Medicaid & Longterm Care Facilities
Medicaid is a federal program designed to pay for the medical expenses of low-income individuals. Before the Affordable Care Act (ACA), eligibility was limited to only those low income individuals who were over 65 years of age, blind, or disabled. Children under 19 still have special eligibility rules under Nevada Check Up. Medicaid will generally pay for certain health services, long term care such as home care, and nursing home care for those with low incomes and limited resources. Medicaid is often confused with Medicare. The basic difference is eligibility for Medicaid is based on financial need. Medicare is not based on financial need but is available to almost anyone who has been determined disabled or who is 65 years of age or older.
Medicaid in Nevada is administered by the Nevada Department of Welfare and Supportive Services (DWSS). To get Medicaid payment for nursing home care, you must be entitled to participate in the program and be financially eligible.
Every applicant through Nevada Health Link is first reviewed for Medicaid eligibility (and Nevada Check Up for Children). You can apply for Medicaid online. The electronic application is available at the Nevada Health Link website, www.NevadaHealthLink.com. If you are over income for the Medicaid programs, you will then be sent to the Exchange to choose the plan that works for you.
You can seek the assistance of a facilitator to help with your application process. You also still have the option of completing a paper application and mailing a completed Application for Health Insurance to Nevada Health Link. You can obtain a paper application from any DWSS office or online at https://dwss.nv.gov/. The application is manually entered into Nevada Health Link. Division of Welfare and Supportive Services will receive the application electronically. Please mail the application to the following address:Nevada Health Link PO Box 97138 Las Vegas, NV 89193
Under the ACA (otherwise known as ObamaCare), anyone - individuals or families - falling below certain income and resource limits may be eligible to receive Medicaid or may be eligible for a subsidy for health insurance on the exchange.
Medicaid can now cover adults and children with income up to 138% of the federal poverty level. Individuals and families with income between 138% and 400% of the federal poverty level will receive tax credits to help cover the cost of insurance on the Exchange. If your household income is less than 250% of the federal poverty level, policies with reduced deductibles and copayments will result in additional cost savings with in enrollment in a Silver Level plan. There is no resource limit under the income based Medicaid program. Resource limits will still affect applications for other medical programs - SSI eligible individuals, individuals over the age of 65, Medicare Beneficiaries, and individuals living in a medical or nursing facility.
Other new eligibility groups also might have additional requirements or different income levels:
- Parents and other caretaker relatives – eligibility is based upon the child’s receipt of Medicaid or Nevada Check Up but the income level still must be below 138% of the federal poverty level. There is no requirment that the parent or other caretaker relative seek child support from any parent.
- Pregnant women – income below 164% of FPL during pregnancy and 2 months after delivery. There is no reevaluation if any income changes but there is a requirement to seek child support to remain eligible for Medicaid unless good cause exists. Example of good cause include: incest or rape, pending adoption, WCSS involvement, domestic violence.
- Adults without children with income less than 138%
Children – under 19 years old and income less than 164%
- Newborn children are eligible for Medicaid for 1 year following birth if mother was eligible prior to birth and there is no redetermination of income eligibility.
- Nevada Check Up: children under 6 with income between 165-200%; ages 6-18 with income between 139-205%
- Quarterly premiums apply based upon income BUT cannot be eligible in any other category – as part of an assistance unit or under parent’s employment.
Income is calculated based upon the tax filing status of each individual family/household member applying. Nevada Health Link will look at the monthly taxable income of every individual in the "assistance unit" which depends upon tax filing status. Financial eligibility is determined based upon current monthly net earned income and any unearned income of the assistance unit. Annual deductions, including pre-tax deductions, are also taken into account.
Longterm Care Facilities & Medicaid Estate Recovery
- To get Medicaid for nursing home care, both your income and your resources must be within limits set by law.
- An applicant’s assets (resources) are considered either countable or excluded for Medicaid eligibility purposes. The assets test measures whether the applicant’s countable resources are within eligibility levels.
What are countable resources?
- Countable resources consist of all real and personal property owned singularly or jointly with others by the person applying for Medicaid. Examples of countable resources include but are not limited to: Non-home real estate, vehicles, checking and savings accounts, certificates of deposits, cash value in life insurance, stocks, bonds, mutual funds, individual retirement accounts (IRAs), contracts for deed, life estates, oil and mineral rights, items of unusual value (such as jewelry, coins, artwork) and any other assets over which the individual has control (such as assets in trusts).
- An applicant’s countable resources must be used to pay for nursing home care or other allowable expenses before Medicaid benefits become available. A single applicant can keep up to $2000.00 in value of countable resources. For a couple, the resource limit is $3000.00.
What are excluded resources?
- Nevada Medicaid eligibility regulations categorize some items as excluded resources that do not count toward the Medicaid resource limit.
Examples of excluded resources may include but are not limited to:
- A home that the nursing home applicant has been living in and expects to return to.
- A home that is used as a primary residence by the spouse or other dependents of the nursing home resident.
- Most personal effects and ordinary household goods.
- Cash value of all life insurance with a total face value of less than $1500.00.
- Burial plots regardless of value.
- Burial funds up to $1500.00.
- One vehicle used for transportation.
What resources can we have when my spouse applies for Medicaid?
- For married couples, the assets of both the husband and wife are considered as countable resources for Medicaid eligibility purposes, regardless of whose name appears on the titles. All separately owned property of each spouse and all jointly owned property are included in the determination of whether an applicant satisfies the countable resource limitation test for Medicaid assistance.
- The spouse who lives outside the nursing home is termed as the community spouse. The spouse in the nursing home is referred to as the institutionalized spouse. In Nevada, as of 2014, the community spouse is allowed to keep one-half of the countable combined resources up to a maximum of $117,240.
- For example, Betsy and Bill have combined countable resources valued at $70,000. If Betsy goes into the nursing home, under Medicaid eligibility rules Bill may keep $35,000 in value of the countable resources.
What if I am over the resource limit?
- Any of the countable resources valued at more than the countable asset limitations mentioned previously are considered accessible resources of the applicant. Those resources must be spent before the applicant is eligible to receive Medicaid assistance. Resources should be spent by paying for nursing home care, by paying for other medical expenses, or by paying for home repairs.
Can I transfer resources without affecting Medicaid eligibility?
- You cannot simply transfer property in order to become financially eligible for Medicaid. There is a period of Medicaid ineligibility if assets are given away or transferred for less than fair market value within a certain time period (termed look-back period). Currently, there is a 60 month (five year) look-back period. This means that Medicaid will look at your financial history for the five years proceeding the day you applied for Medicaid.
- If an inappropriate transfer was made during the look-back period, the applicant will be INELIGIBLE for as many months as determined by dividing the total value of the transfer by the average monthly cost of nursing home services. For example, the average monthly cost of nursing home care in Nevada is $7,139.00 (2013) so the ineligibility period is one month for every $7,139.00 of uncompensated value that the applicant gave away.
- The penalty period will not begin to run until an individual (1) is in the nursing home; (2) has applied for Medicaid; and most importantly (3) is otherwise eligible for Medicaid.
There are several types of transfers that under Medicaid eligibility rules may be excluded from the look-back rules:
- A home may be transferred to the community spouse, to a child less than 21 years of age, or to an adult child who is blind or disabled.
- A home may be transferred to a child (regardless of age) if the child lived in the home for two years prior to the admission of the parent to a nursing home and it can be verified that the child provided care that permitted the parent to remain at home.
- A home may be transferred to a brother or sister if either already owned an equity interest in the home and lived there for at least one year before the sibling entered a nursing home.
What if I transfer my property to a trust?
- A trust is a legal arrangement by which an individual transfers assets to a trust. A trustee is named to manage the assets for the beneficiaries designated in the trust agreement. Beneficiaries named in a trust agreement can include the individual who formed the trust, friends, family members, a university, a charity or other organization.
- A revocable living trust is created during an individual’s life and can be changed or terminated at any time. Because a revocable living trust can be changed at any time, the income and assets in the trust are considered as countable resources in the Medicaid eligibility determination. The funds are considered available to cover nursing home costs.
- Once an irrevocable trust is formed, the person who established it has no power to amend, cancel, or remove assets from it. For Medicaid eligibility purposes, however, if any circumstances exist under which payment from the irrevocable trust could benefit the individual entering the nursing home, then the trust is considered a resource available to the individual. Even if no payment could possibly be made to benefit the applicant, the transfer of assets into the trust will be subject to the 5 year look-back period.
The income test examines the Medicaid applicant’s countable income. Countable income includes money that is received in the name of the Medicaid applicant. For 2014, the applicant must have countable income less than $2163.00 per month.
Examples of countable income include but are not limited to:
- Social Security or other retirement pensions Railroad retirement
- Veteran’s benefits
- Lease or rental income
- Interest earned on savings
- Trust income
- Monthly annuity payments
Countable income does not include food stamps, housing assistance, or home energy assistance.
Most income counted by Medicaid will be applied toward nursing home and other care costs. Medicaid makes up the difference between the total cost and available income. It is extremely important to realize that Medicaid benefits, even once qualified, are not truly free. The requirement that beneficiaries contribute most of their income toward care is essentially a huge copayment.
What income can I keep if my spouse goes into a nursing home?
- The community spouse may keep all income that is paid solely in his or her name. This amount is not attributed to the institutionalized spouse. All income paid solely in the name of the institutionalized spouse is counted towards the income calculation. Any income paid to both spouses is usually equally divided; one-half is counted as income to the institutionalized spouse and the remaining half is counted as income to the community spouse.
- The community spouse also may qualify to receive a monthly allowance from the income of the institutionalized spouse up to a maximum of $2931.00 (2014). The allowance is calculated using the established amount necessary for home maintenance costs (rent or mortgage, taxes, insurance and utility charges). If the community spouse has sufficient income to cover home maintenance costs no allowance is granted from the income of the institutionalized spouse.
Federal law requires every state to develop a Medicaid estate recovery program to recoup the costs of nursing facility care and other medical services from the estates of recipients who have passed away.
No estate recovery may be made if a Medicaid recipient is survived by a spouse, by a child under the age of 21, or by a blind or disabled child.
All real and personal property and other assets included in the estate of the deceased Medicaid recipient is considered an estate asset. Included would be assets passing by reason of joint tenancy, tenancy-in-common, survivorship, transfer on death deed, life estate, living trust, annuity, declaration of homestead or other arrangement.
The Nevada Medicaid Estate Recovery Unit may pursue all of your real and personal property in which you hold any interest at the time of you death. However, your home cannot be taken while you are alive but a lien may be placed against the interest in your home after you are gone. Therefore, before anything you own can be passed on to your heirs the Medicaid claim must be satisfied. Please keep in mind that if your surviving spouse, child under 21, blind and/or disabled child or their legal representative; wishes to sell the house, the State will release its lien. If you heirs wish to keep the property they may pay the lien and keep the property.