The Medicaid Handbook

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1 The Medicaid Handbook John received his B.A. from LSU in 1970, and his J.D. from the University Of Denver School Of Law, In addition to more than 20 years of legal experience, John is also a Certified Financial Planner. He has served as an adjunct professor at Metropolitan State College, and has written articles and taught attorneys, CPAs, CFPs, stockbrokers, enrolled agents, insurance professionals and trust officers, both academic and continuing education courses, specializing in Estate Planning and Estate and Gift Taxation. He is actively teaching the post-graduate Estate Planning academic requirement course for Certified Financial Planner TM candidates in a number of locations throughout the country. John maintains an active local practice in the southern Denver suburb of Centennial and works with clients from all over the state of Colorado EAST ARAPAHOE ROAD, SUITE 100, CENTENNIAL, CO (303) OFFICE (303) FAX JOHN R. PHILLIPS, JD, CFP John is actively involved in his community, having raised his family here. He serves on the Board of Directors of the Arapahoe Douglas Mental Health Network. He has performed with the Colorado Symphony Chorus for over fifteen years J R Phillips & Associates, PC All Rights Reserved

2 MEDICAID BASICS The average cost of a skilled-care facility (nursing home) in Colorado is between $75,000 and $85,000 per year. There is no governmental program that covers these costs other than Medicaid. Medicare will only cover some amount of rehabilitation following a hospitalization. For long-term care, one is expected to utilize all of one s own resources (including long term care insurance if applicable) until such time as one s resources are substantially depleted. The average cost of a nursing home in Colorado is $75,000- $85,000 per year. Once a person is indigent (as defined for Medicaid purposes) the Federal program known as Medicaid is available to provide such care. This program is a Federal program that is administered by the individual states through the county of the person s residence. Each state (and even counties within a state) is different in the rules, and the procedures to qualify and remain qualified. If one qualifies for Medicaid, after the applicant s income is applied to the nursing home costs, then Medicaid covers the remainder of the nursing home costs. Medicaid vs. Medicare Medicare is the government program that provides health care to those age 65 and over while Medicaid is the government program designed to provide for the basic needs of the indigent. Medicare covers all U.S. citizens for basic health insurance from age 65 on, irrespective of assets and income. Part A provides compulsory coverage for hospitalization while Part B is voluntary covering physician services, medical services, and medical supplies not covered under Part A. The participant pays for Part B. Many individuals purchase private supplemental insurance to add additional protection. Supplemental insurance is statutorily designated in specific groups (A through J). Each group has specific coverages so that policies from different companies can be easily compared. Neither Part A nor Part B covers custodial or long-term care. This specifically excludes inhome custodial care, assisted living costs, and nursing home expenses other than normal medical expenses. The Medicaid program is designed to cover these expenses to meet the minimal health needs of those individuals who cannot provide for themselves. Medicare specifically excludes custodial care, assisted living costs, and nursing home expenses.

3 Eligibility for Medicaid To be eligible for Medicaid long-term care benefits, the applicant must pass three tests. 1. Medical Test In order to receive Medicaid, the applicant must be medically eligible. He or she must require a nursing home level of care. This is determined by the applicant s ability to perform the following activities of daily living: Mobility Bathing Dressing Eating Toileting and Transferring or Need for significant supervision Typically, if the applicant requires assistance with any two of the above ADL s or has a significant need for supervision, then he or she is considered in need of a nursing home level of care. The ADL s are determined by a functional needs assessment. This assessment is performed when an application is submitted. The need for significant supervision alone will medically qualify the applicant 2. Income Test To qualify for Medicaid, the applicant s monthly income must be less than $2,130 in If his or her income is more than the limit but less than $7,046 in 2013, Colorado permits a statutory trust to be used. Only the income of the applicant is counted and there is no limit on the spouse s income. Some income is considered exempt including long term care insurance payments, reverse mortgage payments and VA Aid & Attendance benefits for unreimbursed medical expenses. 3. Asset Test Generally, an applicant cannot have countable resources of more than $2,000. If the applicant is married, the resources of both spouses are counted. However, the community spouse (the spouse not applying for Medicaid) is entitled to retain some countable resources. The community spouse is permitted to keep up to $113,920* of the couple s combined countable assets at the time of the application. The community spouse s countable assets are only counted at the time of application and are not subject to annual reviews. The total countable assets the couple can own and still qualify the applicant for Medicaid is $115,920*. The following are resources that are not counted in the $115,920: Primary Residence up to $525,000 One Vehicle Personal Property Life Insurance up to $1,500 Face Value

4 Irrevocable Burial Insurance Medicaid Friendly Annuities There are exceptions and limitations to each of these assets so it is important to consult a professional if you have any questions. *The figures are effective as of July 1, The look-back period is 60 months prior to the date of application. Transfers An applicant will be ineligible for Medicaid for a period of time, known as the look-back period if he or she transfers assets without fair consideration. The look-back period is 60 months prior to the application. If the county determines that the applicant disposed of any income or resources without fair consideration during this 60 month period, the county will impose a penalty period. The penalty period does not begin to run until the first day of the month in which the transfer was made, or the first day the applicant is receiving nursing home services, whichever is later. The applicant must also be eligible for Medicaid with regards to countable resources and income. There is no limit on how long the penalty period can be. The following types of transfers are exempt and will not incur a penalty period: Transfers between spouses; Transfer of the home in some very limited situations; Transfer of any assets to a trust in some very limited situations; Transfer of assets into an exempt Special Needs Trust or Pooled Trust; Transfers to purchase exempt immediate annuities; Transfers as loans for notes or mortgages; Transfers to purchase a life estate in another person s home An applicant will be ineligible for Medicaid for a period of time if he or she transfers assets without fair consideration. The rules regarding these transfers are very specific and need to be followed very closely. Veterans Pension Benefits VA Aid & Attendance is also available to assist Veterans and their spouses to pay for long-term care. It is important to remember that certain types of VA planning can affect Medicaid eligibility. In order to qualify for Aid & Attendance, the applicant can gift assets to reduce their assets to below the threshold. However, this gift will trigger the penalty period for

5 Medicaid and push back the date in which those benefits will be paid. The applicant should be aware that Aid & Attendance planning may disqualify them from Medicaid for a period of time. If applying for VA Aid & Attendance, and Medicaid is a possibility in the future, there needs to be appropriate planning to consider both programs. Appropriate planning considers both Medicaid Planning VA Aid & Medicaid planning is arranging one s assets to ultimately be able to qualify for Medicaid. The purpose is to meet the requirements and still be able to pass assets on to one s family. Attendance, and Medicaid for those that need both The federal and state governments are making the qualification requirements more and more stringent in order to eliminate many of those who have available assets. The general rule is if nursing home care is imminent, the planning includes arranging the available assets to best comply with the exemptions in the law. However, this must be done before the application is initiated. Application Process A person may apply for Medicaid as soon as they begin receiving long-term care services. The applicant must apply in the county where they reside. The date the agency receives the application is the date from which Medicaid will provide benefits if the application is approved. Generally, the process takes days, but depending on the volume of applications, it can take up to three months. During this time, the nursing home or assisted living facility is required to complete the functional assessment to determine medical eligibility. Using the required documentation, the county will determine financial eligibility. Applications are often denied initially, requiring the applicant to appeal the In general, the most successful strategies include: 1. Converting countable assets to non-countable assets before the application; 2. Converting countable assets to income; or 3. Giving away assets before nursing home care is needed, but retaining enough assets to pay for care during the penalty period Generally, the process takes days, but could take up to 3 months. decision. It is important to consult a professional to ensure the application is done correctly and includes all required documentation.

6 Other Titles In Our Information Series: Probate: What it is and should it be avoided Probate: How to avoid it Medicaid Handbook Uncontested Divorce J R PHI L L I P S & ASS O C I A T E S, PC ATTORNEYS AND COUNSELLORS AT LAW 7700 EAST ARAPAHOE ROAD, SUITE 100, CENTENNIAL, CO (303) OFFICE (303) FAX Living Trusts: What are they and do I need one? Basic Glossary of Estate Planning Terms Wills: What are they and are they enough? Giving Your Children and Grandchildren Asset Protection Powers of Attorney You can find these and other topics: Web Call Visit our office E. Arapahoe Rd., #100 Centennial, CO Call To Schedule Your Free Estate Planning Consultation MEMBERS: NATIONAL ACADEMY OF ELDER LAW ATTORNEYS; AARP LEGAL SERVICES NETWORK; BETTER BUSINESS BUREAU; SOUTH METRO CHAMBER OF COMMERCE; COLORADO BAR ASSOCIATION; DENVER BAR ASSOCIATION; ARAPAHOE BAR ASSOCIATION

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