Medicaid is a joint federal and state, need-based program that is often needed by senior citizens to pay for the catastrophic costs of nursing home expenses. Medicaid planning involves tactics used to preserve assets while establishing or maintaining eligibility for Medicaid. There are terms that are used within the Medicaid system and Medicaid planning that you should know.
Medicaid is a joint federal and state, need-based program that is often needed by senior citizens to pay for the catastrophic costs of nursing home expenses. Medicaid planning involves tactics used to preserve assets while establishing or maintaining eligibility for Medicaid. There are terms that are used within the Medicaid system and Medicaid planning that you should know.
CMS: Centers for Medicare and Medicaid Services, CMS, is the federal agency in the U.S. Department of Health and Human Services (HHS) responsible for the administration of Medicaid, Medicare and the State Children’s Health Insurance Program (SCHIP). This agency was formerly known as the Health Care Financing Administration (HCFA).
Comparability of services: The “comparability” requirement provides that Medicaid services “shall not be less in amount, duration, or scope than the medical assistance made available to any other individual.” In other words, Medicaid cannot shortchange their enrollees just because it is a need-based program.
Countable assets: Although a Medicaid application requires each applicant, as well as their spouse, to report each and every asset, not all assets are counted when adding up the amount of property the individual has in determining eligibility. The distinction between “countable” and “non-countable” assets is important in Medicaid planning, for example, a primary residence where a spouse resides is deemed not countable for Medicaid eligibility.
Dual eligibility. Dual eligibility is an important term for seniors, as it refers to low-income adults, including seniors and young adults with disabilities, who are enrolled in both Medicaid and Medicare. Most dual eligibles qualify for full Medicaid benefits.
Ineligibility Period: The ineligibility period is a period of time during which Medicaid looks forward. The ineligibility period is triggered by transfers of assets during the look-back period and looks forward to determine a date when the person may become eligible for Medicaid.
Look-back Period: The look-back period is the time preceding the person’s application for Medicaid during which asset transfers will be reviewed. The look-back period simply means that after a certain amount of time has passed, Medicaid doesn’t inquire whether the elderly person gave away property. However, a transfer within the look-back period will be questioned and, if something of equal value was not received in return, a penalty will be applied, which will prevent the person from receiving Medicaid long-term care benefits until that penalty period expires.
Spend Down Program: Medicaid requires applicants to reduce their monthly income or resources to the Medicaid standard in order to qualify for Medicaid coverage. In New York, the Medicaid program allows applicants to spend down excess income and resources through a medical bills system or pay down program. The medical bills system is a process in which the applicant is covered by Medicaid once they incur medical expenses equal to their spend-down amount in any particular month. Under the pay down program an individual pays a monthly premium, the spend-down amount, in order to be covered by Medicaid.