Aging in Place with Community Medicaid

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*Updated August 11, 2020

For most of us, if the time ever came that we needed assistance, our preferred option would be to remain at home in our familiar setting surrounded by family. For many, the Community Based Long Term Care Program, commonly referred to as Community Medicaid makes that an affordable and therefore viable option.

Oftentimes we meet with families who are under the impression that they will not qualify for these services through the Medicaid program due to their income and assets.  In most cases, that is not the case. Although an applicant for Community Medicaid must meet the necessary income and assets levels, oftentimes with planning we are able to assist in making an individual eligible with little wait.

Assets

An individual who is applying for home care Medicaid may have no more than $15,750.00 in non-retirement liquid assets.  Retirement assets will not be counted as a resource so long as the applicant is receiving monthly distributions from the account.   An irrevocable pre-paid burial fund is also an exempt resource.  The primary residence is an exempt asset during the lifetime of the Medicaid recipient however, where the applicant owns a home it is advisable to consider additional estate planning to ensure that the home will be protected once the Medicaid recipient passes away.

Income

With respect to income, an applicant for Medicaid is permitted to keep $875.00 per month in income plus a $20.00 disregard. However, where the applicant has income which exceeds that $895.00 threshold, a Pooled Income Trust can be established to preserve the applicant’s excess income and direct it to a fund where it can be used to pay his or her household bills.

It is important to note that UNTIL OCTOBER 1, 2020, there was no “look back” for community Medicaid. Starting on that date – somewhat extended to January 1, 2020 – there will now be a 30 month look back for any transfers made when applying for community medicaid.

These pooled trusts are created by not-for-profit agencies and are a terrific way for persons to take advantage of the many services available through home care Medicaid while still preserving their income for use in meeting their monthly expenses.   Functionally, the way that these trusts work is that the applicant sends a check to the fund monthly for that amount which exceeds the allowable limit.  Together with the check the applicant submits household bills equal to the amount sent to the trust fund.  The trust deducts a small monthly fee for servicing these payments and then, on behalf of the applicant, pays those household bills.  As you can see, this process allows the applicant to continue relying on his or her monthly income to pay his or her bills, and at the same time, reduce the countable income amount to the amount which is permitted under the Medicaid rules.

Once an individual is financially approved by the local Department of Social Services for Community Medicaid, he or she must enroll with a Managed Long Term Care Agency. This is the agency that will coordinate care services for the Medicaid recipient.   The MLTC will send a nurse to the Medicaid recipient in order to evaluate and create a care plan.  The evaluation will result in an award of hours to the Medicaid recipient for a home health aide to come to the home and assist the recipient with activities of daily of living.  The amount of hours can vary from a few hours per day where the needs are less all the way to live-in care.  Tis award of hours depends solely on the needs of the Medicaid recipient.  If the Medicaid recipient is satisfied with the care plan, he or she may choose to enroll with the MLTC.  Otherwise, he or she can request another evaluation with a different MLTC.

What this means is that for most people, with minimal planning, both the income and asset requirements can be met with a minimal waiting period allowing families to mitigate the cost of caring for their loved ones at home.

Nancy Burner, Esq.

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Burner Law Group, P.C.

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