When applying for Medicaid you must understand that under the 60-month look-back Rule, Medicaid coverage can be denied if assets have been transferred within 60 months prior to applying for the benefits. As described previously, 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. Question 2: Medicaid application: Is it too late to give away my assets and qualify for Medicaid if I am already in a nursing home?

It’s never too late to reallocate your assets. Question 3: Should I make use of a trust to protect my assets? It is much more beneficial to use an irrevocable trust instead of transferring assets to family members. Seek for the UltraTrust(TM) for superior irrevocable trust asset protection.

Question 1: How to apply for Medicaid: Are there other ways to protect my assets?

There are many ways to protect assets. Medicaid will not penalize anyone if they choose to spend their assets; however, one must be careful to avoid fraudulent conveyance. An expert can walk you through a proper estate plan that will avoid these potential problems or contact Estate Street Partners.

Question 2: How can I protect my home?

Medicaid allows for the applicant to retain a principal residence. Your home is considered exempt property. Question 6: Is it wrong to hide assets to qualify for Medicaid? When applying for Medicaid, full financial disclosure is required. Question 7: Is this information reliable?

Find out what the current requirements are for eligibility in your state and consult with an experience attorney or contact Estate Street Partners to discuss your assets. States typically offer online information and 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 application eligibility, forms, contact information, and address as well as an overview of your states plan, click here.

Question 3: Should I hire an expert?

Simply stated: absolutely. Any expert that practices elder law can help or contact Estate Street Partners.

Tags: applying for medicaid, estate street partners, financial disclosure, fraudulent conveyance, how to apply for medicaid, income eligibility requirements, irrevocable trust asset protection, medicaid application, medicaid coverage, property question
]]> http://www.ist-broadway.org/medicaid-eligibility-application-protect-assets-from-nursing-homes/feed 0 http://www.ist-broadway.org/medicaid-overview http://www.ist-broadway.org/medicaid-overview#comments Fri, 16 Jul 2010 02:57:17 +0000 admin http://www.ist-broadway.org/?p=35 Medicaid is a state administered program and provides more comprehensive coverage than Medicare, particularly with regard to nursing home care. However, not all nursing homes participate in the Medicaid program. In the absence of any other public program covering long-term nursing home care, Medicaid has become the default nursing home insurance of the middle class.

Resource (Asset) Rules

In order to be eligible for Medicaid benefits in Illinois a nursing home resident may have no more than $2,000 in “countable” assets. While a Medicaid applicant may be eligible even if these assets exceed the limits, the applicant will be required to “spend down” these assets. The spouse of a nursing home resident–called the ‘community spouse’– is limited to one half of the couple’s joint assets up to $84,120 (in 2000) in “countable” assets (see Medicaid, Protections for the Healthy Spouse). A motor vehicle owned by a nursing home resident is also exempt if transferred to a spouse. The Home

Nursing home residents do not have to sell their homes in order to qualify for Medicaid. In Illinois, the home will not be considered a countable asset for Medicaid eligibility purposes as long as the nursing home resident intends to return home. The home may also be kept if the Medicaid applicant’s spouse, sibling, minor or disabled child lives there. However, if the applicant leaves the home with no intention of returning, the property must be counted as an asset.

The Transfer Penalty

The second major rule of Medicaid eligibility is the penalty for transferring assets. This penalty is a period of time during which the person transferring the assets will be ineligible for Medicaid.
Example: If a Medicaid applicant made gifts totaling $90,000 in a state where the average nursing home bill is $5,000 a month, he or she would be ineligible for Medicaid for 18 months ($90,000 ÷ $5,000 = 18). Example: To use the above example of the $400,000 transfers, if the individual made the transfer on January 1, 1998, and waited until February 1, 2001, to apply for Medicaid — 37 months later — the transfer would not affect his or her Medicaid eligibility. Exceptions to the Transfer Penalty

Transferring assets to certain recipients will not trigger a period of Medicaid ineligibility. (1) A spouse (or a transfer to anyone else as long as it is for the spouse’s benefit);

(2) A blind or disabled child;

(4) A trust for the sole benefit of a disabled individual under age 65 (even if the trust is for the benefit of the Medicaid applicant, under certain circumstances).

The Medicaid applicant may freely transfer his or her home to the following individuals without incurring a transfer penalty:

(1) The applicant’s spouse;

Congress has created a very important escape hatch from the transfer penalty: the penalty will be “cured” if the transferred asset is returned in its entirety, or it will be reduced if the transferred asset is partially returned.

Is Transferring Assets Against the Law?
You may have heard that transferring assets, or helping someone to transfer assets, to achieve Medicaid eligibility is a crime.
As part of a 1996 Kennedy-Kassebaum health care bill, Congress made it a crime to transfer assets for purposes of achieving Medicaid eligibility. Treatment of Income
The basic Medicaid rule for nursing home residents is that they must pay all of their income, minus certain deductions, to the nursing home. A deduction may also be allowed for a dependent child living at home. A deduction is also allowed for community spouse maintenance needs. This allows the Medicaid recipient to exempt some of his/her income for the purpose of spouse maintenance. For Medicaid applicants who are married, the income of the community spouse is not counted in determining the Medicaid applicant’s eligibility. Protections for the Healthy Spouse

Example: If a couple has $100,000 in countable assets on the date the applicant enters a nursing home, he or she will be eligible for Medicaid once the couple’s assets have been reduced to a combined figure of $52,000 — $2,000 for the applicant and $50,000 for the community spouse.

In all circumstances, the income of the community spouse will continue undisturbed; he or she will not have to use his or her income to support the nursing home spouse receiving Medicaid benefits. But what if most of the couple’s income is in the name of the institutionalized spouse, and the community spouse’s income is not enough to live on? Estate Recovery and Liens
Under Medicaid law, following the death of the Medicaid recipient a state must attempt to recover from his or her estate whatever benefits it paid for the recipient’s care.

Tags: class resource, community spouse, countable assets, eligibility purposes, home residents, medicaid benefits, medicaid eligibility, medicaid program, nursing home care, nursing home insurance

Related posts

• Medicaid Planning: Transfer Assets for Medicaid Eligibility

It is often seen that the Medicare policy that you are having does not cover for the total bill charged for your medical treatment. Therefore it is a big concern to pay the extra bill that is not covered by the original Medicare policy. To bear the extra cost is not easy. For this reason the supplementary policy has been introduced in order to overcome the cost. This policy is stated as Medicare supplementary policy. It is also known as Medigap plan or policy. Medigap is something that fills up the gap between the original Medicare policy and the supplementary policy. The expenditure which is not paid by the original is paid by this Medigap plan. It helps you to get relieved of that extra burden of medical cost. The fact is that in the original Medicare policies there always remain several gaps for which it doesn’t pay for all the health care services that you may need. Therefore if you are the one of the beneficiaries of the original Medicare plane, you may be in the need to buy Medicare supplement insurance. Now you can understand the reason why it is called Medigap plan. This health insurance policy helps you to pay for some of the costs in the original Medicare program and also for the part that it doesn’t cover.

This policy had been standardized by Centers of Medicare and Medicaid Services (CMS) in 1992. But it is not that this policy was not present before that. It was present prior that but prior 1992 the policy holders under this scheme remains under non-standardized plan. And those plans are now no longer applicable for the newly introduced plans. It is to be mentioned that the Medigap or the Medicare supplement plans are sold by the private insurance companies and there are no government sponsorship behind them. And for that reason the insurance policies may vary from state to state. According to the law, the companies can offer only 12 Medicare supplement insurance plans. All these plans are named after the letter series of English alphabet. From A to L, all these plans are for separate benefits. You have to go through all the plans carefully and then decide what the plan is you are opted for. In 2006 it has been clearly stated that the Medigap Plans H, I, and J, cannot be sold to people with prescription to drug benefits, although there is a lax of this rule for people who already have those plans and they can keep them.

The insurance company can not change its scheme or any thing under its policy rules unless you become a defaulter. Any irregularity in your premium giving and other thins can be measured as default. So be careful about paying the premiums within the time period. However, the company can increase the insurance premium, but that too they can’t do without providing your prior notice of the increase in due time.

However, it is sure that if you are under a Medicare policy and have a Medicare supplement plan along with it you need not have to worry about the Medical costs that you may have to face any time in life.

Related posts

• Obama’s Small Business Stimulus Plan – Start Your Small Business With Obama’s Stimulus Package
• Medicare Eases Rule on Termination of Provider Medical Records Review
• Paying For Home Health Care – What Do Medicare and Medigap Cover?
• Legal Issues Impacting Physician Recruitment Relationships
• Justice & Sec Clamping Down On Corrupt Practices: Beware Of The Conduct Of Strategic Partners

MEDICAID MORATORIA

Sec. 5003 – Extends or creates moratoria – through June 30, 2009 – on four Medicaid regulations for the following: 1) outpatient hospital and clinic services, 2) targeted case management, 3) provider taxes, and 4) school-based administration and transportation services. Congress also included a Sense of Congress that the Secretary of Health and Human Services should not promulgate three regulations concerning rehabilitative services, intergovernmental transfers, and Graduate Medical Education. It is hoped that this action will result in the Administration repealing these draft regulations.

FEDERAL MEDICAL ASSISTANCE PERCENTAGE

Sec. 5001 provides for an $87 billion increase to the Medical Assistance Percentage (FMAP) over the next two years (Oct. 1, 2008-Dec. 31, 2010). All states will receive an increase in their FMAP by 6.2 percentage points. In addition, some states are eligible to receive additional ?hold harmless’ and unemployment-related FMAP increases. This means that a state’s FMAP rate is equal to its current FMAP rate, plus a 6.2% base increase and ?hold harmless’ and unemployment adjustments (see below). Lastly, the FMAP increase includes ?prompt pay’ requirements and a maintenance of effort clause, which is applicable for the next two years.

>>The first two quarters of the new funding for FY 2009 (approximately $15.2 billion) was released February 25th by the U.S. Department of Health and Human Services. See map on DHHS site for allocations for each state.
Scope of Application

>>This increase applies to Medicaid, Foster Care, and Adoption Assistance

>>This increase does not apply to: 1) Temporary Assistance to Needy Families (TANF), 2) child welfare, 3) child support enforcement, 4) State Children’s Health Insurance (SCHIP), 5) Disproportionate Share Hospital (DSH) Payments, 6) items/services subject to an enhanced match, 7) individuals who become eligible as a result of income eligibility standards (expressed as a percentage of the poverty line) that are higher than those that were in effect on July 1, 2008, including standards that were proposed to be in effect under enacted state law that was not effective on July 1, 2008 or a state plan amendment or waiver request that was pending approval as of that date.

>>>In these cases, the regular state FMAP applies.

HOLD HARMLESS

>>States that would otherwise experience a drop in their federal medical assistance percentages (FMAPs) under the normal FMAP formula would be held harmless against any decline.

>>In FY09: If a state’s FY09 FMAP is less than its FY08 FMAP, the FMAP increase will be added to the FY08 FMAP. So, if a state has an FY08 FMAP of 60% and an FY09 FMAP of 58%, the 6.2% increase via the ARRA will be applied to the FY08 rate.

>>In FY10: If a state’s FY10 FMAP is less than either the levels in FY08 or FY09, the FMAP increase in FY10 will be applied to the greater of the FMAP levels for FY08 and FY09. So, if a state has an FY08 FMAP of 60%, an FY09 FMAP of 58%, and an FY10 FMAP of 59%, the 6.2% increase via the ARRA will be applied to the FY08 rate.

>>For the 1st calendar quarter of FY11(through Dec. 31, 2010): If a state’s FY11 is less than the FMAP for FY08, FY09 or FY10, the FMAP increase for the first calendar quarter of FY 2011 will be applied to the greater of the FMAP level of the previous fiscal years. So, if a state has an FY08 FMAP of 60%, an FY09 FMAP of 58%, an FY10 FMAP of 59%, and an FY11 FMAP of 57%, the 6.2% increase via the ARRA will be applied to the FY08 rate.

UNEMPLOYMENT

>>$30.45 billion of the $87 billion is reserved for the unemployment provision based upon a formula for each state’s unemployment rate during the current economic recession. Under this formula, the FMAP increase and the unemployment bonus are weighted on a 65% (FMAP increase) and 35% (unemployment bonus). See the initial 2009-2011 projections for individual states.

MAINTENANCE OF EFFORT

>>A state will be ineligible for the FMAP increase if eligibility standards, methodologies, or procedures under the Medicaid state plan (including Medicaid and/or Section 1115 waivers) are more restrictive than the eligibility standards, methodologies or procedures under the state plan or waiver that was in effect on July 1, 2008 (see “Special Rule” below for exceptions).

>>States retain the flexibility to make changes in benefits and reimbursement.

>>State Reinstatement of Eligibility Permitted: A state that has restricted eligibility standards, methodologies, or procedures after July 1, 2008, will become eligible for the FMAP increase beginning with the first calendar quarter in which the state has reinstated eligibility standards, methodologies and procedures that are no more restrictive than those that were in effect on July 1, 2008.

>>>Special Rule: A state will not be ineligible for the increased FMAP under the following circumstances: 1) on the basis of a restriction that was     applied after July 1, 2008 and before the date of enactment of the ARRA and 2) on the basis of a restriction that was effective under state law as of     July 1, 2008, and would have been in effect as of that date if it weren’t for a delay (of no more than one calendar quarter) in the approval of a     request for a new waiver under section 1115 with respect to the restriction.

PROMPT PAY

>>Requires states to report monthly to HHS on the states’ compliance with the Medicaid prompt pay requirements in Medicaid Statute (42 U.S.C. 1396a(a)(37)(A)), which specifies that the state must pay 90% of clean claims within 30 days of the date of receipt of the claims and that 99% of claims are paid within 90 days of the date of receipt. States must also provide for procedures of prepayment and post-payment claims review, including review of appropriate data with respect to the recipient and provider of a service and the nature of the service for which payment is claimed, to ensure the proper and efficient payment of claims and management of the program.

>>Existing prompt payment provisions apply to practitioners, in individual or group practice, and the ARRA amendment extends its application to nursing facilities and hospitals.

>>Prevents a state from receiving the increased FMAP claims received by the state for days during any period when the state is out of compliance with the Medicaid prompt pay requirements.

>>Permits the Secretary to waive this requirement during any period in which there are exigent circumstances – including natural disasters – that prevent the timely processing of claims or the submission of required compliance reports.

Related posts

• Protect Assets from Nursing Home: Medicaid Eligibility & Application
• An Introduction to Medicaid NH Insurance
• Medicaid Information For Homecare Services And Other Care Options
• Medicare & Medicaid Facts
• Learn Whom Are Medicaid Providers

Charity care is a term used in the United States to refer to health care services rendered to patients unable to pay for some, in whole or in part.

More specifically, the term refers to a scheme used by the state of New Jersey to provide reimbursements to hospitals and other health-care institutions which provide uncompensated or undercompensated health care to patients lacking private health insurance whose income falls below a certain amount but is too high to qualify them for Medicaid and are not old enough to be eligible for Medicare (New Jersey’s situation is somewhat unique among American states in that the state has no county or municipal hospitals).

The scheme provides free health care to uninsured state residents whose income is up to 200% of the federally-designated poverty line, and provides discounts which gradually phase out at incomes between 200% and 300% of the poverty line; the patient’s liquid assets (not including the patient’s home and one automobile) must not exceed $7,500. Also, the maximum any individual qualifying for aid under the aforementioned criteria can be liable for in a single year is 30% of that patient’s gross income for that year. A special fund compensates the health-care provider – which may have furnished either inpatient or outpatient services – for the applicable difference in cost.

Some private health-care providers in other states – particularly those that are operated on a nonprofit basis (often by religious entities) – also provide free and/or low-cost health care to uninsured patients, using income thresholds similar to those observed statewide in New Jersey; but state laws vary widely as to how much, if any, reimbursement (usually in the form of tax credits) the institution receives for so doing (and in only one other state besides New Jersey – Washington – does an outright mandate exist to provide charity care). Perhaps the most famous example of such an institution is the Charity Hospital of New Orleans, founded in 1732 and now run by the Medical Center of Louisiana.

Many political moderates in the United States point to the success of the New Jersey program, and recommend its adoption at the federal level as an alternative to national health-insurance proposals advocated by many liberals, which conservatives pejoratively characterize as “socialized medicine”.

Related posts

• Paying For Home Health Care – What Do Medicare and Medigap Cover?
• SpeediCath Compact with accessories is now available!
• Attorney questions and answers
• Medigap health insurance policy is for your utmost heath benefits
• The consumer’s in charge of individual health insurance