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Long Term Care and Medicaid

An important way Medicaid helps seniors is by covering long-term care costs. More than 60% of all nursing home residents receive Medicaid coverage, and close to half of all LTC services for the elderly are paid by Medicaid.

Medicaid is a state and federal government health insurance program. The government sets the broad requirements and the states implement them. The Michigan Department of Health and Human Services administers the program.

LTC services help meet the medical and non-medical needs of people unable to care for themselves. Services can be provided at home, in the community, in assisted living facilities or in nursing homes.

There are three primary Medicaid LTC programs:  The MI Choice Waiver program, the Program of All Inclusive Care for the Elderly, and nursing home Medicaid.

There are four requirements for LTC eligibility:

  1. 1. Level of Care: Applicant must be age 65 or older, blind, disabled and

a). Be in a nursing home, or be approved as a MI Choice Waiver or PACE client,

and

b). Be approved through the Medical Level of Need Screening Tool that measures the extent to which a person’s medical needs qualify them for either LTC nursing home benefits or MI Choice Waiver benefits.

  1. 2. Income: Any payment owned by the client, including payments made to a representative on their behalf, is income.  Countable income includes the total income, minus any income that is excluded by government policy.  Income is not an asset in the month it is received; it is not an asset if transferred from one type of account to another; i.e. transferring funds from savings to checking account.

When a person qualifies for nursing home Medicaid, the State will guarantee the nursing home receives a set amount for their care, thus the term “ Medicaid beds.” The amount a Medicaid recipient contributes from their own income for their care is called the “patient pay amount.”  It is calculated by subtracting from their income:

  1. • $60 for personal care needs ($90 if a veteran);

  2. • The amount necessary to pay health, vision, and/or dental insurance premiums;

  3. • $95 for a guardian or conservator fee;

  4. • The amount contributed, if applicable, to a community dwelling spouse.

Assets Eligibility: Applicant’s assets cannot be more than $2,000 on any day during the month for eligibility.  If an applicant is married, there is an additional allowance for the community dwelling, non-institutionalized spouse.

“Countable assets” are everything a person owns that is not excluded by government regulation.  Excluded assets are:

  1. • The homestead. Value depends on whether a spouse, a blind or disabled child, or a child under age 21, remains in the home. Generally, value must be less than $585,000

  2. • Personal property

  3. • 1 vehicle

  4. • Burial fund, exclusion up to $1500

  5. • Burial space and items

  6. • Funeral contracts.  Current cap of $12,770

  7. • Life Insurance with a face value of less than $1500

The MDHHS frequently updates and revises Medicaid eligibility rules. Visit www.mfia.state.mi.us/olmweb/ex/html for current Medicaid manuals, or contact your local Area Agency on Aging.

Adrienne C. Watts is a licensed attorney with over 30 years of experience and specializes in probate, estate planning and how to protect assets as well as Elder Law including Medicaid planning, guardianships and conservatorships. Visit http://www.adriennecwatts.com/, call 248.399.6985 or email attyacw@aol.com for more information or a complimentary consultation.

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