Government Benefits for Older Adults
Older Americans may qualify for and make part of their
retirement and health care planning one or more government benefits such as
Social Security, Medicare and Medicaid.
Some Government Benefit Programs
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Social Security
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Medicare
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Medicaid
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State Assistance
Nature of Program
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Joint federal-state program
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Default nursing home insurance of the middle class
Administered By
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US Department of Health and Human Services Centers for
Medicare and Medicaid Services (CMS)
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DSS [Department of Social Services ] processes
applications and makes initial eligibility determinations
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DMAS [Department of Medical Assistance
Services]--policy, administration, and handling eligibility and related appeals
Current Law and Changes in Current Law
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Federal and state governments limited fisc
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Medicaid rules impacting eligibility and asset transfer
rules may change with future legislation and practices
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2005 example is Virginia House Bill No 2601
Applicant Profile
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65 or older adults or disabled adults for Social
Security Administration purposes
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Require long-term care in a nursing home or in the
community under the community-based care waiver
Eligibility Limits
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Nursing home costs are "Patient Paid"
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Family assets are used for long term care
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Until reach "Medicaid qualifying levels"
Medicaid qualifying levels -- Income of
Institutionalized Adult
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All income, minus certain deductions, to the nursing
home
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Deductions
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Include month personal needs allowance
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Uncovered medical costs (including medical insurance
premiums),
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Spousal allowance for financially needy healthy spouse
living at home[community spouse and MMMNA]
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Dependent child living at home
Income of Community Spouse
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Under Medicaid, all community spouse's income to
community spouse support
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Under Medicaid, if CS's income less than MMNA [Maximum
Monthly Maintenance Needs Allowance], then apply institutionalized spouse's
income to support of community souse
Medicaid Qualifying Levels -- Tally Assets on Snapshot
Date
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Countable assets of both spouses totaled to assess
Medicaid qualification level met
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Go to family assets [countable assets] for any
shortfalls until reach Medicaid qualification levels for assets
Dollar Limits
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Single Person is Countable assets of $2,000
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Married Couple is set by Minimum Community Spouse
Resource Allowance (CSRA) or minimum assets community spouse entitled to retain
before being required to contribute towards Institutional
Spouse's cost of care
General Community Spouse Resource Allowance Rule
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Community Spouse keeps up to 50% countable assets a/o
snapshot date
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Important Exception: Appeal for increased resource
allowance
Estate Recovery
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State attempt to recover from his or her estate
whatever benefits it paid for the recipient's care
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Timing is at death of the recipient's spouse, or as
long as there is a child of the deceased who is under 21 or who is blind or
disabled
