Medicaid can be a very confusing process for most individuals. Sadly a basic understanding of how Medicaid works is essential for many caregivers due to the high cost of long term care. This is especially important for those with cognitive issues such as Dementia. How do I access Medicaid? Does my family member qualify? When and in what way does it cover care costs? What is Medicaid anyways?
To start, Medicaid is a program that was developed by the federal government to cover the cost of medical services for low-income individuals. The Affordable Care Act expanded coverage for the poorest Americans by creating an opportunity for states to provide Medicaid eligibility, for individuals under 65 years of age with incomes up to 133 percent of the federal poverty level (FPL). The Centers for Medicare & Medicaid Services (CMS), which was in the past referred to as the Health Care Financing Administration (HCFA), is the agency within the US Department of Health and Human Services (HHS) that oversees and manages the Medicaid program. They collaborate with state governments to administer this program. A person can qualify for Medicaid eligibility by meeting specific federal income and asset criteria. Criteria change over time, so this process can be extremely difficult to navigate without the assistance of a Elder Care attorney. In all states however, Medicaid will provide health coverage for specific levels of low-income people. Some people can have duel eligibility, meaning that they are eligible for both Medicare and Medicaid. If a person meets criteria for dual coverage, most of their health care costs will be covered. For services that both Medicare and Medicaid cover which are generally doctors visits, home care related services, inpatient / hospital care, and skilled nursing facility care, Medicare will pay first, then Medicaid will pay second, by covering any remaining costs.
The phrase spend down is often discussed in conjunction with long term care planning. You may hear this phrase while planning for your family member if they require long term care, dementia care, or a skilled nursing facility. But what does it really mean?? Spending down means that you are basically using up your loved one's assets to pay for their nursing care until they reach a specific asset level where they will then qualify for financial assistance under Medicaid. Wow, that's a lot!
So basically excess income needs to be spent. This can be very upsetting for many individuals and families. It is hard enough to lose independence, functionality, etc without having to lose move. An individual however, may have $2000 in cash and investments that will not be counted as a part of Medicaid eligibility determination. A person's home if they plan to live in it will also not be counted. An individual who resides in a nursing facility can retain $35 per month of their income for personal use with the remainder of their income being applied to the cost of their care. Married couples are of course given different guidelines to follow. Spouses who live at home can keep a car, their home, personal property, a specific amount of cash / investments (the amount varies by state for this) plus a portion of the couple's joint monthly income. An elder care attorney can provide the most up to date specifics for these areas. Guidelines and criteria do change over time, so the rules set today may not be the rules tomorrow....
I therefore cannot stress enough that Medicaid Applications are extremely complicated! Like any government form, they are time consuming and tedious. Any minor mistake or delay in terms of a missed date or information error, can be financially significant for those involved. If an application date / window is missed, the process can become much longer and very much drawn out. As with any process involving state and federal government it is important to comply with the rules and deadlines, (as these agencies rarely make exceptions). So, start early, do not delay beginning this process if needed!!!! Procrastination will only lead to disappointment and stress for all involved!
Seek assistance from an Elder Care Attorney early in this process as it will save a great deal of heartache, aggravation and financial resources in the end.