QUALIFYING A CLIENT FOR MEDICAID William M. Copeland
The Medicaid Interview <ul><li>Review the regulations - OAC § 5101:1-39  </li></ul><ul><li>Review publications - Ohio Medi...
The basis for Medicaid eligibility  <ul><li>Resources and income  </li></ul><ul><li>Assets: $1,500.00 ($2250.00 for husban...
What to Ask <ul><li>Determine the goals and economic status of the client.  </li></ul>
What to Ask <ul><li>Is the client in  </li></ul><ul><ul><li>A nursing home? </li></ul></ul><ul><ul><li>Other healthcare fa...
What to Ask <ul><li>Evaluate income and assets </li></ul><ul><li>Transfers of assets – last 5 years </li></ul><ul><ul><li>...
What to Ask <ul><li>Get information regarding:  </li></ul><ul><ul><li>Personal data </li></ul></ul><ul><ul><li>If in nursi...
What to Ask <ul><li>Get information regarding:  </li></ul><ul><ul><li>Proof of residency status  </li></ul></ul><ul><ul><l...
What to Ask <ul><li>Get information regarding: </li></ul><ul><ul><li>Children – any special needs? </li></ul></ul><ul><ul>...
What to Ask <ul><li>Income from any source </li></ul><ul><ul><li>Social Security </li></ul></ul><ul><ul><li>Retirement ben...
What to Ask <ul><li>Determine the applicant’s assets: </li></ul><ul><ul><li>Checking and/or savings accounts, money market...
What to Ask <ul><li>Determine the applicant’s assets: </li></ul><ul><ul><li>Personal residence (need stated value, assesse...
What to Ask <ul><li>Is there a personal residence? </li></ul><ul><ul><li>Is the spouse living there? </li></ul></ul><ul><u...
Defining the Goals of the Client <ul><li>Protection of assets </li></ul><ul><li>Access to care </li></ul><ul><li>Needs of ...
Defining the Goals of the Client <ul><li>Remember the applicant is your client no matter who writes the checks. </li></ul>
Countable Assets  <ul><li>Cash, checking and savings accounts; </li></ul><ul><li>CDs; </li></ul><ul><li>Stocks, bonds and ...
Non-Countable Assets  <ul><li>$2000 in cash or in a checking or savings account </li></ul><ul><li>The primary residence of...
Transfer Of Assets Rules And The “Look-back” Period.  <ul><li>If a transfer is made within 5 years of the application date...
Economic Need Criteria <ul><ul><ul><li>Children under the age of 19 </li></ul></ul></ul><ul><ul><ul><ul><li>gross monthly ...
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Qualifying A Client For Medicaid

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How to qualify a nursing home client for Medicaid.

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Qualifying A Client For Medicaid

  1. 1. QUALIFYING A CLIENT FOR MEDICAID William M. Copeland
  2. 2. The Medicaid Interview <ul><li>Review the regulations - OAC § 5101:1-39 </li></ul><ul><li>Review publications - Ohio Medicaid agency </li></ul><ul><ul><li>Getting Long-Term Care </li></ul></ul><ul><ul><li>Transfer of Resources </li></ul></ul>
  3. 3. The basis for Medicaid eligibility <ul><li>Resources and income </li></ul><ul><li>Assets: $1,500.00 ($2250.00 for husband and wife) </li></ul><ul><li>Income: 64 percent of the federal poverty level or less. </li></ul>
  4. 4. What to Ask <ul><li>Determine the goals and economic status of the client. </li></ul>
  5. 5. What to Ask <ul><li>Is the client in </li></ul><ul><ul><li>A nursing home? </li></ul></ul><ul><ul><li>Other healthcare facility? </li></ul></ul><ul><ul><li>Living at home? </li></ul></ul><ul><ul><li>In assisted living? </li></ul></ul><ul><li>Nursing home - community spouse living at home? </li></ul>
  6. 6. What to Ask <ul><li>Evaluate income and assets </li></ul><ul><li>Transfers of assets – last 5 years </li></ul><ul><ul><li>Outright gifts </li></ul></ul><ul><ul><li>Trusts </li></ul></ul><ul><ul><li>Annuities </li></ul></ul><ul><ul><li>To who were the transfers made, when, and in what form. </li></ul></ul>
  7. 7. What to Ask <ul><li>Get information regarding: </li></ul><ul><ul><li>Personal data </li></ul></ul><ul><ul><li>If in nursing home, what type – get name and address </li></ul></ul><ul><ul><li>Health insurance – who is paying for care? </li></ul></ul><ul><ul><li>Mental and physical health status </li></ul></ul>
  8. 8. What to Ask <ul><li>Get information regarding: </li></ul><ul><ul><li>Proof of residency status </li></ul></ul><ul><ul><li>Spouse living at home - obtain personal data </li></ul></ul><ul><ul><li>Is spouse in a healthcare facility – get information – who is paying for care? </li></ul></ul>
  9. 9. What to Ask <ul><li>Get information regarding: </li></ul><ul><ul><li>Children – any special needs? </li></ul></ul><ul><ul><li>Other dependents </li></ul></ul><ul><ul><li>Child or other family member living at home </li></ul></ul>
  10. 10. What to Ask <ul><li>Income from any source </li></ul><ul><ul><li>Social Security </li></ul></ul><ul><ul><li>Retirement benefits </li></ul></ul><ul><ul><li>Disability compensation </li></ul></ul><ul><ul><li>Dividends </li></ul></ul><ul><ul><li>Interest </li></ul></ul><ul><ul><li>Rental income </li></ul></ul><ul><li>Obtain statements or other documentation </li></ul>
  11. 11. What to Ask <ul><li>Determine the applicant’s assets: </li></ul><ul><ul><li>Checking and/or savings accounts, money market and CDs, </li></ul></ul><ul><ul><li>Investments - stocks, bonds, mutual funds, and real estate holdings </li></ul></ul><ul><ul><li>IRAs, Keoghs, 401K plans, military retirement </li></ul></ul><ul><ul><li>Business interests </li></ul></ul><ul><ul><li>Insurance policies </li></ul></ul><ul><ul><li>Trusts </li></ul></ul><ul><ul><li>Annuities </li></ul></ul><ul><ul><li>Automobiles </li></ul></ul>
  12. 12. What to Ask <ul><li>Determine the applicant’s assets: </li></ul><ul><ul><li>Personal residence (need stated value, assessed value and mortgage outstanding) </li></ul></ul><ul><ul><li>Burial policies </li></ul></ul><ul><ul><li>Burial plot </li></ul></ul><ul><ul><li>Cash on hand. </li></ul></ul><ul><li>Get documentation </li></ul>
  13. 13. What to Ask <ul><li>Is there a personal residence? </li></ul><ul><ul><li>Is the spouse living there? </li></ul></ul><ul><ul><li>Minor or disabled child living there? </li></ul></ul><ul><ul><li>Other relative who cared for applicant? </li></ul></ul><ul><ul><li>Has applicant moved to assisted living? </li></ul></ul><ul><ul><li>13 month rule for nursing home. </li></ul></ul>
  14. 14. Defining the Goals of the Client <ul><li>Protection of assets </li></ul><ul><li>Access to care </li></ul><ul><li>Needs of daily living </li></ul>
  15. 15. Defining the Goals of the Client <ul><li>Remember the applicant is your client no matter who writes the checks. </li></ul>
  16. 16. Countable Assets <ul><li>Cash, checking and savings accounts; </li></ul><ul><li>CDs; </li></ul><ul><li>Stocks, bonds and mutual funds; </li></ul><ul><li>IRA, 401 (k), 403 (b), and other retirement – type accounts; </li></ul><ul><li>Life-insurance cash values (if the total cash value of all policies exceeds $1500); </li></ul><ul><li>Annuities not yet in pay status; </li></ul><ul><li>Any automobiles in excess of primary car; </li></ul><ul><li>Any trucks, tractors, boats, machinery and/or livestock; and </li></ul><ul><li>Buildings and land not part of the primary residence. </li></ul>
  17. 17. Non-Countable Assets <ul><li>$2000 in cash or in a checking or savings account </li></ul><ul><li>The primary residence of the applicant or spouse </li></ul><ul><li>One automobile of any value </li></ul><ul><li>Household goods, personal effects and other personal property </li></ul><ul><li>Funds for funeral and burial expenses </li></ul><ul><li>Business property </li></ul><ul><li>Non-business property if it is used for self-support; and </li></ul><ul><li>Term life insurance or insurance with a cash value is less than $1500. </li></ul>
  18. 18. Transfer Of Assets Rules And The “Look-back” Period. <ul><li>If a transfer is made within 5 years of the application date, it is a countable asset. </li></ul><ul><li>The period of ineligibility is determined by: </li></ul><ul><ul><li>Dividing the value of the transferred asset by the average monthly private pay nursing home cost. </li></ul></ul><ul><li>The period of ineligibility begins to run on the date of the application for Medicaid, not the date of the asset transfer. </li></ul>
  19. 19. Economic Need Criteria <ul><ul><ul><li>Children under the age of 19 </li></ul></ul></ul><ul><ul><ul><ul><li>gross monthly income 200% of the federal poverty level. </li></ul></ul></ul></ul><ul><ul><ul><li>Pregnant women </li></ul></ul></ul><ul><ul><ul><ul><li>gross monthly income 150 % of the federal poverty level. </li></ul></ul></ul></ul><ul><ul><ul><li>Families </li></ul></ul></ul><ul><ul><ul><ul><li>gross monthly income 90 % of the federal poverty level. </li></ul></ul></ul></ul><ul><ul><ul><li>Individuals age 65 or older </li></ul></ul></ul><ul><ul><ul><ul><li>income 64 % of the federal poverty level and resources do not exceed $1,500 for an individual or $2,250 for a couple. </li></ul></ul></ul></ul><ul><ul><ul><li>Individuals with disabilities </li></ul></ul></ul><ul><ul><ul><ul><li>income is 64 % of the federal poverty level or less and whose resources do not exceed $1,500 for an individual or $2,250 for a couple. </li></ul></ul></ul></ul>
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