What is Medicaid?
Medicaid is a joint federal and state program that is available to certain low income individuals and families that helps to pay for costs associated with long term medical and custodial care. The program is largely funded by the federal government but Medicaid is a state program so the rules due vary per state. Each state has certain thresholds for income, property, assets, etc. that are tested in order to qualify for Medicaid. There are rules for individuals living in nursing facilities and for disabled children living at home.
Does Medicaid Pay for Long Term Care ?
In the state of Illinois, Medicaid will pay for a nursing home only when it is medically necessary. Medicaid will not pay for nursing home care that is custodial care. Custodial care means that non-medical care such as help with transfer to and from a whellchair, bathing, or eating will not be covered for a nursing home stay.
Before Medicaid will pay for a nursing home you must have a “Determination of Needs” screen completed by Department of Aging.
If you are in a hospital the hospital will arrange for this screen to be completed. If you are at home, it is the responsibility of the family/resident to contact the state to arrange for a screen. Individuals that are 60 years or above in age should contact the Department of Aging at 800.252.8966 to arrange a “Determination of Needs” screen. Individuals with a physical disability can call the Department of Human Services at 877.761.9780 to arrange the screen. Individuals who are developmentally delayed or have a Mental Illness can call DHS at 800.843.6154.
For More information on Illinois Medicaid contact the Illinois Department of Healthcare and Family Services at 217. 782.1200.
What is the minimum asset requirement to qualify?
In order to qualify, a person has to deplete all of their assets down to $2000.00.
If I give money away or a home will I qualify?
No. The state has a look back period of 5 years to see where your money has gone. If there is any suspicious activity such as giving away a huge chunk of money or a home in the last 5 years then a person will not qualify. There are items that are acceptable ways to “spend down” assets to qualify for Medicaid as a low income senior. Some money/assets can be gifted within reason. Prepaid funeral and burial arrangements can be paid up to $3000 per couple. It is recommended to consult an Elder-law attorney to understand all of the “acceptable” ways to spend down assets to qualify for Medicaid.
What happens with my monthly income?
The nursing home patient must contribute all of his/her income towards the cost of care except for $30 per month. The $52 per month can be used on personal needs or anything that is not covered by Medicaid. This contribution of income to the facility for the care received at the nursing home is called “liability”.
What about my spouse?
On September 30, 1989, The Spousal Impoverishment Protection Law was put in place. The purpose of this law is to ensure that the spouse in the community is able to keep some of the couple’s assets and income while qualifying the nursing home spouse for Medicaid. In the state of Illinois, the Community Spouse Maintenance Needs Allowance (CSMNA) will remain at $2,739 (1/2016). If the community spouse does not equal $2739 per month, then he or she may keep part of the nursing home spouse’s income to bring his/her minimum to equal $2,739 per month.
For More information on Illinois Medicaid contact the Illinois Department of Healthcare and Family Services at 217.782.1200.