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Medicare Advantage Plans
A Fairfield call center has reopened and hired 400 seasonal workers to answer questions regarding Medicare prescription drug coverage options for a national health care provider. TeleTech Holdings Inc. , based in Colorado, began adding customer ...
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Publ.Date : Fri, 21 Nov 2008 14:39:00 GMT
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Publ.Date : Fri, 21 Nov 2008 16:19:00 GMT
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Publ.Date : Thu, 13 Nov 2008 23:53:00 GMT
YOUNGSTOWN/CANFIELD — Shepherd of the Valley Home Health is offering flu shots for $10 on Sunday from 8 a.m. to 1 p.m. at Lord of Life Lutheran Church, 550 North Broad St., Canfield; and on Dec. 2 from 4 to 6 p.m. at St. John Lutheran Church, 1429 ...
Publ.Date : Fri, 21 Nov 2008 18:50:00 GMT
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Medicaid Overview, Part I
by Paul Nicolosi
Medicaid, also known as medical assistance is a joint federal-state program
that provides health insurance coverage to low-income children, seniors and
people with disabilities. In addition, it covers care in a nursing home for
those who qualify. 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. There
are no limits on the maximum length of a Medicaid recipients stay at a facility.
The Federal government pays roughly one-half of the costs, while the State
covers the remainder. In Illinois, the agency that administers Medicaid is the
Illinois Department of Public Aid (IDPA). 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. While Congress and the federal
Health Care Financing Administration set out the main rules under which Medicaid
operates, each state runs its own program. As a result, the rules are somewhat
different in every state, although the framework is the same throughout the
country. The following describes some of the basic rules regarding Medicaid in
Illinois.
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. This means that the cost of care
must be paid for by the Medicaid applicant to the extent that the assets exceed
the $2,000 limit. The spouse of a nursing home resident--called the community
spouse-- is limited to one half of the couples joint assets up to $84,120 (in
2000) in "countable" assets (see Medicaid, Protections for the Healthy Spouse).
The $84,120 figure changes each year to reflect inflation. In addition, the
community spouse may keep the first $17,400, even if that is more than half of
the couples assets. These figures change annually and are found in the
Department of Human Services policy manual. Basic Medicaid information is also
available at
http://www.state.il.us/dpa/mednews.htm. All assets are counted against these
limits unless the assets fall within the short list of "non countable" assets.
These include: (1) Personal possessions, such as clothing, furniture, and
jewelry with an equity value of no more than $2000. However, wedding rings,
engagement rings and items required because of an individuals medical or
physical condition are exempt regardless of value. (2) One motor vehicle if it
meets any one of the following criteria: A) If it is necessary for employment B)
If it is necessary for transportation for medical treatment of a specific or
regular medical problem C) If it is modified for operation by or transportation
of a handicapped person or D) If it is necessary because of terrain, remoteness
or similar factors to provide necessary transportation to perform essential
daily activities. A motor vehicle owned by a nursing home resident is also
exempt if transferred to a spouse. In all other cases the exemption is limited
to $4,500. (3) The applicants principal residence, provided it is in the same
state in which the individual is applying for coverage although some
limitations, discussed below, exist. (4) In Illinois, up to $1,500 of revocable
burial expenses are exempt and up to $4,120 in irrevocable prepaid expenses are
exempt. However, the amount of the revocable expense exemption is reduced by the
amount of irrevocable expenses. In all cases, expenses for burial space or plots
and other customary items such as a casket or headstone are completely exempt.
(5) Assets that are considered "inaccessible" for one reason or another. These
assets often come in the form of specific types of trusts.
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 applicants
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. Congress does not want you to move into a
nursing home on Monday, give all your money to your children (or whomever) on
Tuesday, and qualify for Medicaid on Wednesday. So it has imposed a penalty on
people who transfer assets without receiving fair value in return. This penalty
is a period of time during which the person transferring the assets will be
ineligible for Medicaid. The penalty period is determined by dividing the amount
transferred by what Medicaid determines to be the average private pay cost of a
nursing home in Illinois. The period of ineligibility starts on the first day of
the month of the transfer. 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).
Another way to look at the above example is that for every $5,000 transferred,
an applicant would be ineligible for Medicaid nursing home benefits for one
month. In theory, there is no limit on the number of months a person can be
ineligible. Example: The period of ineligibility for the transfer of property
worth $400,000 would be 80 months ($400,000 ÷ $5,000 = 80). However, the IDPA
may look only at transfers made during the 36 months preceding an application
for Medicaid (or 60 months if the transfer was made to certain trusts). This is
called the "look-back period." Effectively, then, there is now a 36-month limit
on periods of ineligibility resulting from transfers. This means that people who
make large transfers must be careful not to apply for Medicaid before the
36-month look-back period passes. 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. However, if the
individual applied for benefits in December 2000, only 35 months after
transferring the property, he or she would have to wait the full 80 months
before becoming eligible for benefits.
Rockford native Paul Nicolosi concentrates his legal practice in business law
and transactions, and business and estate planning. He is active on several
company boards and participates in regular company reviews for consideration by
venture capital firms.
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