Medicaid 2008

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A quick slide show guide to Medicaid

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  • Medicaid 2008

    1. 1. Medicaid Darren Hotton Utah Aging and Adult Services
    2. 2. Medicaid <ul><li>Medicaid is administered at the State level </li></ul><ul><li>Medicaid programs vary from state to state </li></ul><ul><li>Medicaid follows some federal guidelines but allows states to make some choices in services </li></ul>
    3. 3. Medicaid Categories <ul><li>Persons who are blind, disabled or over 64 </li></ul><ul><li>Nursing home residents </li></ul><ul><li>Children under age 19 </li></ul><ul><li>Adults who care for children under age 19 who are deprived </li></ul><ul><li>Pregnant women </li></ul><ul><li>PCN (Primary Care Network) </li></ul><ul><li>Waiver Programs </li></ul>
    4. 4. Primary Care Network (PCN) <ul><li>Services are limited. They include </li></ul><ul><ul><li>Primary care (what your doctor can do in his office). </li></ul></ul><ul><ul><li>Pharmacy – maximum of 4 prescriptions a mo. </li></ul></ul><ul><ul><li>Emergency Room </li></ul></ul><ul><li>$50 annual enrollment fee </li></ul><ul><li>Enrollment is currently open if the adult has children and they are in their custody. CLOSED for adults without children. </li></ul>
    5. 5. Medicare Cost Sharing Programs <ul><li>There are three Medicare cost sharing programs for low-income Medicare recipients. These programs help Medicare Part A beneficiaries. All of these programs pay the Medicare Part B premium. </li></ul><ul><ul><li>Qualified Medicare Beneficiary (QMB) - pays the co-payments for Medicare services and the Part B premium. </li></ul></ul><ul><ul><li>Specified Low-Income Beneficiary (SLMB) - The SLMB program pays the Medicare Part-B premium only. Recipients receive no other benefit. </li></ul></ul><ul><ul><li>Qualified Person group 1 (QI-1) - the program covers the Medicare Part B premium only. Recipients receive no other benefit. </li></ul></ul>
    6. 6. Medicaid Eligibility <ul><li>For Most programs: </li></ul><ul><li>Assets can not exceed $2,000 for an individual and $3,000 for a couple </li></ul><ul><li>Income will vary depending on the type of Medicaid requested. </li></ul>
    7. 8. Exempt Resources <ul><li>Home </li></ul><ul><li>Life Insurance - face value of $1500 or less </li></ul><ul><li>Burial Space </li></ul><ul><li>Irrevocable Funeral Plan or Burial Trust </li></ul><ul><li>One Vehicle for ABD </li></ul>
    8. 9. SPENDDOWN <ul><li>For some Medicaid programs, if countable income exceeds the limit for the program, a person can meet (pay) a “spenddown” in order to qualify. A spenddown is the difference between the income that counts and the income limit for the household size and program type. If a person’s projected medical expense for a given month exceeds the amount of the spenddown, the person may choose to meet the spenddown and become eligible. Spenddown must be paid for each month that a person wants to have Medicaid eligibility </li></ul><ul><li>Spenddown can be met in one of three ways: </li></ul><ul><ul><li>Medical bills that are still owed. </li></ul></ul><ul><ul><li>Some people can use some current-month medical expenses to meet spenddown for that month. (Medicaid will not pay for those bills.) </li></ul></ul><ul><ul><li>People can pay the spenddown in cash, check or money order. </li></ul></ul>
    9. 10. Medicaid Nursing Home Information
    10. 11. Nursing Home Medicaid <ul><li>Ask for the Spousal Assessment of Assets </li></ul><ul><li>Nursing home resident is allowed to keep $45 of his income for personal needs </li></ul><ul><li>Most of the resident’s income will go toward their cost of care </li></ul>
    11. 12. Transfer Of Assets <ul><li>Some transfers which will not affect eligibility for Nursing-Home Medicaid </li></ul><ul><ul><li>Transfer of a home or any other asset to a spouse </li></ul></ul><ul><ul><li>Transfer of any asset to a blind or disabled son or daughter or to a trust established for the sole benefit of a disabled son or daughter </li></ul></ul><ul><ul><li>Transfer of a home to a son or daughter under 21 years of age </li></ul></ul><ul><ul><li>Transfer to a trust set up for the sole benefit of a person who is blind or disabled and who is under age 65 </li></ul></ul><ul><ul><li>Transfer of a home to a brother or sister who has an equity interest in the home and who has lived in the home for at least one year just before the person entered the nursing home </li></ul></ul><ul><ul><li>Transfer to a son or daughter who has: </li></ul></ul><ul><ul><ul><li>Lived in the home, and </li></ul></ul></ul><ul><ul><ul><li>Provided care to the parent which allowed the parent to remain at home rather than be in a nursing home, and </li></ul></ul></ul><ul><ul><ul><li>Has done so for at least two years just before the parent’s entry into the nursing home. </li></ul></ul></ul>
    12. 13. NURSING HOME ELIGIBILITY – INCOME CRITERIA <ul><li>For a person who is single , only that person’s income is counted in determining his/her eligibility. </li></ul><ul><li>For a married person whose spouse lives at home, Medicaid looks at the nursing home spouse’s income. Medicaid may look at the community spouse’s income but only to see if the community spouse can keep some of the nursing home spouse’s income. The decision is made as follows: </li></ul><ul><ul><li>Start with $1,604 (This amount increases July 1 of each year) </li></ul></ul><ul><ul><li>Subtract the amount of the couple’s monthly income that is in the name of the spouse at home. </li></ul></ul><ul><ul><li>Add an amount that is computed by adding up the monthly amount of any housing costs (rent, mortgage, utilities and taxes), minus $481. </li></ul></ul><ul><ul><li>The remaining figure is the amount of the nursing-home spouse’s income that the spouse at home can keep. In all cases the nursing-home spouse is allowed to keep the $45 personal needs allowance. The maximum amount the spouse at home may keep is $2489 a month. </li></ul></ul>
    13. 14. Example: <ul><li>Suppose your spouse has $500 of gross monthly income, your income is $1,500 per month, and the monthly housing cost for your spouse at home is $600. </li></ul><ul><ul><li>1. Subtract $500 from $1,750 ($1,750 - $500 = $1,250). Your spouse keeps $1,250 of your income. </li></ul></ul><ul><ul><li>2. Subtract $525 from $600 ($600 - $525 = $75). Since the housing costs for your spouse are over $525, your spouse can keep an extra $75 of your income. </li></ul></ul><ul><ul><li>3. The total amount of your income your spouse keeps is $1,325($1,250 + $75 =$1,325). </li></ul></ul><ul><li>The rest of your income, minus your $45 per month for personal needs, is paid to the nursing home. This amount is your share of the cost of nursing home care. </li></ul><ul><li>Family Members </li></ul><ul><ul><li>A family member who lives with your spouse may rely on you for support. Your spouse may be able to keep some of your income to help pay for the family member’s needs . </li></ul></ul><ul><li>Hearings </li></ul><ul><ul><li>If your spouse needs more income than we have allowed, you can ask for a hearing. Your Medicaid worker can tell you how. </li></ul></ul>
    14. 15. NURSING HOME ELIGIBILITY – ASSET CRITERIA <ul><li>To be eligible for Medicaid in a nursing home, the person’s countable assets must not be greater than $2,000. Assets include all things a person owns or has part interest in. Assets are things such as real estate (i.e., houses, land, farm ground, and buildings), bank accounts, stocks or bonds, trusts, annuities, and in some cases, the cash value of life insurance policies. Some assets count and some do not. </li></ul><ul><ul><li>For a person who is single , only that person’s assets are counted as his/her eligibility is determined. </li></ul></ul><ul><ul><li>For a married person whose spouse lives at home, the couple’s entire assets are considered as initial eligibility is determined. The spouse at home is allowed to keep half the total amount of countable assets, or a minimum of $ 20 ,880 and a maximum of $ 104,400 (these amounts change January 1 of each year). </li></ul></ul>
    15. 16. For example: <ul><li>#1 You ask for an assessment on January 21, 2008. Your total assets are $22,000. We divide the total by 2 and get $11,000. Your spouse can keep the greater of the spousal share ($11,000) or the Minimum ($20,880) and the balance ($22,000 -$20,880 = $1120) is counted as your asset. Since your countable amount ($1120) is less than $2,000, you would be asset eligible. </li></ul><ul><li>#2 You ask for an assessment July 20, 2008. Your total assets are $100,000. We divide the total by 2 and get $50,000. This is more than the minimum and less than the maximum. The spousal share is $50,000 and your share is $50,000. You would not be eligible for Medicaid until your share is less than $2,000. </li></ul><ul><li>After your nursing home Medicaid is approved, the spouse’s share of assets must be put in the spouse's name. Your share of the assets (no more than $2,000) can be in your name. If you have to transfer property from one spouse to another, that must be done before your scheduled review (usually 12 months). Your assets must be less than $2,000 to remain eligible for Medicaid. </li></ul>
    16. 17. ALTERNATIVES TO LIVING IN A NURSING HOME <ul><li>Medicaid Waiver Services - There are five different waivers: </li></ul><ul><ul><ul><li>Medicaid Aging Waiver - This is a program for people who are over 65. It helps them get the services they need in order to stay in their own home or other community living arrangement, instead of going into a nursing home. </li></ul></ul></ul><ul><ul><ul><li>Utah Community Supports Waiver - This is a program for people of all ages who are developmentally disabled and mentally retarded and need help with activities of daily living. </li></ul></ul></ul><ul><ul><ul><li>Technology Dependent Waiver - This is a program for children under age 21 or who qualify for waiver services in the month they turn 21. They must live in the community and have extraordinary medical needs . </li></ul></ul></ul><ul><ul><ul><li>Brain Injury Waiver - This is a program for people who are 18 years of age or older and have brain damage which causes problems with their ability to provide self-care and engage in regular activities of daily living. </li></ul></ul></ul><ul><ul><ul><li>Physical Disabilities Waiver - This is a program for people who are 18 years of age or older who are frail enough to be in a nursing home, and have lost the use of at least two limbs. </li></ul></ul></ul><ul><ul><ul><li>New Choices Waiver – provides home and community based services in a community setting for eligible clients who require the level of care provided in a nursing facility. Age 65 or older or 21 through 64 and meet disability critieria. </li></ul></ul></ul>
    17. 19. Questions?
    18. 20. QUESTIONS <ul><li>Randa Pickle & John Nicoalisen </li></ul><ul><li>1-877-291-5583 </li></ul><ul><li>Email: [email_address] </li></ul><ul><li>[email_address] </li></ul>

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