Which Medicaid programs might I qualify for if I have Medicare?
If you are eligible for Medicare and have low income, you may qualify for help from certain Medicaid programs in your state. In general, your state will have more than one program that can help people who are eligible for Medicare.
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Whether you qualify for a Medicaid program will depend on:
• Your income (money you take in for example, Social Security payments, or wages that you earn)
• Your assets (resources such as checking accounts, stocks, bonds, 401k, property investments)
• If you need long-term care, whether you meet your state’s functional eligibility or level-of-care criteria standards for assessing your need for help with activities of daily living (for example, toileting, bathing, dressing) and your need for nursing care. Each state sets its own standards.
Medicaid programs can help pay for Medicare’s costs and for services that Medicare does not cover. BACK TO TOP
In general, people with Medicare who have low income may qualify for one of the following:
Medicaid for people who are over 65, are blind or have a disability and do NOT need long-term care.
If you are over 65, blind or have a disability, do not have a pressing need for long-term care and meet the financial requirements, you may qualify for Medicaid coverage of a broad range of health services, including doctors’ visits, hospital care, and medical equipment.
Nursing Facility Medicaid
If you have limited income and meet your state’s level-of-care or functional eligibility criteria, Nursing Facility Medicaid may pay for a stay in a skilled nursing facility (nursing home). Nursing Facility Medicaid covers services such as room and board, nursing care, personal care and therapy services. States determine their own functional eligibility standards, but usually your state will assess your need for help with activities of daily living (for example, toileting, bathing, dressing) and your need for nursing care. All states have Nursing Facility Medicaid programs.
Medicaid Waiver Programs for long-term care in your home or community
If you have limited income and meet your state’s level-of-care or functional eligibility criteria, a Medicaid home and community-based service (HCBS) waiver program (or programs) may cover long-term care services in your home or a community setting (for example, in an assisted living facility). States determine their own functional eligibility standards, but usually your state will assess your need for help with activities of daily living (for example, toileting, bathing, dressing) and your need for nursing care. BACK TO TOP
Spending Down Assets to Qualify for Medicaid
In order to be eligible for Medicaid, applicants must have no more than $2,000 in "countable" assets (the dollar figure may be slightly more depending on the state). Applicants for Medicaid and their spouses may protect savings by spending them on non-countable assets.
The following are examples of such expenditures:
In the case of married couples, it is often important that any spend-down steps be taken only after the unhealthy spouse moves to a nursing home if this would affect the community spouse's resource allowance.
Prepay Your Funeral
An easy way to protect your assets from Medicaid is to prepay your funeral. This can be done by purchasing an insurance policy specifically for your final expenses. If this policy is irrevocably assigned to a funeral provider or Trust, the funeral provider or Trust will hold these funds and pay the provider of funeral services for you. If you prepay your funeral in accordance with Medicaid rules, it is a lawful way to reduce your assets, a key part of making you eligible for Medicaid assistance. Prepaying your funeral will also spare grieving family members and friends some of the financial and emotional burdens that exist during such a difficult time. BACK TO TOP
• Prepaying funeral expenses
• Paying off a mortgage
• Making repairs to a home
• Replacing an old automobile
• Updating home furnishings
• Paying for more care at home
• Buying a new home
Medicaid Protections for the Healthy Spouse
Medicaid law provides special protections for the spouses of Medicaid applicants to make sure the spouses have the minimum support needed to continue to live in the community while their husband or wife is receiving long-term care benefits, usually in a nursing home.
The so-called "spousal protections" work this way: if the Medicaid applicant is married, the countable assets of both the community spouse and the institutionalized spouse are totaled as of the date of "institutionalization," the day on which the ill spouse enters either a hospital or a long-term care facility in which he or she then stays for at least 30 days. (This is sometimes called the "snapshot" date because Medicaid is taking a picture of the couple's assets as of this date.)
In order to be eligible for Medicaid benefits a nursing home resident may have no more than $2,000 in assets (an amount may be somewhat higher in some states). In general, the community spouse may keep one-half of the couple's total "countable" assets up to a maximum of $119,220 (in 2016). Called the "community spouse resource allowance," this is the most that a state may allow a community spouse to retain without a hearing or a court order. The least that a state may allow a community spouse to retain is $23,844 (in 2016).
Example: If a couple has $100,000 in countable assets on the date the applicant enters a nursing home, he or she will be eligible for Medicaid once the couple's assets have been reduced to a combined figure of $52,000 -- $2,000 for the applicant and $50,000 for the community spouse.
Some states, however, are more generous toward the community spouse. In these states, the community spouse may keep up to $119,220 (in 2016), regardless of whether or not this represents half the couple's assets. For example, if the couple had $100,000 in countable assets on the "snapshot" date, the community spouse could keep the entire amount, instead of being limited to half.
The income of the community spouse is not counted in determining the Medicaid applicant’s eligibility. Only income in the applicant’s name is counted. Thus, even if the community spouse is still working and earning, say, $5,000 a month, she will not have to contribute to the cost of caring for her spouse in a nursing home if he is covered by Medicaid. In some states, however, if the community spouse’s income exceeds certain levels, he or she does have to make a monetary contribution towards the cost of the institutionalized spouse’s care. The community spouse’s income is not considered in determining eligibility, but there is a subsequent contribution requirement.
But what if most of the couple's income is in the name of the institutionalized spouse and the community spouse's income is not enough to live on? In such cases, the community spouse is entitled to some or all of the monthly income of the institutionalized spouse. How much the community spouse is entitled to depends on what the Medicaid agency determines to be a minimum income level for the community spouse. This figure, known as the minimum monthly maintenance needs allowance or MMMNA, is calculated for each community spouse according to a complicated formula based on his or her housing costs. The MMMNA may range from a low of $1,991 to a high of $2,980 a month (in 2016). If the community spouse's own income falls below his or her MMMNA, the shortfall is made up from the nursing home spouse's income.
Example: Joe Smith and his wife Sally Brown have a joint income of $3,000 a month, $1,700 of which is in Mr. Smith's name and $700 is in Ms. Brown's name. Mr. Smith enters a nursing home and applies for Medicaid. The Medicaid agency determines that Ms. Brown's MMMNA is $2,000 (based on her housing costs). Since Ms. Brown's own income is only $700 a month, the Medicaid agency allocates $1,300 of Mr. Smith's income to her support. Since Mr. Smith also may keep a $60-a-month personal needs allowance, his obligation to pay the nursing home is only $340 a month ($1,700 - $1,300 - $60 = $340).
In exceptional circumstances, community spouses may seek an increase in their MMMNAs either by appealing to the state Medicaid agency or by obtaining a court order of spousal support.
For the dollar amounts that your state allows community spouses to retain, go to Find an Attorney, click on your state, and then "Key Medicaid Information" for that state. BACK TO TOP
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