Overview of Medicaid/ Asset Protection- Asset Protection for Single Person
- Asset Protection for Married Persons
- Medicaid Applications
- Medicaid Appeals
Overview of Medicaid and Asset Protection
Medical Assistance ( Medicaid) is a public benefit program which is needs based. It provides a range of medical services to persons who fall into specific coverage categories (statuses such as age or disability) and who also meet set standards of income and asset limitations. Persons unfamiliar with the program often confuse Medicaid with Medicare. Unlike Medicare, eligibility for Medicaid is not related to a person's insured status under the Social Security Act. Also, Medicaid is state administered and provides more comprehensive coverage than Medicare, particularly with regard to nursing home care.
Medicaid is particularly important for low-income aged and disabled persons because it covers virtually all of the substantial gaps in Medicare insurance. Medicaid pays the Medicare Part A and Part B deductibles and co-insurance for many recipients, Medicaid has no maximum stays for most medically necessary services, including nursing home stays, and will thus pay when Medicare coverage is exhausted; and Medicaid covers services (e.g., dental services, drugs) that are not covered by Medicare.
Medicaid coverage extends to Long Term Care Facilities, Supportive Living Facilities, and the Community Care program which assists people over the age of 60 who are disabled but living at home.
Asset Protection in the context of Medicaid refers to planning to qualify for Medicaid coverage in the event it is required so that less of a person's assets must be paid to a nursing home for care.
Janna Dutton & Associates, P.C. has extensive experience in understanding both federal and state Medicaid regulations and formulating legal methods of protecting assets from being spent for nursing home care by accelerating eligibility for Medicaid.
Asset Protection for Single Person
To qualify for Medicaid coverage, a single person is allowed the following assets, called exempt assets, and all other assets must be spent down towards nursing home care prior to qualifying for coverage:
- $2,000.00 in cash assets;
- Homestead property;
- Personal Effects and household goods;
- Motor Vehicle in some situations;
- $1,500.00 in life insurance designated for burial or a prepaid burial plan that meets the requirements of Medicaid policy; and
- Burial Spaces and Merchandise.
Asset Protection for Married Persons
The Medicaid program for long term care facility residents provides for the support of a spouse in the community and prevents impoverishment.
The Community Spouse Asset Allowance is the amount of non-exempt assets the resident of a long term care facility may transfer (without affecting eligibility) to his/her community spouse or to another individual for the sole benefit of his/her spouse. This amount is considered an allowable transfer and is not considered in the determination of eligibility for the resident of the long term care facility.
The Community Spouse Asset Allowance is calculated by deducting non-exempt assets of the community spouse from the asset allowance standard of $95,100 for 2005. The nursing home spouse may transfer this amount to the community spouse for his or her support.
The asset allowance may exceed $95,100 for 2005 only by court order, or as a result of a fair hearing decision where it is determined that the asset allowance is insufficient to provide the community spouse with income equaling the amount permitted as the Community Spouse Maintenance Needs Allowance of $2,378 in 2005.
The nursing home spouse is allowed to divert income to the Community Spouse to bring his or her income to the Community Spouse Maintenance Needs Allowance of $2,378 in 2005 if the Community Spouse's separate income is under that figure.
Currently, if the community spouse has owned assets in his or her own name (exclusive of the nursing home spouse) of more than $95,100.00 for 36 months or more, Medicaid may still be applied for and the community spouse may refuse to disclose his or her own separately held assets. The refusal of the community spouse to disclose his or her assets does not affect the eligibility of the nursing home spouse.
PROPOSED POLICY CHANGE:
The Department of Human Services is proposing changes which will prevent a community spouse from refusing to disclose his or her separate assets and count those assets as being available to the Community Spouse. Proposed regulations are expected sometime during the fall of 2005.
Medicaid Application Completion
Janna Dutton & Associates has many years of experience in filing Medicaid applications for its clients and can advise as to how to proceed in each individual situation keeping in mind the preservation of assets, the prevention of spousal impoverishment, and the best approach in each situation so that an application Medicaid has the best chance of success.
Services include advice as to the components of a successful application, assistance in gathering materials and preparing them for filing, and interaction and advocacy with the Department of Human Services, the agency that administers the Medicaid program in Illinois. We will prepare and file the application materials and forms, monitor the application's progress through the system, and will work with the assigned caseworkers in any capacity necessary - such as responding to questions, faxing materials and checking on status on a regular basis as well as advocating the most advantageous position and policy interpretations for our clients.
Medicaid Appeals
Often there is misunderstanding between the caseworker and the applicant as to issues, deadlines, and what is required resulting in denials of applications for Medicaid. Caseworkers often make mistakes and misinterpret policy, also resulting in denials of applications.. We are often retained to file an appeal and follow through until the application is approved. Janna Dutton & Associates has handled many appeals and has extensive experience in this process.
Services include filing the appeal, working with the client to prepare a defense or advise as to the missing materials that caused the denial; preappeal meetings with appeals caseworkers; and representation at a hearing if one is required. When interpretation of policy is at issue, we work directly with the Springfield Policy Office of IDHS to obtain policy clarifications for caseworkers.