Some Medicaid classes of assistance do not require verification, but most long-term care classes of assistance do. Verification documentation includes financial and non-financial information. Sometimes, tracking documentation down can be problematic. If you’re having trouble getting documentation, especially when a caseworker demands it on an unreasonable time-table, here’s what the manuals say: You are not […]
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Government Bonds are debt instruments issued by a government entity. The most common form of government bond owned by a Medicaid applicantis U.S. Savings Bonds. Savings bonds are not transferrable. They can only be sold back to the government. If they are owned solely by the applicant or the applicant’s spouse, they are countable. However, […]
General Rule One vehicle of any value is exempt. If the applicant has more than one vehicle, then the most valuable vehicle will be exempt and other vehicles will count toward the $2,000 resource limit. In Georgia, “Automobile” means any vehicle used for transportation. These include cars, trucks, motorcycles, golf carts, animal-drawn vehicles and animals. […]
Another “option” that may be considered in appropriate cases is divorce. Deeming between spouses terminates when the marriage terminates. In most cases, this “option” should be avoided because the emotional turmoil associated with divorce is significant and the CSRA can be set by court order, see § 1396r-5(f)(2)(iv) and (f)(3). Divorce also prevents an applicant […]
MCCA includes a mechanism for increasing both the CSRA and the MMMNA in certain cases. The methods by which this can be effected are described in 1396r-5(e), (d)(5) and (f)(3). Blumberg v. Tennessee Department of Human Resources, 2000 WL 1586454 (Tenn.Ct.App.) was a case where a Community Spouse sought a court adjustment of the default […]
As eligibility is being determined, if the Community Spouse’s monthly income falls below the Minimum Monthly Maintenance Needs Allowance (“MMMNA”), then MCCA contemplates two methods of raising her income up to the MMMNA. First, a portion of the Institutionalized Spouse’s income may be transferred to her to bring her income up to the MMMNA. Second, […]
Income and resources are treated differently. Unlike resources, income is not pooled in determining eligibility; the Community Spouse’s separate income is never considered available to the Institutionalized Spouse. Thus, the standard income eligibility process for one person applies. First, all income earned by the Community Spouse is always unavailable to pay nursing home bills, regardless […]
In Dullard v. Minnesota Department of Human Services, 529 N.W.2d 438, 443 (Minn. App. 1995), Minnesota was allowed to reevaluate eligibility after a couple moved from Illinois to Minnesota. There, Illinois (like Georgia) allowed the Community Spouse to keep the maximum CSRA, while Minnesota (like Tennessee) applied a formula resulting in a lower CSRA. The […]
Some couples might consider reducing the size of the marital estate by giving their resources away. Frequently this is the result when the plan is “home-made.” However, transfers for less than fair market value, including complete and partial gifts) trigger a period of ineligibility. 42 U.S.C. 1396p(c). It does not matter whether the applicant or […]
Federal law protects the healthy (or healthier) spouse of a nursing home resident. The healthier spouse is known in Medicaidland as the Community Spouse. The protections, known as the Spousal Impoverishment Rule (but logically be called the anti-impoverishment rule) were passed as part of the Medicare Catastrophic Coverage Act of 1988, P.ub. L. No. 100-360 […]
The following the committe report for the Medicare Catastrophic Coverage Act of 1988 (MCCA): The leading cause of financial catastrophe among the elderly is the need for long-term care, especially the need for nursing home placement. The expense of nursing home care–which can range from $2,000 to $3,000 per month or more–has the potential for […]
While nursing home bills accrue, the healthy or well spouse, known as the “Community Spouse,” [Note 1] struggles to identify and keep income and resources that are necessary to support herself. [Note 2]. To remedy this situation, Congress enacted spousal impoverishment provisions as part of the Medicare Catastrophic Coverage Act of 1988 (“MCCA”). [Note 3]. […]
Medicaid planning is discussed in more detail in subsequent chapters. Planning is the process of restructuring an estate in a legal manner to accelerate Medicaid eligibility. Often, the purpose is to protect the Community Spouse or a disabled child, but it can be done to protect a family inheritance as long as you follow the […]
Medicaid beneficiaries cannot “fix” eligibility by giving away resources. A transfer of resources without receipt of fair market value will trigger calculation of a transfer penalty. “The penalty for an institutionalized individual consists of ineligibility for certain services for a period or periods of ineligibility that equal the number of months calculated by taking the […]
As with the income rules, the resource defaults may be changed. First, if all of the Applicant’s income has been diverted to the Community Spouse and the monthly income available to the Community Spouse still does not reach the minimum monthly maintenance needs allowance, then 42 U.S. Code § 1396r–5(e)(2)(C) provides an administrative remedy for […]
A Community Spouse is entitled to a resource allowance in addition to the income allowance. 42 U.S. Code § 1396r–5(f)(1) and (2) provide: (1) In general An institutionalized spouse may, without regard to section 1396p(c)(1) of this title, transfer an amount equal to the community spouse resource allowance (as defined in paragraph (2)), but only […]
The SSI regulations describe deeming as the process of considering another person’s income or resources to be your own. See 20 CFR § 416.1160 (income) and 20 CFR § 416.1202 (Resources). Prior to the time Medicaid is approved, all marital resources are deemed available to the Applicant. See 42 U.S. Code § 1396r–5(c)(2)(A). However, 42 […]
As a general rule, all countable resources owned by the Institutionalized Spouse are considered available to pay his or her nursing home bills. It does not matter whether the resource is co-owned with someone else unless co-ownership makes it impossible to liquidate the resource. Georgia ABD Manual § 2300 states that resources include cash, other […]
The law protects a Community Spouse with low income. It does this by diverting a portion of the applicant’s income to the Community Spouse. The rules are different in each state so we’re giving you the law. In 2023, states that allow a maximum income allowance say that a Community Spouse with less than $3,715.50 […]
On the income side, there are three pathways to Medicaid eligibility for nursing home residents. First, SSI recipients are almost always eligible. Second, in most States, if the resident’s income does not exceed 300% of the federal poverty level ($2,742 in 2023), then he or she qualifies for Medicaid under a “special income level.” Third, […]
In evaluating financial eligibility for Medicaid, both monthly income and resources must be considered. The basic rule is everything having value is an asset. 42 U.S.C. § 1396p(h)(1). This includes monthly income and resources. Income includes both earned and unearned income. 42 U.S.C. § 1396p(h)(2) incorporates by reference the definition of income found at 42 […]
Categorical and medical eligibility is covered in Chapter 2. Here we begin an aerial fly-over of financial eligibility. In this chapter we are painting with a broad brush. Subsequent chapters will examine financial eligibility and planning techniques in more detail. In reviewing financial eligibility, it is important to know which class of assistance the applicant […]
Only those persons with a medical need are eligible for Medicaid and not all persons needing help receive Medicaid. In Georgia, medical eligibility determinations for nursing home facility care are performed by the facility using Form DMA-59. Determinations for CCSP (HCBS) are made by the CCSP RN Care coordinator. 2240 – Level of Care As […]
With few exceptions (such as the existence of an interstate compact), a Medicaid applicant must be a resident of the State where benefits are provided. 42 CFR § 435.403. [Note 10]. The “duration” of residence cannot be a condition of eligibility. See 42 CFR § 435.403(j)(1); Shapiro v. Thompson, 394 U.S. 618 (1969). HCFA 64 […]
An applicant must be a U.S. Citizen or a legally admitted alien to receive Medicaid. 42 CFR § 435.406. In that regard, HCFA 64 provides as follows: 3210.1 General Requirements.–The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193) significantly changed Medicaid eligibility for individuals who are not citizens of the United States. […]
In addition, to establish technical eligibility for nursing home Medicaid, an applicant must be (i) a U.S. Citizen or lawfully admitted alien, (ii) a resident of the State where benefits are sought and (iii) have been treated for a continuous period of 30 days in a medical facility. 42 C.F.R. § 435.211. [Note 7]. By […]
Individuals who are aged (age 65 or older), blind or disabled may be entitled to Medicaid if they are medically eligible and financially needy. In Georgia and Tennessee, SSI recipients are immediately eligible. See 42 U.S.C. § 1396a(a)(10)(A)(i)(II). Although the focus here is on long term care Medicaid, other classes of assistance make Medicaid available […]
The remainder of this book focuses on long-term care Medicaid. Long-term care refers to a wide range of supportive and health services for persons who have lost the capacity for self-care due to illness, frailty, or a disabling condition. It differs from acute care in that the goal of long-term care is not to cure […]
The enactment of the Omnibus Budget Reconciliation Act of 1986 (OBRA 86) offered States an option for covering persons whose income exceeds SSI or 209(b) levels. (CRS Report, How Medicaid Works: Program Basics, January 4, 2006). This option allows States to cover aged and disabled individuals with incomes up to 100 percent of FPL. In […]
Many States provide SSP benefits with State-only dollars on a monthly basis. These payments are intended to cover such items as food, shelter, clothing, utilities, and other daily necessities. The amount of the benefit is determined by the individual States. States may provide supplemental payments to all persons who receive SSI, and/or to individuals who […]
With one important exception, States are required to provide Medicaid coverage to recipients of SSI. SSI, authorized under Title XVI of the Social Security Act, is a means-tested cash assistance program for aged, blind, and disabled individuals whose income falls below the Federal maximum monthly SSI benefit and whose resources are limited. To qualify for […]
The Federal Medicaid statute defines over 50 distinct population groups as being potentially eligible for States’ programs. Some groups (classes of assistance) are mandatory, meaning that all States that participate in the Medicaid program must cover them; others are optional. Prior to the 1980s, Medicaid eligibility was limited to very low-income families with dependent children, […]
Medicaid was enacted in 1965, in the same legislation that created the Medicare program, the Social Security amendments of 1965 (P.L. 89-97). [Note 2]. A history of Medicaid’s evoluation is recounted in Wilbur Cohen’s article Reflections on the enactment of Medicare and Medicaid. “The program is designed to provide medical assistance to persons whose income […]
The Medicare program (Title XVIII of the Social Security Act) provides hospital insurance (HI), also known as Part A coverage, and supplementary medical insurance (SMI), also known as Part B coverage. Free HI coverage (a/k/a Premium-free Part A) is automatic for persons with insured status (those eligible for Social Security benefits) aged 65 and older […]
What are people talking about when they say you have to “spend down” to become eligible for Medicaid? Well, it can describe two different things. Most of the time elder law attorneys are referring to to resource spend-down where the applicant is trying to get below the resource eligibiity threshold. But it can also refer […]
