9/8/2017 Medicare Coverage • Everyone over age 65; • Up to 100 days of skilled nursing following a 3-day hospital stay; • “Admitted” vs. “Under Observation” • For a medical condition either: • Hospital related, or • Which began while in skilled nursing care due to a hospital-related condition Examples “Admitted for Care” vs. “Admitted for Observation” 1
9/8/2017 Medicaid Eligibility (largest single payer of long term care) Medicaid is a federal/ state partnership Administered by states on federal regulations In Virginia, by the Department of Medical Assistance Services (“DMAS”) Eligibility is based on financial/ medical need Qualified individuals may receive nursing home care, limited alternatives, e.g. personal services, home health services… Medicaid Eligibility (cont’d.) Supplemental Security Income SSI = Eligibility Resource Test Less than $2000 of “countable” assets, (including your spouse’s assets) Income Test Some percentage of the federal poverty level (Medicaid) Resource Test Before applying, may ask for a “Resource Assessment List all assets Assets will be categorized as “countable” or “non-countable” Spousal share determined (the part the spouse gets to keep) 2
9/8/2017 Resource Test (cont’d.) Assets “Countable” vs. “Non-countable” Assets with a meaningful possibility of being converted into cash are “countable.” “Non-Countable Assets”* Home and contiguous property with equity up to $552,000 for a married couple; Personal furniture and effects; One vehicle, regardless of value; Burial plots or arrangements and up to $1500 each for final disposition; and Some insurance policies. * (a/ k/ a “Exempt Resources”) 5-Year Lookback CAUTION There are stiff penalties for “uncompensated transfers” affecting Medicaid eligibility. 3
9/8/2017 (Medicaid) Income Test Income below 80% of the federal poverty level Countable Income greater than the SSI benefit ($733/ mo.)*, but less than 80% of FPL ($792/ mo.)* “Medically needy” applicants Countable income greater than 80% FPL, but below their medical need (or) Less than 300% of monthly SSI benefit ($2199 meets income test) More than $2199/ mo. will require a spend-down * 2016 figures Income Test (cont’d.) “Countable” vs. “Non-countable” income Everything is countable unless it is expressly excluded. Examples: SSI payments Tax refund payments LTC policy payments Refer to Medicaid Manual for additional exclusions Planning to establish or maintain eligibility Financial planning Annuities Long term care insurance Some life insurance policies Legal planning Special Needs Trust (SNT) Irrevocable Trust Permissible property transfers 4
9/8/2017 CYA THIS PRESENTATION IS OFFERED FOR EDUCATIONAL AND ENTERTAINMENT PURPOSES ONLY, AND IS NOT A SUBSTITUTE FOR COMPETENT PROFESSIONAL ADVICE Planning to protect the home Do not sell or transfer until/ unless Medicaid eligibility has been established If title to the home is in an LLC or RLT, tranfer to individual owner(s) Life insurance is exempt from Medicaid lookback Aging in place Medicare may cover: Intermittent skilled nursing care Physical therapy Speech/ language pathology Occupational therapy BUT NOT 24-hr daycare at home Meals delivered to your home Personal care/ homemaker services 5
9/8/2017 Medicaid Waivers for Home and Community Based Services Adult day healthcare Assistive technology Companion services Personal assistance services Respite care Environmental modifications Assisted living (only Alzheimer’s assisted living waiver) Private Pay Health Insurance (very limited) Long term care insurance And life insurance benefits may be used BUT this is very plan-specific 6
9/8/2017 Lelia Winget-Hernandez, Esq. Michael Winget-Hernandez, Esq. Winget-Hernandez, P.C. 5570 Richmond Road, Suite 201 Troy, Virginia 22974 (434) 589-2958 lelia@winget-hernandez.com Also by appointment at Lake Anna: Commonwealth Life & Legacy Counsel, PLLC 200 Boardwalk Way, Suite B Mineral, Virginia 23117 7
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