Medicaid Home Care and Nursing Home Care
~ New Income and Resource Guidelines Announced ~
Denver, Colo. – Each year when the Social Security Administration announces a cost of living adjustment for Social Security beneficiaries, individuals who need long term care and receive Medicaid are allowed to have more income and resources as well.
In 2014, individuals who are applying for (or receiving) home and community based services (including assisted living services) or nursing home care are allowed to earn $2163 per month in income and still be eligible for Medicaid to help with the cost of care.
A single individual who needs care is allowed to keep $2000 in resources such as a savings account as well as a home, a car, a term life insurance policy and an irrevocable burial policy. The equity value of the home cannot exceed $543,000.
If the individual is married and needs care, the community spouse (the one who continues to live in the home) is allowed to retain $1939 in monthly income (either from the person’s own income and/or a combination of the person’s income and that of the spouse). This is known as the minimum monthly maintenance needs allowance (MMMNA).
Similarly if the individual is married and needs care, the community spouse is allowed to retain $117,240 in cash and other assets with the same exclusions as noted previously.
If an individual has more than $2163 in monthly income, the individual can still be eligible for Medicaid by creating a Medicaid qualifying trust or a Miller Trust. Any monthly income over $2163 is placed in the trust and is paid to the State of Colorado upon the death of the individual.
Individuals who transfer cash or property to another individual or organization are subject to a 60-month look back period. If funds have been transferred or given away, the penalty for 2014 is $7112. For example if an individual applying for Medicaid in January 2014, files a quit claim deed on a $350,000 house within the past 24 months making an adult child a joint tenant to avoid a Medicaid lien, the individual would be subject to a transfer without fair consideration penalty for 50 months. However, if the same individual filed a quit claim deed in December 2008, there would be no look back period and no transfer without fair consideration because 60 months have passed since the date of the transfer.
Individuals who own a home may have a Medicaid lien placed on the house unless the individual meets one the following exceptions: a) has a spouse; b) has a dependent child who is disabled; c) has a brother or sister who is an equity owner in the home; or d) has an adult child who has lived in the home as the primary residence for the past two years (prior to requesting Medicaid assistance) and who continues to live there after the individual receives long term care.
If a home is owned in joint tenancy, it is also exempt from a lien. The State of Colorado will only file a lien if the individual receives Medicaid for more than six months and if it is financially beneficial to the State of Colorado. Most liens are filed against property of individuals who are very high users of Medicaid services for an extended period of time.
Applications for Medicaid can be filed either through PEAK, the state of Colorado’s online system, or with paper applications that can be obtained from the county department of human services. Applications that have been filed electronically tend to be processed faster. Applications must be accompanied with the necessary documentation to prove eligibility.
In addition to financial eligibility, individuals must meet the functional requirements to receive Medicaid. Individuals must have significant deficits in at least two of the following areas: bathing, dressing, mobility, transferring, eating, and continence; or at least one significant deficit in behavior or supervision such as confusion, forgetting to take medications, or a need for ongoing oversight to prevent harm to self or others.
Eligibility for functional needs is determined by the Options for Longterm Care Agency while financial eligibility is determined by the county department of human services.
Medicaid is a complex program that is available to low and middle income individuals who need long term care services and who meet the eligibility requirements. If you have questions or concerns, you may call 303-333-3482 and talk with one of our counselors.
Eileen Doherty, MS is the Executive Director of the Colorado Gerontological Society since 1982. She has almost 40 years of experience in education and training, advocacy, clinical practice, and research in the field of gerontology. She is an adjunct instructor at Fort Hays State University teaching non-profit management. She can be reached at 303-333-3482 or at firstname.lastname@example.org.