As stated in the previous segment, Medicare, HMO's, and some secondary health insurance policies cover skilled nursing care or therapy in the nursing home typically only for a limited amount of time. Indeed, skilled nursing facilities care for a variety of residents. Some are there for a temporary stay while receiving rehab from an injury, illness, or surgery. Others, who require around the clock nursing care because of the expertise that is required to meet their needs, are there as permanent or long-term residents. Because of the substantial costs of long-term placement in a skilled nursing facility, many find it necessary to apply for the “Medicaid for Institutional Care” benefit. This is a different type of Medicaid than that which covers doctor office visits and prescriptions out in the community. Long-term Medicaid in a skilled nursing facility requires an entirely different application process.
*Alabama Medicaid Long Term Care Program:
Alabama is an income cap state, meaning that in order to be eligible for Medicaid long term care benefits there is a hard income limit. Income cap states require the amount to be no higher than their limit at the time of their application for benefits.
Single Individuals: For all programs, an applicant must be a resident of Alabama and a U.S. citizen or have proper immigration status. An applicant for Nursing Home Medicaid must also be a resident of an approved skilled nursing facility for at least 30 consecutive days to be eligible for Medicaid benefits. Applicants need to meet medical approval by Medicaid. The nursing facility must submit the medical information to Medicaid.
The income limit for Nursing Home Medicaid is $2,199 per month for an individual (this income limit changes each January). There is a personal needs allowance of $30.00 per month that is not factored into the countable income. The resource limit is $2,000 before the first day of the month. This means that in order to be eligible for Medicaid you must not have more than $2,000 in resources on the first day of any given month.
Married couples: If the community spouse has less than $2,003 per month (2017) he/she is eligible to retain some of the institutionalized spouse’s income to reach the minimum (this amount changes each July). If the community spouse has gross income at or above $2,003, no additional income can be allocated from the institutionalized spouse to the community spouse.
Alabama is an “income first” state, meaning the state limits the right to petition for an increased community spouse resource amount (CSRA) to couples whose combined income fails to meet the community spouse’s income needs. Basically, this means a community spouse can petition for an increased CSRA where there’s an income gap only after factoring in the nursing home spouse’s income first.
If the community spouse’s resources are less than $27,000 he/she may retain some of the institutionalized spouse’s resources to reach the minimum. The maximum amount of resources the community spouse can retain equals one-half of the couple’s total assets up to a value of $238,440.
Meeting the various financial limits is often a process involving the structuring of one’s assets so they can be considered exempt and / or placing excess assets into trusts. The Medicaid applicant cannot give away their excess assets as Medicaid looks into financial records as far back as 60 months prior to the application date. The applicant cannot sell anything below fair market value as this will result in ineligibility as well.
It is important to remember that the long-term Medicaid benefit for
permanent care in a skilled nursing facility is awarded by the state of Alabama Medicaid agency and not the facility. All applications are reviewed by the Alabama Medicaid Agency and must meet their criteria before the benefit can be awarded.
As always, Marshall Manor is glad to help in this course. It is not difficult but it is extremely detailed! Feel free to call or come by our business office anytime Monday thru Friday between the hours of 8am and 4pm to discuss any questions you may have about the Medicaid Long Term Care application or process.
For further information on qualifying for Medicaid: http://www.medicaid.alabama.gov/CONTENT/3.0_Apply/3.2_Qualifying.aspx