At this point you may be swimming in a sea of questions.
Assets – Any money or property owned by the applicant via bank accounts, investments, property, etc.
Income – Monthly income via Social Security, VA, Retirement Pension, Retirement (IRA), Compensation, etc.
Joint Income – Income of applicant plus that of their spouse.
Long Term Home Care (MLTC) provided by Managed Long Term Home Care (MLTC) – Primarily for Home Health Aide Services but can include Adult Day Care, RN visits and SW Services are approved based on need. Assessments are made by an RN for the individual MLTC you chose. You can shop around to see who offers you the best deal. MLTCs are basically HMOs which case manage your long term care at home. The MLTCs contract with certain agencies and they provide the actual services in the home. SO if you are using an agency already, you want to see what MLTC the contract with when you are approved for Medicaid.
Consumer Directed Home Care Program – This allows one to hire her/his own aide and have them paid via certain agencies that participate in this program. The chosen home care worker does not require any formal training. However, the worker must be legal to work in the United States and provide proof of this. They are offered health benefits and vacation time. If one chooses to use this program, that person is entirely responsible for retaining all home care aides.
Nursing Home Transition and Diversion Program – Uses Medicaid funding to provide supports and services to assist individuals with disabilities and seniors toward successful inclusion in the community. Waiver participants may come from a nursing facility or other institution (transition), or choose to participate in the waiver to prevent institutionalization (diversion). Waiver services may be considered when informal supports, local, State and federally funded services and Medicaid State Plan services are not sufficient to assure the health and welfare of the individual in the community, or when waiver services are a more efficient use of Medicaid funds.
Medicaid Pooled Income Trust – This trust is used to shelter income which exceeds the Medicaid limits. Once the income is placed in the trust, the person can submit to the trust any non-medical bill that is in the participant’s name, (such as rent, power, telephone, cable, life insurance, auto insurance, credit card for new charges only, food shopping receipts, etc). The trust will then pay the bill directly on the person’s behalf.
Spousal Refusal – This provision in the Medicaid law specifies that a well spouse may sign a form that allows them to retain their income and assets in their name thus allowing the ill spouse to qualify for Medicaid.
Spousal Impoverishment – Special eligibility levels for the assets and income of married couples when one spouse needs long term care and the other does not. (This has eligibility limits of $74,820 in assets and $2980.50 in joint monthly income.)
Medicare part A is hospital coverage. Most people who have worked or were married to someone who worked,will be automatically eligible for this when they turn 65. It is a hospital medical benefit. If you worked enough quarters, there is no cost for this coverage. Most people get this when they turn 65.
Part B Medicare is medical coverage. This covers Medical doctors. There is a monthly fee for this benefit. It is withheld automatically from your SS check. If you are low income in NY, sometimes the state can help pay for this premium. You do have to apply for this assistance.
Medicare is a benefit you get when you turn 65 (or if you are on Social Security Disability for at least 2 years) which covers basic health care. Medicaid is a means tested program which covers most medical care. There are income and asset restrictions and they vary by state.
Medicaid will pay for:
Medicaid helps with prescriptions covered via Medicare Part D. Medicaid will pay the monthly Part D premium. There is NO so-called “donut hole” (if you have heard that phrase) and the co-pays for medications are lowered to $ 1 for generic and $ 3 for brand name.
No. Medicare coverage remains primary and any secondary coverage (e.g. Blue Cross or AARP) remains secondary. Medicaid will only pay for things not covered by primary and secondary insurance.
Yes. Individuals are limited to $825 per month. Couples are limited to $1209 per month.
You are allowed to keep additional income to pay for the cost of Secondary Health Insurance. All excess or “surplus” income goes to Medicaid, toward the cost of your Medicaid covered care. There is also something called a Medicaid Pooled Income trust which can be used to “protect” excess income.
Asset limits for Medicaid are $14,850 for individuals and $21,750 for couples.
Not if you are taking the Required Minimum Distribution (RMD). For those over 70.5, there is no issue as this is required by law. The Principal of Retirement funds and some annuities are exempt if you are taking at least the RMD.
If you have a ROTH IRA and no distribution is required, you will have to take the equivalent of the RMD on this account to exempt the principal of the fund.
Actually, many middle class people are enrolled in Medicaid and consider it a valuable resource to spare their families from the financial burden of having to provide for their long term care needs.
There are too many myths about Medicaid that get circulated despite their incorrectness. I encourage my clients to rely on me for the real answers. I hope you will do yourself the favor of coming to a source that will relieve you of anxiety that is too often based too often on misinformation.
“Colin has a realistic and very human approach, not cold or merely factual. There was not one topic that felt uncomfortable when speaking with her.”
I carefully apply my services in New York State, but not in other states.
I do not provide legal advice to clients. All information I share is based upon 20 years of knowledge and experience in working with Medicaid and Pooled Income Trusts programs.
2127 Crompond Road, Suite 105
Cortlandt Manor, NY 10567
914 924 2566