What is Medicaid?
Medicaid is health insurance that helps many people who can't afford medical care pay for some or all of their medical bills. Good health is important to everyone. If you can't afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy and stay healthy.
Medicaid is available only to people with limited income. You must meet certain requirements in order to be eligible for Medicaid.
Medicaid does not paymoney to you; instead, it sends payments directly to your health care providers. Depending on your state's rules, you may also be asked to pay a small part of the cost (co payment) for some medical services. (For more information, download "Medicaid At-A-Glance 2005" from the bottom of the page.) To learn about the Medicaid program in your state see Related Links inside CMS at the bottom of the page.
Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home.
Your child may be eligible for coverage if he or she is a U.S. citizen or a lawfully admitted immigrant, even if you are not (however, there is a 5-year limit that applies to lawful permanent residents). Eligibility for children is based on the child's status, not the parent's. Also, if someone else's child lives with you, the child may be eligible even if you are not because your income and resources will not count for the child.
In general, you should apply for Medicaid if your income is limited and you match one of the descriptions of the Eligibility Groups. (Even if you are not sure whether you qualify, if you or someone in your family needs health care, you should apply for Medicaid and have a qualified caseworker in your state evaluate your situation.)
For specific information about enrolling in Medicaid, eligibility, coverage and services for your State, please contact your local Medicaid office. You can view your State's Medicaid Office contact information by visiting the www.Benefits.gov website (see the link on the CMS home page http://www.cms.hhs.gov/medicaideligibility/ or check the contact information for State Medicaid offices (see the link on the CMS home page http://www.cms.hhs.gov/medicaideligibility/
Medicaid is available only to people with limited income. You must meet certain requirements in order to be eligible for Medicaid.
Medicaid does not paymoney to you; instead, it sends payments directly to your health care providers. Depending on your state's rules, you may also be asked to pay a small part of the cost (co payment) for some medical services. (For more information, download "Medicaid At-A-Glance 2005" from the bottom of the page.) To learn about the Medicaid program in your state see Related Links inside CMS at the bottom of the page.
Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home.
Your child may be eligible for coverage if he or she is a U.S. citizen or a lawfully admitted immigrant, even if you are not (however, there is a 5-year limit that applies to lawful permanent residents). Eligibility for children is based on the child's status, not the parent's. Also, if someone else's child lives with you, the child may be eligible even if you are not because your income and resources will not count for the child.
In general, you should apply for Medicaid if your income is limited and you match one of the descriptions of the Eligibility Groups. (Even if you are not sure whether you qualify, if you or someone in your family needs health care, you should apply for Medicaid and have a qualified caseworker in your state evaluate your situation.)
For specific information about enrolling in Medicaid, eligibility, coverage and services for your State, please contact your local Medicaid office. You can view your State's Medicaid Office contact information by visiting the www.Benefits.gov website (see the link on the CMS home page http://www.cms.hhs.gov/medicaideligibility/ or check the contact information for State Medicaid offices (see the link on the CMS home page http://www.cms.hhs.gov/medicaideligibility/
Medicaid Questions & Answers
(Information supplied by Senior Planning Services) What is the maximum income I can have and still be eligible for Medicaid?Medicaid is a joint Federal and State program, and although there are federal minimum standards, individual eligibility criteria are largely at the discretion of each state. As such, income caps vary significantly state to state.
Additionally, in some states if a Medicaid applicant has income that exceeds the income limit, they can place the excess into a Miller fund, also known as a Qualified Income Trust (QIT) in some states.
A Miller Fund is an irrevocable trust fund where one can transfer an amount of money which will be used to pay for various expenses, depending on the individual state guidelines. This will allow an individual Medicaid-sponsored care although they may be above the income cap.
What is considered income?
Medicaid considers any monies that are available for use upon receipt to be income. This would include salaries, wages, social security checks, pensions and the like.
How much income can the nursing home resident keep?
As a general rule, Medicaid requires all income to go toward paying for Medical care. However, the Medicaid beneficiary may keep a minimal PNA (Personal Needs Allowance) which varies somewhat from state to state, as well as premium costs of a secondary insurance.
In addition, the ‘community spouse’, the spouse of the Medicaid beneficiary living in the community, may get to keep a Monthly Maintenance Needs Allowance (MMNA) from the Medicaid recipients’ income if his/her income does not meet the state specified limit.
Can I set aside some of my assets for funeral and burial expenses?
Yes, you can purchase a burial plot, and set aside expenses for a funeral so long as the money for the funeral expenses is set up as an irrevocable trust fund. Generally there is a funeral cutoff that can be placed in the trust fund that varies from state to state.
An irrevocable trust fund means that the funds are nonrefundable. They can be transferred to another funeral home or even to another state, though, if that is the wish of the family.
Are there any other types of irrevocable trust funds that can be set up for specific expenses?
An individual can set up a special needs fund for a disabled child, also known as a Supplemental trust fund.
How far does Medicaid look at my financials to determine my eligibility?
Medicaid has what’s called a 5 year ‘look back’ where they reserve the right to request documentation for any account that is held within a financial institution before they determine an individual’s eligibility.
The reason for this is to uncover large money transfers or monetary gifts within this period. Medicaid will impose penalties based on the amount of these gifts before they begin paying for the nursing home cost.
Can I spend some of my assets in order to be eligible?
Yes, this we call the ‘spend down’ process. You can make certain purchases to help achieve Medicaid eligibility. Some examples are; purchasing a wheelchair, clothing, toiletries, etc. for the nursing home resident.
The community spouse can pay for home repairs for the primary residence in which he or she will reside or purchase a vehicle. As mentioned, irrevocable trust funds can also be set up for specific expenses, as well as some other expenses.
The cost of paying for a Medicaid consultant who may be able to advise an individual on how to achieve eligibility may also be deducted from the total assets to help bring one down under the asset limit. It is important to bear in mind that gifting monies is not allowed, as mentioned previously.
For additional information contact http://www.senior-planning.com.
Additionally, in some states if a Medicaid applicant has income that exceeds the income limit, they can place the excess into a Miller fund, also known as a Qualified Income Trust (QIT) in some states.
A Miller Fund is an irrevocable trust fund where one can transfer an amount of money which will be used to pay for various expenses, depending on the individual state guidelines. This will allow an individual Medicaid-sponsored care although they may be above the income cap.
What is considered income?
Medicaid considers any monies that are available for use upon receipt to be income. This would include salaries, wages, social security checks, pensions and the like.
How much income can the nursing home resident keep?
As a general rule, Medicaid requires all income to go toward paying for Medical care. However, the Medicaid beneficiary may keep a minimal PNA (Personal Needs Allowance) which varies somewhat from state to state, as well as premium costs of a secondary insurance.
In addition, the ‘community spouse’, the spouse of the Medicaid beneficiary living in the community, may get to keep a Monthly Maintenance Needs Allowance (MMNA) from the Medicaid recipients’ income if his/her income does not meet the state specified limit.
Can I set aside some of my assets for funeral and burial expenses?
Yes, you can purchase a burial plot, and set aside expenses for a funeral so long as the money for the funeral expenses is set up as an irrevocable trust fund. Generally there is a funeral cutoff that can be placed in the trust fund that varies from state to state.
An irrevocable trust fund means that the funds are nonrefundable. They can be transferred to another funeral home or even to another state, though, if that is the wish of the family.
Are there any other types of irrevocable trust funds that can be set up for specific expenses?
An individual can set up a special needs fund for a disabled child, also known as a Supplemental trust fund.
How far does Medicaid look at my financials to determine my eligibility?
Medicaid has what’s called a 5 year ‘look back’ where they reserve the right to request documentation for any account that is held within a financial institution before they determine an individual’s eligibility.
The reason for this is to uncover large money transfers or monetary gifts within this period. Medicaid will impose penalties based on the amount of these gifts before they begin paying for the nursing home cost.
Can I spend some of my assets in order to be eligible?
Yes, this we call the ‘spend down’ process. You can make certain purchases to help achieve Medicaid eligibility. Some examples are; purchasing a wheelchair, clothing, toiletries, etc. for the nursing home resident.
The community spouse can pay for home repairs for the primary residence in which he or she will reside or purchase a vehicle. As mentioned, irrevocable trust funds can also be set up for specific expenses, as well as some other expenses.
The cost of paying for a Medicaid consultant who may be able to advise an individual on how to achieve eligibility may also be deducted from the total assets to help bring one down under the asset limit. It is important to bear in mind that gifting monies is not allowed, as mentioned previously.
For additional information contact http://www.senior-planning.com.
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How to Achieve Optimal Medicaid Coverage
When a loved one requires professional care, beyond the family’s capabilities, it is time to consider a skilled nursing facility. Committing a parent or spouse to a nursing home is never an easy decision, and quite naturally numerous questions abound.
The most important thing to do when applying for Medicaid is to stay informed. Medicaid is a joint federal and state fund for the disabled, children, pregnant women and seniors. The federal government covers about 60% of the budget with the individual states picking up the tab from there, leaving much discretion to the states in instituting guideline and eligibility protocol.
In addition, regulations such as asset and income limits are subject to frequent change. One needs to educate themselves on the individual state guidelines and speak to experts regarding their specific scenario to ensure that they receive optimal coverage and maximized benefits.
www.Senior-Planning.com provides a plethora of resources to help applicants better understand the Medicaid process. Here are some of the FAQs answered every day.
- “What kind of care does Mom or Dad need?”
- “What should we be looking for in a nursing home?”
- And often most troubling,
- “How are we going to pay for it?”
The most important thing to do when applying for Medicaid is to stay informed. Medicaid is a joint federal and state fund for the disabled, children, pregnant women and seniors. The federal government covers about 60% of the budget with the individual states picking up the tab from there, leaving much discretion to the states in instituting guideline and eligibility protocol.
In addition, regulations such as asset and income limits are subject to frequent change. One needs to educate themselves on the individual state guidelines and speak to experts regarding their specific scenario to ensure that they receive optimal coverage and maximized benefits.
www.Senior-Planning.com provides a plethora of resources to help applicants better understand the Medicaid process. Here are some of the FAQs answered every day.
What is the asset threshold for Medicaid?
The exact numbers vary state by state and can be as high as $15,000.00 or as low as $1,500.00.
What about other non-liquid assets such as my house; does Medicaid take that away from me?
Typically, when a single person is admitted to a skilled nursing facility Medicaid will place a lien on the house for the total amount they pay out for an individual’s long-term care.
For example; an individuals’ house is worth $300,000. The average cost of a nursing home stay is anywhere between $70,000 and $100,000 annually. Just to simplify things, let’s assume the individual qualifies for a higher level of care and comfort and is admitted to the facility that costs $100,000.
If the individual remains in the nursing home for two years, Medicaid will place a lien for the amount of $200,000 which will need to be fulfilled upon the death of the Medicaid recipient before the heirs can claim the remaining $100,000.
There are many ways for the scenario to play out, but a Medicaid Lien will always need to be paid out first.
For example; an individuals’ house is worth $300,000. The average cost of a nursing home stay is anywhere between $70,000 and $100,000 annually. Just to simplify things, let’s assume the individual qualifies for a higher level of care and comfort and is admitted to the facility that costs $100,000.
If the individual remains in the nursing home for two years, Medicaid will place a lien for the amount of $200,000 which will need to be fulfilled upon the death of the Medicaid recipient before the heirs can claim the remaining $100,000.
There are many ways for the scenario to play out, but a Medicaid Lien will always need to be paid out first.
What about if I’m married and my wife wants to remain in the house?
Medicaid has rules concerning what they refer to as the ‘community spouse’, the spouse of the nursing home resident that remains in the community. In most cases, he or she can remain in the primary residence and there will be no lien placed on the house. This applies to a child under the age of 18 and a disabled child of any age, as well. The name of the Medicaid applicant will need to be removed from the deed
Is there any way for me to protect my assets while applying for Medicaid?
There are several things that can be done to preserve your assets. As a general rule Medicaid has a five year ‘look back’ where they will want to see all bank documentation and whether any large amounts of money were transferred out of the applicants account.
Any large monetary gifts that an individual would like to gift to a family member-- so they don’t wipe out their entire savings on their own care leaving nothing over-- must be done prior to this 60 month period.
Conclusion: As was discussed, the single most important thing a Medicaid applicant can do to ensure that they receive the quality care that they may be entitled to is to stay informed. The Medicaid process can be unduly frustrating, and consulting with those in the know is the first step toward a secure financial future.
Any large monetary gifts that an individual would like to gift to a family member-- so they don’t wipe out their entire savings on their own care leaving nothing over-- must be done prior to this 60 month period.
Conclusion: As was discussed, the single most important thing a Medicaid applicant can do to ensure that they receive the quality care that they may be entitled to is to stay informed. The Medicaid process can be unduly frustrating, and consulting with those in the know is the first step toward a secure financial future.
Where Might You Live: And how Medicaid might help pay for it
Retire in place Independent living is lasting longer for many seniors than ever before. Previously, seniors who were no longer able to care for themselves moved into nursing homes or moved in with their adult children. Thanks to in-home care options, seniors are able to receive the quality of care they need without having to leave home.
In some cases it is necessary to remodel the home to make it livable for seniors as daily tasks that were once taken for granted have become difficult. Simply climbing up a flight of stairs or stepping up to get into the bathtub can present difficulties that they couldn't have anticipated when they first purchased their homes. There are many home renovation options available that will make life easier. You can add ramps, change showers and bathtubs to walk-in models, and widen doorways to make room for walkers and wheelchairs.
Some of these modifications are pricey, but Medicaid will often help pay for many home modifications.. Make sure you are up to date with all the Medicaid qualifications and the constant changes to the system, or reach out to long-term care Medicaid eligibility experts to get the info you need.
New tools & conveniences. Today's seniors have unprecedented access to tools that can make their lives easier. From devices that make it easy to reach out and grab an item that's a little bit out of reach to motorized scooters and chairs that make getting around a breeze after walking becomes difficult. There are countless tools and conveniences that will make senior’s lives easier and more enjoyable throughout their retirement years.
Staying in your home during your retirement years means you remain close to friends and family and you are also more familiar with the area as far as shopping, where to seek professional services and areas of entertainment. Not long ago retirement meant a move to a state with a warm climate and a variety of options for aging seniors. Now, many retirees are finding it is less expensive and more convenient to stay where they have lived for many years and more and more retirees who had moved to warmer climates are moving back home.
If you are interested in a better understanding of the Medicaid process and how Medicaid might help pay for some services this Medicaid planning company can help. (link to http://www.senior-planning.com/new-jersey-medicaid-planning-eligibility/)
In some cases it is necessary to remodel the home to make it livable for seniors as daily tasks that were once taken for granted have become difficult. Simply climbing up a flight of stairs or stepping up to get into the bathtub can present difficulties that they couldn't have anticipated when they first purchased their homes. There are many home renovation options available that will make life easier. You can add ramps, change showers and bathtubs to walk-in models, and widen doorways to make room for walkers and wheelchairs.
Some of these modifications are pricey, but Medicaid will often help pay for many home modifications.. Make sure you are up to date with all the Medicaid qualifications and the constant changes to the system, or reach out to long-term care Medicaid eligibility experts to get the info you need.
New tools & conveniences. Today's seniors have unprecedented access to tools that can make their lives easier. From devices that make it easy to reach out and grab an item that's a little bit out of reach to motorized scooters and chairs that make getting around a breeze after walking becomes difficult. There are countless tools and conveniences that will make senior’s lives easier and more enjoyable throughout their retirement years.
Staying in your home during your retirement years means you remain close to friends and family and you are also more familiar with the area as far as shopping, where to seek professional services and areas of entertainment. Not long ago retirement meant a move to a state with a warm climate and a variety of options for aging seniors. Now, many retirees are finding it is less expensive and more convenient to stay where they have lived for many years and more and more retirees who had moved to warmer climates are moving back home.
If you are interested in a better understanding of the Medicaid process and how Medicaid might help pay for some services this Medicaid planning company can help. (link to http://www.senior-planning.com/new-jersey-medicaid-planning-eligibility/)