What is Medicaid?
Medicaid is a state-federal partnership program that was initiated by the federal government but is run by state social service agencies. At its core, it is an all-encompassing health insurance program, primarily for low-income, medically-needy, and otherwise vulnerable individuals. Funding comes from both the state and federal government as do the rules for eligibility.
What does Medicaid cover?
There are many different types of Medicaid programs in the State of Utah, ranging from programs designed to help children or pregnant women to programs to assist individuals who are aged, blind, or disabled or in need of long-term care. Medicaid Planning Services specializes in helping people receive the benefits these programs provide.
Does Medicare cover long-term care?
Medicare will cover up to 100 days of a rehabilitation stay, only 20 of those days are covered completely the following 80 require a co-pay. Medicare does not cover care provided in an assisted living, skilled nursing, or other long-term care facility.
What are the eligibility requirements for the Medicaid program?
It depends on the Medicaid program that is being applied for, but regardless of the program, eligibility depends on three things: 1. Medical Assessment 2. Assets and 3. Income.
What is the “Look-Back Period?”
Both federal statutes and state policy enforce a ‘look-back’ period on an applicant’s transferred assets. A Medicaid applicant is prohibited from transferring any assets for less than fair market value which extends five years. Any transfers made are considered a gift during the ‘look-back’ period (5 years) & result in a period of ineligibility equal to the fair market value of the transferred asset.
Can I gift assets to family members and subsequently apply for Medicaid?
No. Gifted assets, within the 5 year look-back period will result in a sanction and the applicant will be ineligible for Medicaid. The ‘look-back’ period applies to gifts made to spouses, children, friends, or any other third-party. If you have made gifts however, in certain conditions you can cure such transfers and be made eligible for Medicaid.
Do I have to sell my home to get Medicaid coverage?
No. Medicaid exempts your primary residence during its financial assessment procedure so long as you provide the necessary documentation. If you sell your home while receiving Medicaid benefits, you must notify Medicaid within 10 days and subsequently spend the proceeds to under the asset limit by the end of the month in order to maintain eligibility.
Can the State of Utah place a lien on my home?
Yes. Eligibility for Long-Term Care Medicaid is conditioned on the individual consenting to estate recovery proceedings. The State of Utah is required to seek reimbursement from the estates of deceased Medicaid beneficiaries who were aged 55 and older at the time they received medical assistance. This procedure, often called Estate Recovery, means that the State of Utah Office of Recovery Services may recoup the amount paid out in benefits. The enforcement vehicle of this procedure often takes the form of a lien.
Are there ways to protect my home from Estate Recovery?
Yes, but within certain conditions only. Federal law allows for Estate Recovery only if, at the time of death, there was no surviving spouse or child under the age of 21, or child who is blind or permanently disabled. Additional protections can be implemented in pre-planning and spousal cases.
What is a Medicaid Waiver?
In 1981, Congress passed legislation allowing states greater flexibility in providing services to people living in community settings. This legislation, Section 1915© of the Social Security Act, authorized the “waiver” of certain Medicaid statutory requirements
The Waiving of these mandatory statutory requirements allowed for the development of joint federal and state funded programs called Medicaid 1915© Home and Community Based Service Waivers.
What do Medicaid Planners Do?
Medicaid eligibility is very complex; the rules change frequently, & differ by state, the application is time consuming and the review process lengthy. The consequences of being denied by Medicaid are severe and can negatively impact the comfort, happiness and even the health of the individual applying for Medicaid and their entire family. Medicaid Planners help clients structure their financial resources and prepare documentation to ensure the best possibility of being accepted into the Medicaid program. They create trusts, manage asset transfers and convert countable assets into exempt assets to ensure eligibility and preserve a family’s resources. In addition, they manage finances to ensure a healthy spouse has adequate income and resources to continue living independently during and after the time when their partner is receiving care assistance.
When to Hire a Medicaid Planner?
Many families wonder if it is really necessary to hire a Medicaid planner. Hiring a Medicaid Planner is not always necessary. However, for many situations it is prudent, cost-effective and strongly advised. The decision should be based on a family’s specific situation. As an example, Medicaid has a countable asset limit of approximately $2,000. It is not necessary to hire a planner if the applicant has less than that amount and free application assistance is available. If the applicant has countable assets one should probably retain paid Medicaid planning help. If the applicant has countable assets, then it is probably prudent to retain a Medicaid planner as the planning techniques become considerably more complicated.
How Much Does Medicaid Planning Cost?
The average cost of working with a Medicaid planning professional is less than the cost of one month’s care in a nursing home. There is a wide variety of costs associated with engaging a Medicaid Planner; this is due to the type of Planner as well as the needs of the applicant. With some planners, there are no costs associated with their services (though applicants should be cautious in this situation). At the other end of spectrum are Elder law Attorneys whose fees can be as high as $5,000-$8,000. This is a high cost for a family that is struggling to pay for care. However, as Attorneys will point out, this is less than the cost of one month of nursing home care. Persons retaining a Medicaid Planner should ask if the Planner will guarantee acceptance into the Medicaid program.
How Does the Medicaid Planning Process work?
Most Medicaid Planners start the process with a free consultation in which they will discuss the health status and financial resources of the individual who is applying or will someday apply for Medicaid. They establish the likelihood of success as well as the positive impact they can have on preserving a client’s assets. They use this information to determine whether or not to accept the prospective client. Once engaged with a client, several weeks are typically required for the collection of information and formal analysis of the family’s assets. A plan is built, discussed, modified as needed. Putting the plan into action can take longer. Depending on the strategy, it can take several weeks, even up to 3 months in some cases. In situations where there is an immediate need for Medicaid care, the Medicaid application documentation can be prepared concurrent with the execution of the plan.
Does Medicaid Pay for Assisted Living?
The Utah Medicaid New Choice Waiver program is a benefit that allows you to keep your income, and have Medicaid pay everything minus room and board per month. So it pays towards the “supportive services” of your assisted living costs. For many, living in an assisted living facility is a much more desirable environment than living in a nursing home. Assisted living facilities provide a home-like environment with more privacy and control over your daily activities. It’s not my goal to explain all the details of the New Choice Waiver (“NCW”) program here, but I do want to point out some important aspects:
1. NCW is a “De-institutionalization” program.
The purpose of the New Choice Waiver Program (NCW) is to “De-institutionalize” existing nursing home residents by moving them from nursing homes to a home based or assisted living settings. It’s cheaper for the State and some people would rather live in an assisted living facility than a nursing home. Thus, when Utah set up its program, only current nursing home residents could apply. However, in 2013 that requirement changed, and Medicaid started to allow people who had lived in an assisted living facility for 365 days or longer, to directly apply for the NCW benefit without ever having lived in a nursing home.
2. The NCW program is an allocated program.
Each year, the legislature allocates the number of individuals that will be accepted into the program. In 2015 there were 2,000 “slots.” Their fiscal year runs from July to July.
3. The 2015 Changes.
When Utah amended its waiver program in 2014 to allow existing assisted living residents to directly apply for NCW after 180 days, the slots quickly filled up – in fact the state stopped taking applications on December 31. The program didn’t open again until July 1 of 2015 – and they made some changes. Here are the main ones:
- Of the 2,000 slots allocated for 2015, only 20% (400 are available to assisted living facility (“ALF”) direct application individuals.
- Applications can only be filed during 3 Open Enrollment periods – March, July and November (approximately 1/3 of the allocated slots are used each period).
- Screening to receive a slot is based on the applicants length of residency in an ALF. The minimum length of stay has been expanded to 1 year (from 180 days). So essentially, once an individual meets the normal Medicaid qualifications, seniority determines if you get a slot.
4. NCW program for Nursing Home Residents.
Although the ALF direct application program has become more competitive and limited, the NCW program for existing nursing home residents is still a great benefit and can really provide a great solution for those elders who can function in an assisted living setting and have the right financial situation. It’s available for the following:
- Those currently living in a Medicaid reimbursed nursing facility care on an extended stay basis of 90 days or more; or
Those who are Receiving Medicare reimbursed care in a licensed Utah medical institution (that is not an Institution for Mental Disease), on an extended stay of at least 30 days, and will discharge to a Medicaid certified nursing facility for an extended stay of at least 60 days; or
- Those Receiving Medicaid reimbursed services through another of Utah’s 1915(c) waivers and have been identified as in need of immediate or impending nursing facility care; and
Applying for the New Choice Waiver program still requires that the applicant first qualify for Medicaid. So, when applying you actually must file two separate applications. One for the New Choice Waiver program and one for the regular Medicaid program. It’s a bit of a circular problem. If you don’t qualify for regular Medicaid, you don’t qualify for the New Choice waiver program. If you qualify for regular Medicaid, that doesn’t mean you also qualify for the NCW program. They actually look at the NCW application first, and if you qualify, then they consider your long term care Medicaid application. That means, even if NCW says you qualify for their program, if you don’t meet the LTC Medicaid requirements, you won’t get either benefit. Bottom line – it all boils down to whether you meet the financial tests of regular long term care Medicaid. So, that’s where we start. And that means we need to use all of the strategies I use to help people arrange their assets to save resources and meet the eligibility requirements. This just gives you an overview – and the exact details of your unique situation will dictate how we should proceed. However, what I want you to take away from this is – the NCW program is a great program and really can be the perfect solution for your loved one. Living in an assisted living facility can be much better than living in a nursing home for those that can live with less hands on nursing home care, but still meet the level of care required
This program is fairly new and often misunderstood. Don’t be misled, the qualification rules for this program are similar, but are not the same as Long-Term Care Medicaid. Eligibility rules are less restrictive for New Choices Waiver and allow for more favorable planning outcomes.
Skilled Nursing vs. Assisted Living
A skilled nursing facility offers a high level of care and serves people with extensive and demanding care needs. Most long-term care residents in a skilled nursing facility will have a shared room.
An assisted living facility is a care facility that offers more basic caregiving services. Assisted living residents usually enjoy a private room and are allowed more independence than skilled nursing residents.
To qualify for Medicaid.
We can answer all the common questions that seniors have about Medicaid Such As:
- Do I need to spend down all my assets to qualify for Medicaid?
- Will my spouse living at home have enough money to pay for living expenses?
- How long does it take to get approved for long-term Medicaid coverage?
- Are my Veteran benefits compliant with Medicaid?
- What medical services does Medicaid cover?
- If I accept Medicaid assistance, can the state seize my house from my spouse or loved one after I die?
- Are my adult children responsible for my medical bills?
*** The preceding is not to be construed as an engagement of our services and while we try to keep up-to-date and correct information, we do not warrant any of the content. ***