Qualifying A Client For Medicaid
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Qualifying A Client For Medicaid

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How to qualify a nursing home client for Medicaid.

How to qualify a nursing home client for Medicaid.

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