How to Determine if Your Loved One Qualifies for Medicaid Home Care
As we ourselves age, we start to look at our loved ones a little differently. Your parents or grandparents appear to be aging even faster as time goes on. It is hard to watch this decline.
Maybe you’ve noticed that they’re having trouble getting out of bed in the morning. They are no longer able to do seemingly simple tasks. The doctor has determined they are at increased risk for falling and injuring themselves. Or worse, they are permanently disabled or blind.
As they age, some of them will inevitably require long-term care to address their increasing healthcare needs. But the thought of a nursing home facility is out of the question. You’ve read so much negative news about these facilities and prefer that your loved one is safe and sound at home. But does your loved one actually qualify for Medicaid home care?
What is considered Medicaid home care?
Home care benefits are paid by Medicare when health care and other qualifying services are provided at home. For some, this is the preferred healthcare option of choice. And the good news is that all 50 states offer some type/amount of Medicaid home care benefits.
These benefits, however, are specific to each state and part of a state/federal program. The healthcare benefits are provided “to low-income children, seniors, and people with disabilities.” But the approved services paid by Medicaid varies from state to state. The benefits provided may include services such as:
● Health care in the home including medically necessary and allowable services
● Personal care services such as bathing, feeding, toileting, preparing meals, etc.
● Caregiver support
● Home modifications for accessibility
● Medical equipment as needed
● Housekeeping services including up-keeping chores, laundry, etc.
Take a look at the state where your parent resides to find out what coverage is provided. For example, some states, like New York, provide a comprehensive home care program “enabling about 100,000 elderly or disabled persons a year to remain in their homes.”
Who is eligible for home care coverage?
According to the Medicaid government website, each state is able “to tailor services to meet the needs” of their populations. This makes sense as state demographics can change from one state to the next. States are allowed to determine certain criteria to zero in on those groups and their healthcare needs. As a result, eligibility under state “waiver” programs can be based on age or a diagnosis such as “autism, epilepsy, cerebral palsy, traumatic brain injury, or HIV/AIDS.”
In any case, depending on the state of residence, individuals who are eligible “must demonstrate the need for a Level of Care” that meets the state’s eligibility requirements. As a general rule, eligibility is based on age (65+ years old), health condition, disability, or blindness.
What are the financial requirements?
As you may already know, financial eligibility can be tough. It can be a frustrating process to navigate. To be eligible for Medicaid, you must be considered low-income. And each state has different limits of income and assets in order to qualify.
For example, in the state of New York, the 2020 monthly income limit for a single individual is $875 per month with an asset limit of $15,750. Colorado on the other hand, has a monthly income limit of $2,349 with an asset limit of $2,000.
Most of the time, the potential beneficiary simply has too much in income and assets to qualify. If this is the problem you’ve run up against with your parent’s situation, there are ways to help your loved one qualify.
Getting help to qualify for home care benefits.
So, what can be done to help someone financially qualify for Medicaid home care? If your loved one has more in income, you should consider a Medicaid qualifying trust. If your loved one’s situation is seemingly complex, you may consider seeking help from an attorney who specializes in this area.
Many times, they will refer you to a pooled trust option to help. The fact is that in order to receive Medicaid benefits, any excess monthly income has to be paid to Medicaid or a Managed Long Term Care (MLTC).
This is called a “spend down” or a “surplus.” Unfortunately, this can leave an individual who receives Community Medicaid without enough funds to pay for daily living expenses. A Pooled Income Trust can help as the funds deposited into the trust can be used to pay a member’s expenses.
So, before you throw up your hands feeling like there may be no resolve, seek help. The effort will be well worth it knowing your loved one is safe at home.
Let KTS Pooled Trust help you to find the right solution for your loved one to allow them to remain in their own home. Contact us today.