.  TWOFC are only applicable to the Long Term Care Medicaid programs which include nursing facility services, Program for All-Inclusive Care for the Elderly (PACE) and Home and Community Based Services (HCBS).

Other Considerations

In addition to giving away income or resources for less than fair market value, the following actions are also examples of a TWOFC: 1.) Waiving pension income 2.) Waiving a right to receive an inheritance 3.) Diverting assets to certain trusts 4.) Failure of a surviving spouse to elect a share of a spouse’s estate 5.) Not accepting or accessing a personal injury settlement 6.) Transferring assets to an irrevocable private annuity which was not purchased from a commercial company.

Period of Ineligibility

The penalty period is the amount of time during which the individual will be ineligible for Long Term Care Medicaid and depends on the amount of assets transferred. The POI begins when the individual would have been otherwise eligible for Long Term Care Medicaid benefits or the first day of the month after the transfer occurred, whichever is later. If the individual is currently serving a period of ineligibility and that period has not expired when a new TWOFC is made, the newly calculated POI will not begin until the current POI has expired.  Medicaid will begin paying for Long Term Care benefits once the penalty period expires.

Getting Help

Helping Hands Consulting, LLC is Colorado’s premiere Medicaid consulting group. We can assist you and your family navigate through the complexities of rules and regulations involved in obtaining Long Term Care Medicaid. We will streamline and simplify this process while working to maximize your eligibility. Call 303-717-6082 or Toll Free (888) 849-4346 for a free phone consultation or visit www.helpinghandsconsultingllc.com for more details on how we can assist you.

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Long Term Care Medicaid – Home and Community Based Services

Introduction

Many believe the term Medicaid Long Term Care only refers to individuals in need of nursing facility services, but it also encompasses Home and Community Based Services (HCBS) which are services rendered in an individual’s home. It is far more cost effective to keep someone in their home and provide medical care versus having them reside in a nursing facility.  If you have a loved one or you yourself are in need of medical assistance but do not require placement in a nursing facility HCBS may be ideal for your situation.

Eligibility Criteria

The eligibility criteria for HCBS is the same as that provided in last month’s article on Medicaid nursing facility eligibility. The monthly income limit for 2010 is $2,022 a month, however if your income is higher you can establish an income trust which will allow you to be income eligible for Medicaid LTC Benefits. The upper income limits under the income trust rules vary by county and range from $5,762 to $6,909 a month.  The resource limits for an individual is $2000.  If you have a spouse who is not Medicaid eligible the resource limit increases to $109,560 (this amount increases every year). If both you and your spouse need HCBS through Medicaid the resource limit is $2000 per person.  Transfer without fair consideration rules apply to Medicaid HCBS as well.  A transfer without fair consideration occurs when something of value is given to someone else without the seller receiving fair market value for that item.  Doing this impacts the individual applying for Medicaid Long Term Care if they, or their spouse, were the owner/seller of the valuable.   There is a penalty period assessed for Transfers Without Fair Consideration which results in the applicant being ineligible for a period of time.

HBCS Level of Care and Services

The Single Entry Point Agency will conduct a level of care assessment to evaluate your activities of daily living and determine if your medical needs meet the nursing facility level of care guidelines but can be maintained through HCBS.  HCBS patients may receive all or one of the following services depending on their level of care: adult day services which are health and social service to include individual therapeutic and psychological activities furnished in an adult day services center; homemaker services which includes routine light housekeeping, meal preparation, dishwashing, bed making, laundry, and shopping; personal care services which includes bathing, skin care, hair care, nail care, mouth care, shaving, and dressing; electronic monitoring which includes personal emergency response systems and medication reminders; home modification which includes installing or building ramps, installing grab bars; widening doorways, modifying bathrooms, modifying kitchen facilities, and installing specialized electric and plumbing systems; non-medical transportation includes, but is not limited to, transportation between the client’s home and non-medical services or resources such as adult day services, shopping, therapeutic swimming, dentist appointments, and counseling sessions; respite care services are provided on a short term basis because of the absence or need for relief of those persons normally providing the care, these services are provided in a nursing facility where the HCBS client will reside for no more than 30 days.  There are also services available for individuals transitioning out of a nursing facility and back into the community.  These services assist in that transition process and establish the individual for community living

Getting Help From Advocates

Helping Hands Consulting, LLC is Colorado’s premiere Medicaid consulting group. We can assist you and your family navigate through the complexities of rules and regulations involved in obtaining Long Term Care Medicaid. We will streamline and simplify this process while working to maximize your eligibility. Call 303-717-6082 or Toll Free (888) 849-4346 for a free phone consultation or visit www.helpinghandsconsultingllc.com for more details on how we can assist you.

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Medicaid Nursing Facility Eligibility Criterion …. Do You Qualify?

Introduction

Many have great misunderstandings when it comes to Medicaid eligibility criterion.  Those with a high monthly income and/or substantial assets believe they will never qualify for Medicaid Long Term Care (LTC) Benefits if they have to enter a nursing facility.  The resource and income limits for Medicaid LTC benefits might surprise you and you may find that Medicaid is an insurance option for covering your nursing facility services.  ?

Income Eligibility

The monthly income limit for 2010 is $2,022 a month, however if your income is higher and you are in a nursing facility you can establish an income trust which will allow you to be income eligible for Medicaid LTC Benefits. The upper income limits under the income trust rules vary by county and range from $5,762 to $6,267 a month.  These limits apply on an individual basis even if you are married. Income received as wages from an employer or through self-employment as well as sheltered work, royalties and honoraria are all considered countable earned income. There are reduction calculations that apply to self-employment income which reduces the countable amount when determining eligibility. Countable unearned income includes death benefits, prizes/rewards, gifts/inheritances, interest from promissory notes and dividends, lump sum payments from social security, workers’ compensation, and insurance settlements, dividends/royalties from mineral rights, income from annuities, and retirement benefits.  Receipt from any of the above is counted as income in the month of receipt and as a resource the month following if still available. Supplemental Security Income is an exempt unearned income source and not counted when determining eligibility. Although income calculations are used to determine eligible Medicaid beneficiaries’ patient payment responsibility to the nursing facility, the spouse who remains in the community could be eligible for a minimum monthly maintenance needs allowance from the spouse in the nursing facility up to a maximum of $2739 a month if they qualify.

Resource Eligibility

The resource limits for an individual is $2000 and $3000 -$4000 for a couple if both are in a nursing facility.  If only one spouse is in a nursing facility and the other remains in the community (and is not receiving Medicaid) the resource limit for the couple increases to $109,560.00. Certain things are exempt as a resource and are therefore not counted when determining eligibility. These things include your principal place of residence that you were living in prior to entering the nursing facility (certain requirements must be met), one automobile, household goods, personal effects, life insurance policies with a face value at or under $1500, term life insurance policies, irrevocable burial policies and revocable burial policies up to $1500, and burial spaces. For those with resources over the allowable limits you may have options in still being eligible for Medicaid LTC Benefits.  There are specific rules imposed to close loop holes and potentially penalize you for protecting your assets.  Medicaid professionals can assist you with your Medicaid planning options and assessing those penalties accurately

Getting Help From Medicaid Consultants

Helping Hands Consulting, LLC is Colorado’s premiere Medicaid consulting group. We can assist you and your family navigate through the complexities of rules and regulations involved in obtaining Long Term Care Medicaid. We will streamline and simplify this process while working to maximize your eligibility. Call 303-717-6082 or Toll Free (888) 849-4346 for a free phone consultation or visit www.helpinghandsconsultingllc.com for more details on how we can assist you.

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Accessing Nursing Facility Care for your Loved Ones

Introduction

Coming to terms with having to place a loved one in a nursing facility is difficult, but determining the resources available to cover the costs of long term care services can be just as stressful. This article will provide you with information on starting the process of placing a loved one in a skilled nursing facility as well as the available resources to help pay for those services.

Selecting a Skilled Nursing Facility

This first thing to consider when searching for a nursing facility are the financial resources currently available which will help in determining what your family is able to afford. Depending on location and level of care, nursing facilities cost between $35K and $150K a year.  Most people end up paying for nursing facility care out of the savings of their loved one until the money runs out. Those who plan ahead and purchase long term care insurance are able to use this benefit along with the savings to pay for care.  Since neither of these financial sources last in perpetuity it’s important to know if the facility you choose also accepts Medicaid. 9 out of 10 nursing facilities that accept private pay patients also participates in the Medicaid program as Medicaid currently pays for nearly half of all nursing facility expenses.  Once you’ve found a nursing facility that meets the needs of your loved one and can care for them effectively you will need to go through the pre-admission screening process which will evaluate your loved one’s level of care and the skilled nursing services they need. If you are unable to privately pay the nursing facility costs at the time of admission, application for the Medicaid Long Term Care program should be made when the pre-admission screening takes place if not sooner.

Applying for Medicaid Long Term Care (LTC)

Applications for LTC Medicaid can be obtained from the County Department of Human Services (DHS) where your loved one currently resides; on occasion the nursing facility may also have copies of the application.  If your loved one is already in a nursing facility and was paying privately the application for LTC Medicaid should be submitted to the County DHS office in the county where the nursing facility is located. There are three agencies involved in determining eligibility for LTC Medicaid benefits, the County DHS who determines financial eligibility, the Single Entry Point Agency who ensures applicants meet the level of care for nursing facility services, and the Disability Determination Services Agency who determines if the applicant meets the disability criteria. Getting together the required documentation for a LTC Medicaid eligibility determination to be made can be time consuming and frustrating. In addition understanding the rules associated with the program and the required processes one must take to seek eligibility can be daunting. Managing the LTC Medicaid application process can be eased through the help of Medicaid consultants who know and understand the process and can provide their assistance in getting all the paperwork organized and submitted to the appropriate agencies.  Medicaid consultants are also a good resource for knowing the program’s rules, which ensures you are not being made to go through unnecessary bureaucratic hoops.

Getting Help from Medicaid Consultants

Helping Hands Consulting, LLC is Colorado’s premiere Medicaid consulting group. We can assist you and your family navigate through the complexities of rules and regulations involved in obtaining Long Term Care Medicaid. We will streamline and simplify this process while working to maximize your eligibility. Call 303-717-6082 or Toll Free (888) 849-4346 for a free phone consultation or visit www.helpinghandsconsultingllc.com for more details on how we can assist you.



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