Prepared by
Douglas F Ocker P.C.
Attorney At Law
This information does not serve as a replacement for competent professional advice and it is only a matter of time before the information changes.
When it comes to Medicaid the road gets rocky and there is not much good news. The eligibility rules are designed as such to limit access to public benefits as much as possible. The elderly and disabled being those who need it the most have a difficult time understanding the ever changing regulations and they are confronted with this dismal task at a tough point in thier life. Could the situation get any worse? Each year the staff at Health and Human Services changes, the number of applicant increase, and the rules are different. Unfortunately, we must take the cards as they are dealt and all we can do is understand the current requirements as well as possible.
General Requirements to Qualify:
a) U.S. Citizenship or resident alien status and residency in Texas;
b) 65 or older, blind, or disabled according to the Social Security Disability definition; and
c) There must be a "medical necessity" determined by an assessment, and there is a 30 day in residence requirement.
Monthly Income Limits for 2009:
- $2,022.00 for a single person
- $2,022.00 for a married person with an ineligible spouse
- $4,044.00 for a married couple if both apply.
Limits on Countable Assets for 2009:
a) $2,000.00 for a single person
b) For a married person with a spouse who is not in a medical institution, the limit is one-half of the couple's combined resources, with a minimum protected resource amount of $21,912.00 and a maximum of $109,560.00.
c) If both spouses apply for nursing home Medicaid the limit is $3,000.00, unless they are in seperate facilities in which case resources in the name of each are limited to $2,000.00.
d) If both spouses are in a nursing home, but only one applies for Medicaid, the resource limit for that spouse is $2,000.00.
Countable Assets Mean All Assets Except:
a) One principle place of residence in Texas (i.e., a home)
b) Burial spaces and prepaid burial contracts
c) One automobile (two under certain circumstances)
d) Personal property with a $500 per item limit.
e) Term Life Insurance
f) Some very limited retirement benefits.
g) Livestock
h) Reverse mortgage lines of credit
i) Qualified Annuities
Methods for Dealing With the Income and Property Limits Include:
a) Miller Trusts (aka Qualified income Trusts) are used when applicant's income exceeds the monthly limit. They allow an individual to qualify for Medicaid regardless of his or her income.
b) Special Needs Trusts (aka Supplemental Needs Trusts) are used to receive and manage assets for the benefit of a Medicaid recipient without violating the limits on countable assets.
c) Converting countable assets into non-countable assets requires a clear understanding of the regulations, and any mistake will lead to some period of ineligibility.
d) In some cases, transfering assets can be a short cut to eligibility, but the transfer penalty is serious and careful calculations are required.
e) Expanding the protected resource amount is only availible to an applicant with a spouse at home, when their combined monthly income (less a $60 personal needs allowance for the applicant) is less than the minimum monthly maintenance needs allowance which is $2,739.00 in 2009.
M.E.R.P. INFO:
a) The value of the estate is $10,000.00 or less.
b) The recoverable amount of Medicaid costs is $3,000.00 or less.
c) The cost of the sale of the property would be equal to or greater than the value of the property.
d) There is a surviving spouse.
e) There is a surviving child under 21 years of age.
f) There is a surviving child of any age who is blind or permanently and totally disabled under Social Security requirements.
g) There is an unmarried adult child residing continuously in the Medicaid recipient's home for one year before the recipient's death.
h) Recovery would cause an undue hardship.
Recovery claims may be avoided be transferring a remainder interest in the home using a specially designed life estate deed.
Penalties for Transfers:
Rules exist to penalize applicants for transfers made within five years of the date of application. For every $122.50 transferred, an applicant loses one day of Medicaid eligibility, and the period of ineligibility begins to run on the date the applicant would have otherwise been eligible to receive Medicaid.
For example: A woman transferred $22,050.00 to her children on January 1, 2009. She applies for Medicaid on February 1, 2009, and she meets all of the income, asset and other requirements for eligibility. She will be denied Medicaid benefits for six months ($22,050.00/$122.50=180 days), during which time she must continue to be eligible for Medicaid. There are ways to minimize the impact of these new transfer penalty rules, but they require very careful planning.
Additional Sources of Information:
Medicaid Hotline - 1 (800) 252-8263
Puts you in touch with the Health and Human Services Commission (HHSC) which handles Medicaid for the State of Texas.
This is the website for the HHSC which can provide a wealth of information and links to other useful sites.
This is the Federal counterpart to the HHSC website.
This is also a Federal website, but there you can obtain specific information about individual nursing homes including evaluation reports.
With all this information you may be asking what can I do next? Well nothing takes the place of competent professional advice to fit your unique situation. Call The Law Office of Douglas F. Ocker P.C. and ask for a phone consultation with one of our attorneys.
Ph. Toll Free: 1.866.492.8963
Ph. Local: 361.985.2444
Fax: 866.422.9991
5350 S. Staples, Suite 208 Corpus Christi, Texas 78411
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