Medicaid is a State of Idaho and Federal government program that helps people with long-term care costs.  The laws and regulations in this area change often so this article will just cover the high points of what it takes to qualify for Medicaid to have the government program pay for long term nursing home care costs.

 

     There are many tests that need to be passed before a person can qualify for Medicaid.  

 

     •  The Medicaid applicant must be age 65 or older, or blind or deemed disabled according to the Social Security standards.

 

     •  the applicant usually must be a citizen.

 

     •  the applicant must have a medical need.

 

     •  the applicant must past the income test.

 

     •  the applicant (and their spouse, if any) must pass the asset test.

 

What are the benefits of receiving Medicaid?

     Medicaid will pay 100% for residential nursing home care and all prescription drug costs in facilities that participate in the Medicaid program

     Medicaid will pay 100% for residential care in assisted living, but will not pay for drugs.  There are a few Assisted Living facilities that participate in Medicaid because the facilities are often reimbursed at below their break-even point.

     Medicaid will pay $16/hour for a maximum of 8 hours per day for in home care by a certified caregiver.

 

Income Test

     Single Person

          If the applicant’s gross income is more than $2,022 per month, then the applicant fails the income test.  If there income is less than $2,022 per month they will pass this test.  Income is usually from social security and pensions, but there are other sources of income that can be considered.

 

     Income for a Married Applicant’s Spouse.

            If the income of the healthy spouse [called the “community spouse”] is less than $1,821.25, she can get additional funds from her husband’s social security and pension to bring her up to $1,821.25 and if she has excess shelter costs, she can have a maximum of $2,739 per month.  If she needs even more monthly income, she can petition the court for a greater income.  There is no limit on the income received by the healthy spouse, so she can have income from her social security, wages and pension of more than $1,821 and her husband may still qualify for Medicaid.

 

     Solution to failing the income test.

            If the Medicaid applicant fails the income test by having too much income, that person can set up an irrevocable “Income Qualifying Trust” which is often referred to as a “Miller Trust.”  

 

     How does this “Income Qualifying Trust” work?  The Trust creator is the Medicaid applicant.  The Trustee of the Trust is that person’s spouse, a child or some other trustworthy person.  Often the entire amount of the Medicaid applicant’s social security and pension are automatically deposited in the old checking account.  The Trustee then sets up a new checking account and every month transfers all the social security and pension to the new account.  Then the Trustee makes monthly checks:  one for $40 for personal needs, one for $25 for Trustee fees and the balance to the facility.  

 

     Next week we will address the Asset Test requirements to qualify for Medicaid.