This document provides guidance on qualifying a client for Medicaid benefits. It outlines the key steps in determining eligibility, which include reviewing the client's goals, economic status, income, assets, transfers of assets in the last 5 years, living situation, health insurance coverage, and dependents. Eligibility is based on having income at or below 64% of the federal poverty level and countable assets at or below $1,500 for an individual or $2,250 for a couple. The document also discusses the transfer of asset rules and period of ineligibility if assets were transferred within the last 5 years.

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.