Articles Posted in Medicaid Applications

Family members as caregivers overwhelmingly provide for elderly and disabled loved ones at home. Although a labor of love, taking care of ailing loved ones also has a market value, meaning that caretakers may be paid as a way to protect assets.
Through the use of a Caregiver Agreement, also known as a Personal Services Contract, the disabled or elderly person may transfer money to family members as compensation rather than as a gift. Gifts to family members made in the last five years before applying for Medicaid to pay for nursing home costs disqualify the applicant from receiving Medicaid for a certain period of time, known as a “penalty period.”
For example, mom depends on daughter Janice for her care. If mom gifts $100,000 to Janice, then goes into a nursing home in the next five years and applies for Medicaid, the gift to Janice will result in about a ten month penalty period. Janice will have to give the $100,000 back to mom to pay nursing home costs during the penalty period, or mom will have to use other resources to pay.

Medicaid is state and federal funding that pays for long-term care costs, either at home, called “Community Medicaid,” or in a nursing home, called “Institutional” or “Nursing Home Medicaid.” The Medicaid rates change every year for income and asset requirements to determine eligibility for benefits. Following are the 2020 New York rates.

A single applicant for Community Medicaid may keep up to $15,750 in assets and $875 in income. If the applicant’s income is greater than the limit, a “Pooled Income Trust” created by a non-profit organization may shelter the excess income to make the applicant eligible for community Medicaid.

A married applicant for Community Medicaid may keep up to $15,750 in assets and $875 in monthly income. The non-applicant spouse may keep their own income and keep up to $128,640 in assets. The rules are different if one spouse is enrolled in a Managed Long Term Care Plan. The applicant spouse may keep $409 of monthly income and the other spouse may keep $3,216 of monthly income. The healthy spouse may keep between $74,820 and $128,640 in assets. “Spousal Refusal” is another option that may help the healthy spouse keep more income and assets. A review of the couple’s income and assets helps determine which approach is more favorable.

THOROUGH PLANNING NEEDED IN ADVANCE

This blog has discussed the necessity of proper and thorough planning to ensure a smooth transition into a continuing care retirement community.  This requires, among other things, that a person properly and legally transfer all of their assets, or a substantial portion of their assets that is, to people or entities that would enable them to be eligible for Medicaid.  As many people know, there is a look back period where the state examines all transfers of assets or money over a certain period of time for purposes of Medicaid eligibility purposes.  

If during that time a person transferred any aset for less than full market value or did not transfer the assets to a proper investment vehicle that is otherwise exempt from Medicaid assets, the Medicaid applicant will likely be denied for financial reasons.  In other words Medicaid will claim that the applicant has too many assets or their income is too high to qualify.  Some examples of a Medicaid exempt transfer is the purchase of a graveyard plot, prepayment for funeral services or the purchase of a short term Medicaid annuity.  An interesting case from November, 2015 out of Broome County, entitled Good Shepherd Village at Endwell v. Peter Yezzi shows the many problems that can result when people start their Medicaid planning after admission to a continuing care retirement community.

SOME LIMITED RELIEF

Patients who rely on Medicare sometimes experience sticker shock after being released from the hospital only to find out that because some hospital administrator classified their stay as “observational” that they must pay a large portion of the final bill. Many times a doctor will seek to have a patient admitted for any number of reasons, only to have a bureaucrat reclassify the patient’s time at the hospital as observational. Such a designation will mean that Medicare will not pay for this time in the hospital. For Medicare to pay for a hospital stay, the patient has to be an admitted patient for at least three days (three midnights in the hospital).

Observational status does not equate to an admitted patient in Medicare’s own set of self defined definitions. That may be quite different to the patient who went to the hospital and received a number of drugs and tests during their time their and was consistent with the majority of their non-surgical stays in a hospital in life. In an effort to address these obvious problems that will only grow with time, President Obama signed a bill that required hospitals to warn patients that their stay will be considered observational in nature and that they are not being admitted under Medicare’s rules, which may result in a bill from the hospital that they will have to pay. The Notice of Observation Treatment and Implications for Care Eligibility Act would have to inform the patient that they are going to receive outpatient services under Medicare’s rules which requires cost sharing from the patient and that the observational status does not count towards the necessary three day inpatient in order to transition to a skilled nursing care facility.

Medicaid is one of the most utilized government programs for elderly American citizens that are in need of medical assistance that they cannot afford. In order to qualify for the Medicaid program, an applicant must meet a number of criteria and an application can either be filled out online or in paper form. However, many applicants to the Medicaid program have run into issues of red tape and other problems when attempting to apply for benefits.

Online Medicaid Application

The online application for Medicaid can be found on the federal Medicaid program website. For seniors that are tech savvy, the online application can be filled out in about 45 minutes. The website contains all kinds of information like eligibility, benefits, and required documentation needed to be considered for the program. After an online application is submitted, there may be follow-up phone calls by the program to make sure that everything regarding their application is in order, but usually an accepted applicant can receive their benefits card within 45 days of submitting the online application.

The federal government has proposed new rules for private healthcare insurers that have Medicaid and children’s health plans for the first time in over a decade. The proposed rules would cover healthcare plans for millions of people across the United States and calls for insurers to provide a report of what portion of money they’re paid by the government is actually going towards health benefits and is recommending that states take that into account when setting their rates.

Medicaid Program

Medicaid and CHIP cover more than 70 million people in the United States, and 12.6 million people were added last year alone from the expansion of the Affordable Care Act. The Medicaid program is state-run, but it is overseen in part by the federal government and the Centers for Medicare and Medicaid Services. Private Medicaid plans operate in 39 states across the country and cover more than half of all Medicaid beneficiaries.

The first part of this article explained that there are many programs and benefits available to seniors that live in New York. The second part of the article continues to explain various services that are available to the state’s elderly population.

Temporary Assistance

This program provides cash benefits for senior citizens with limited income for essential food, clothing, and shelter items. You can be any age to apply, but people over the age of sixty do not have to meet the program’s work requirements. The resource limit for an individual is $2,000 and $3,000 if any household member is ages sixty or older. Employed applicants may be able to disregard some of their earnings and still qualify for the program. There is a sixty month limit on this program, and it applies for the lifetime of the applicant.

Elderly couples are divorcing at a higher rate than ever before for a surprising reason: soaring medical and long-term care costs. These expenses are being aggravated by longevity and uninsured risk from a lack of long-term care insurance. Although these senior couples still care for each other very much, the cost savings from divorce are inflicting the least amount of damage when compared to other financial options.

Medicare and Medicaid

Seniors are now turning to divorce to stave off financial ruin trying to qualify for Medicare and Medicaid coverage. In terms of Medicare coverage, the program only covers 100 days of nursing care. If you or your spouse needs long-term nursing care you must either pay out of pocket until your assets fall beneath a certain threshold or tap into your long-term care insurance if you have it.

When Medicare was expanded in 2003, the expansion that established prescription drug coverage was called a “promise, a solemn promise, to America’s seniors.” Part D Medicare officially took effect in 2006, but still some seniors were afraid of falling into the infamous “doughnut-hole” coverage gap.

Initial Benefits of Part D

In Part D’s first few years, national data has shown that the program had helped seniors make progress with their prescription drugs. Overall, out of pocket costs decreased for medication, seniors took their medication more regularly, and were less likely to forego basics like food or heat in order to afford for their prescriptions.

The New York Medicaid system is the primary means of providing long-term care to many seniors in the state. However, the system’s popularity led to financial strains, and public officials have worked for years to address rising costs and budget challenges. The most popular large-scale change to the program pushed by reform advocates is referred to as “managed care.”

The idea of managed care is to move away from paying service providers per specific task provided and instead compensate them a flat fee for each resident–regardless of what care the resident needs. The idea is to eliminate the company’s incentive to provide care that is not needed simply to increase their reimbursement. By providing a flat fee per resident, caregivers are incentivized to provide efficient, quality care.

Purging “Unprofitable” Clients?

Contact Information