We start this episode by talking about the legal structure of Medicaid and how states can interpret it. Following that, we go through the distinction between nursing home Medicaid and in-home care Medicaid. There are different approaches for single individuals and married couples. This episode provides the essential information to be able to understand more nuances of Medicaid and be better prepared for any scenario in the future. We'd love to work with you if you need help with qualifying for Medicaid or with anything else related to estate planning and elder law.
Key Takeaways
Takeaway 1: The Law of Medicaid 02:08
- Medicaid is a federal program and the laws that dictate it are Deficit Reduction Act (DRA) '05 and OBRA '96.
- Pennsylvania has a long-term care handbook and it's the state's view of Medicaid, their interpretation and how they make decisions.
- There is a general guideline that every state follows, but there are nuances that set every state apart. There are various state questions.
- Just because our state interprets Medicaid in a certain way doesn't make it the right interpretation. Until the interpretation is challenged, you have to go along with whatever the Department of Human Services says.
Takeaway 2: Nursing Home Medicaid vs. In-Home care Medicaid 06:18
- Once we get an individual qualified after the 3-pronged test, the question is whether or not they go to a skilled facility or receive in-home care.
- We are still able to do the asset protection pieces that we discussed and protect 100% of the community spouse's assets even in a waiver situation.
- The best part: the income from the institutionalized spouse gets to stay in the home to offset the cost of care. They're receiving care in the home and the income actually stays in the home to help with the cost of care in the home.
Takeaway 3: Community HealthChoices 09:37
- Once the person is qualified for Medicaid, a group is sent out to do an assessment to determine how many hours of care the person is going to receive.
- Waiver is very near and dear to Jeff's heart. He's a board member for Leg Up Farm which provides great therapy for children with disabilities, and he is also a solicitor for the Center of Independent Living Opportunities, which is essentially an organization whose mission is to keep people in their home and maximize their ability to stay in the home. Receiving personalized care is great, and is very significant to Jeff.
Takeaway 4: Waiver 12:30
- Once the community spouse is at that income, the remainder of the money will go to the home for the cost of care.
- Pennsylvania's are actually very favorable, particularly in the case of married couples.
Takeaway 5: Single individuals with Waiver 14:58
- With single individuals, it isn't quite the same for the waiver. The income cap limit causes a problem. The problem is that we're not able to protect assets. We cannot turn assets into an income stream because it would put that individual's income too high.
Links and Resources Mentioned
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Ways to work with Jeff Bellomo
Contact Us: https://bellomoassociates.com/contact/ Practice areas: https://bellomoassociates.com/practice-areas/
