Professional Documents
Culture Documents
Pages:
Part One: Veteran’s and their surviving spouses:
aid and attendance pension……………
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The rules for these programs are complex, technical and constantly changing. These
materials are presented as an overview of issues to aid individuals in gaining a basic
understanding of Medicaid. Material contained herein is not to be considered legal
advice to any particular person. Each person’s circumstance is unique and must be
evaluated individually. Competent legal counsel should be sought before taking any
action in reliance upon the information contained in this outline.
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Part One:
B. Service Requirements
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C. Disability Requirements
D. Financial Requirements
However, there are certain items deducted from the income, such as
unreimbursed or out of pocket medical expenses, such as dentist fees,
glasses, doctor’s fees, prescription drugs, therapy, health insurance,
including Medicare Part B, now $96.40 per month, (plus Medicare part
D)and supplemental health insurance premiums.
Subtract your total expenses from your total income to arrive at your
countable income: _____________________________.
Next subtract your countable income from the maximum figure listed
in D.2. above. This is the amount of monthly income the VA will
send to you.
F. Who can help me apply for this pension? How long does the
process take?
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Also, an attorney accredited as a Veteran’s Affairs Claim Attorney
can assist with the application.
Part Two:
Thus, the program now has a major impact on the financing of long
term health care. We realize that it is difficult to keep current on all of
the Medicaid regulations. The information in this paper, combined
with expert advice, can help ensure that those in need of long term
care will qualify for Medicaid assistance in a timely manner without
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falling prey to the quagmire of Medicaid rules. Swift action on the
part of the care giver can help preserve assets for the support of their
families during the course of their long-term care.
1. Assets
The amount of assets that can be kept by Medicaid recipients and their
families depends on whether or not the applicant is married, and if so,
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whether the applicant’s spouse is still living in the community. The
asset limitations according to the State of Connecticut are as follows:
The general rule for a married applicant is that the well spouse (who is
referred to as the community spouse) can keep assets of the couple up
to a maximum amount of $109,560.00 as determined on a “snapshot
date.” This is a new law in Connecticut as of May 2010. You can
apply just to get this snapshot date and an assessment will be made as
to when this applicant needed home care services. If the applicant
was first hospitalized but then came home, the snapshot date would
typically be the initial date of hospitalization. The couple’s assets as
of the snapshot date are tallied and divided in half. These figures
change annually. However in some very limited circumstances, such
as under the “Spousal Impoverishment Rules,” the community spouse
may be able to keep a greater portion of the assets. Counsel familiar
with these rules should be consulted on this matter.
There is an income cap for the Medicaid home care program. In 2010,
that amount is $2,022.00 gross income for the applicant only. (If the
income is social security, this usually means you have to add back in
the Medicare premium of $96.40 per month and the Medicare Part D,
to reach the gross income figure.) A spouse’s income does not count
toward this limit and the Medicaid rules do not require that the income
of the community spouse be spent on the recipient’s care. Make sure
you consider a special needs trust; this discussion in Part 3.
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The income rules are significantly different if the applicant is in a
convalescent home and the community spouse has a low monthly
income. We are now an income first state and counsel familiar with
these rules should be consulted.
3. Transfer of Assets
An Example follows:
Dad, 87, now lives alone since mom passed away last year. He needs
some assistance with his daily activities, especially the homemaker
chores. His son who lives in the Utah, has hired someone to help Dad
with cooking and cleaning.
Dad has long wanted to gift some money to his kids and his wife had
also urged him to do so. He decides he should do this sooner rather
than later and determines to give his children these gifts during the
upcoming holiday in December, 2010. He gives each of his children, 5
in all, $25,000 and each of his grandkids, 11 in all, $1,000.00. Totally
he gifts $136,000. Right after the holidays, he suffers a serious stroke
and will now require care 24 hours, 7 days a week.
Under the new transfer of asset rules, he can apply for Medicaid
services when he is otherwise eligible, i.e. spent down to $1,600. But
the transfer of his assets will cause a period of ineligibility going
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forward. Thus, if he otherwise qualifies for Medicaid (except for these
transfers) in March 2011, the $135,000 gifts will cause a penalty
period (a period of ineligibility) over the next 13 months. It’s
calculated by dividing the total gift by the average nursing home cost
in Connecticut this year $10,366.00 (March 2011-April 2012). So Dad
will be denied benefits for over 13 months.
There are additional transfers which are exempt from these transfer rules and are
not disqualifying events; here is one common example:
An Example follows:
Mother (widowed) falls ill and can no longer care of herself. Daughter
moves in with Mom and takes care of her mother for over two years; this
care giver daughter has prevented Mom from needing nursing home care.
Mom transfers the home to her daughter. But Mom’s condition worsens and
daughter can no longer care for her at home without more assistance. Mom
is placed in a convalescent home; is Mom eligible for Medicaid? Yes,
because of a special provision of federal law which allows the transfer of the
home in this type of situation (care giver child for 2 years).
There are additional transfers which are exempt from these transfer
rules and are not disqualifying events; here are two common
examples:
1. An individual or his or her spouse may transfer his or her
home without penalty to his or her:
a. Spouse; or
b. Child under age 21; or
c. Child of any age if the child is considered to be blind or
disabled under criteria for SSI eligibility; or
d. Sibling, if the sibling:
(1) has an equity interest in the home; and
(2) was residing there for a period of at least one year
before the date the individual is institutionalized; or
e. Son or daughter, other than the one described in
subparagraph b. and c, who:
(1) was residing in the home for a period of at least two
years immediately before the date the individual is
institutionalized; and
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(2) provided care to the individual which avoided the
need of institutionalizing him or her during those two
years.
Another important Medicaid rule is that the individual MUST meet all
of the Medicaid eligibility criteria by the last day of the month in which he
or she applies to receive any help that month. It is essential that the planner
have complete and accurate information concerning the assets owned by the
potential Medicaid applicant and his or her spouse, if married. Spending
down assets must be carefully timed to meet this deadline.
Connecticut has a pilot project underway which utilize the home care
programs services in an assisted-living facility. The assisted-living facility
must be a participant in this pilot project; not every assisted-living facility in
Connecticut is participating. Contact Mr. Vincent Hayes, 1-860-424-5133,
DSS, Alternate Care to get on the waiting list as soon as you enter one of
these facilities. There is a long waiting list currently.
Smithfield Gardens
32 Smith Street
Seymour
1-203-888-4579
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Part Three:
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Disabled, but over assets and over income
Hypothetical Case
CONCLUSION:
The pooled trust can hold the assets and/or income and it
will not be counted for Medicaid purposes, thus you can
stay home or in the community even if you are over-asset or
over-income for one of the Medicaid, Title XIX, home care
programs.
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