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Posts Tagged ‘Medicaid’

Medicaid Benefits, Eligibility Rules & Requirements

There are many benefits that go along with the Medicaid program. As long as you meet eligibility guidelines and requirements, you will have access to these benefits. Medicaid is executed state to state but the funding is made through reimbursements from the federal government.

Apply for Medicaid Online

Currently, there are 25 categories of eligibility which can be classified into five coverage groups. These groups include children, individuals over the age of 65, individuals with disabilities and adults with dependent children. The eligibility will differ from state to state, but all states are required to cover mandatory groups. However, the state can decide whether to cover groups that are categorized as optionally eligible.  Most states have forms online that you can download and print out, however no states currently allow you to submit an online application for Medicaid.

Mandatory Medicaid Groups

These groups include pregnant women, children and low-income families who have dependent children. The income level of these groups must be lower than the poverty level. Some Medicare beneficiaries may also be eligible for additional coverage by Medicaid.

Optionally Eligible Medicaid Groups

These beneficiaries will vary from one state to another. Each state is allowed to use their own discretion to provide benefits to these groups. Always be sure to check the eligibility requirements for your state when planning an application for Medicaid. If you believe you have met the requirements and have been denied coverage, you have the right to appeal the decision. Any appeal information will be printed on your eligibility notice that will be received in the mail.

Applying for Medicaid

To apply for Medicaid, you can obtain an application at an office run by your state government. You cannot yet apply for Medicaid online. If you fill out an application at an office, the office is responsible for processing the application. While the application process does take some time, most states are required to complete the application within 45 days. If the application is based on a disability, the state has up to 90 days. The most common reason for denial is an incomplete application, so make sure all parts of the forms are completed when filling out the application. Also be sure to have all required documentation available to include with the application.

Medicare and Medicaid

In some cases, if you are receiving Medicare, Medicaid may pay for some of the premiums, coinsurances and deductibles. You could also be eligible for Medicare related expense payment if your income is more than 100% or less than 120% of the poverty level. If you are disabled, Medicaid will pay for Medicare Part A premiums if you have lost your Medicare coverage due to employment. Your income must be below 200% of the poverty level.

Health Care Help through Medicaid

For state run programs to be eligible for funding there are certain services that must be provided to certain populations. The health care help must include services including hospital services, payment for physician services, nursing facilities for people over 21 years of age, surgical dental services, family planning, midwife services, x-rays, laboratory services, pediatric services, rural health clinic costs and federally-qualified health center services. An optionally eligible Medicaid program will cover clinical services, prescription drugs, dental, prosthetics, optometry, nursing facilities and intermediate care for the mentally retarded.

Duration of Medical Benefits

Each state will determine the duration of all Medicaid benefits. Federal guidelines must be followed and they require that the amount and duration of service is reasonable. Each state is responsible for placing a limit on benefits thereafter. In most cases, those on Medicaid are allowed to choose between health care providers. The state may also elect to run the program through an HMO. Always check with the state laws and guidelines for Medicaid to know what benefits are available.

Payment of Medicaid Benefits

Medicaid payments are made directly to the health care providers. Providers are required to accept all Medicaid reimbursements in full. However, the state is allowed to change the copayments and deductibles for certain recipients. For emergency care and family planning services, the state cannot make these changes. Pregnant women, children under 18 and individuals in nursing homes are exempt from copayments.

Caps on Medicaid Benefits

Currently, there is no limit or cap on the services received under Medicaid. The federal government is required to match what each state provides. The reimbursement rates must be sufficient so that providers will be attracted. This allows Medicaid benefits and services to be available to the qualifying population in the state.

Questions and Answers Regarding How to Protect Your Assets from a Nursing Home

There are some important questions to consider when there is a chance that you will be in a nursing home in the years to come. You want to make sure your assets are protected completely.

Question 1: How much do nursing homes cost?

Based on recent studies, the average stay in a nursing home is around two years. The nursing home costs about $80,000-144,000 per year depending on the state with which you reside. The states with higher costs of living tend to have more expensive nursing home care, but even within each state there is a range depending on the quality of facility.

Question 2: Will Medicare pay for the cost of the nursing home?

Medicare does not pay any nursing home expenses. Medicare in home nursing care coverage is available, but the only time Medicare will remit a payment is if the individual is placed in a skilled nursing facility.

Question 3: Medicaid application: What government program will pay for the nursing home?

When applying for Medicaid you must understand that if you have sufficient assets to pay for nursing home care yourself, no government agency or program will pay for your nursing home care expenses. Medicaid is a government program that will pay for most of the expenses if you have already spent your money and have run out. If you are a veteran, you may get additional benefits that will help with the expenses.

Question 4: How to apply for Medicaid: How can I avoid being impoverished due to the high nursing home costs?

This will largely depend on your marital status as well as your planning prior to entering a nursing home. Another determining factor is whether you are already in a nursing home or anticipate a long stay. Unless you are facing a lengthy stay, it is recommended you do not give away your assets.  Giving away or gifting your assets will likely cause you to be denied Medicaid coverage.  If you were to gift or divest your assets to your children within 5 years of entering a nursing home and you apply for Medicaid online or off, you will be denied coverage until the money is returned.  The real problem comes in when the children spend the money and do not have it to give back in a situation like this one.

One way to reduce the cost of nursing home care is to live in a state where nursing home care is less expensive.  For instance, in Texas, Medicaid nursing home care costs are less than in New York.  Yet another example would be in Florida, Medicaid nursing home care costs are less than in California.

Question 5: If my spouse is going into a nursing home, can their assets be transferred to me and then qualify for Medicaid?

This will probably not happen. All non-exempt assets owned by the couple are added together to determine your eligibility for Medicaid. The spouse that is going into the nursing home is disqualified from receiving Medicaid until the individual spouses’ assets total $2,000 or less. The other spouse can retain their non-excludible assets to a maximum of around $100,000 (it changes annually). States have different laws pertaining to Medicaid eligibility. It is best to check with your state to learn what the qualifying factors are.

Some assets are exempt and others are not. You have one opportunity at submitting an application form to Medicaid.  Do not submit it until it has been reviewed by an expert – it could cost you tens of thousands of dollars.

States typically offer online forms that you may download and print, however no states allow you to currently apply for Medicaid online.  To get simple information about your state’s Medicaid program, application forms, contact information, and address as well as an overview of your states plan, click here.

Question 6: Medicaid income eligibility requirements: How much income can I make and still qualify for Medicaid?

The requirement is that you are over the age of 64 years and earn less than $1,700 a month. It is possible to qualify if you earn more than this amount, depending on the cost of the nursing home. The spouse of the individual receiving Medicaid benefits is allowed up to $2,300 of income per month. These figures change annually, so be sure to stay up to date on what the actual qualification requirements are.