August 27, 2010

What is the difference between Medicaid and Medicare?
This is a very common question. Medicaid is a type of government program that offers health insurance to people with limited incomes. It is available to people of all ages, including children, and it can vary from state to state. Medicare, on the other hand, is a government health insurance program only available to people 65 and over, people under 65 with certain disabilities, and people of all ages with end-stage renal disease.

Who is eligible for Medicaid?
Medicaid is for certain individuals or families with low income and/or limited available resources, regardless of age. Therefore, in order to qualify the applicant must prove that he or she falls within certain income and asset levels. Be sure to check with your local Medicaid agency to learn what the specific rules for eligibility are in your state. You can find your local Medicaid office using the Centers for Medicare and Medicaid Services website: http://www.cms.gov/apps/contacts/

Does Medicaid pay for long-term care?
Medicaid does pay for long-term care; however, not all providers of long-term care accept Medicaid. You must ask the facility you’re interested in if they accept Medicaid payment and, if so, how many suites are available for Medicaid recipients. Again, coverage varies from state to state so make sure you contact your local Medicaid office to see what is covered.

Due to the reimbursement guidelines of the Medicaid program, many nursing homes and other long-term care facilities limit the number of Medicaid beneficiaries they will accept. Consequently, the Medicaid recipient may have limited options, especially if the facility is in great demand, and private rooms may not be available for Medicaid enrollees. These restrictions may make Medicaid payment for long-term care a less desirable option than paying privately or with private long-term care insurance. Advance financial planning that considers the possibility that long-term care might be needed can help ensure that there are other options.

A married person whose spouse is in a nursing home is entitled to keep the home and a portion of the couple’s assets. This is known as the Community Spouse Resource Allowance. The dollar amount of the assets allowed to be kept varies by state. You should contact your local Medicaid office for more information.

Does Medicaid pay for prescription drugs?
Medicaid coverage of prescription drugs varies by state. To find out what the rules are in your state, contact your local Medicaid office.

If a child is taking care of a parent in their home, can they charge room and board?
A parent may be charged for room and board and for care provided. However, if formal arrangements are not followed, payments from a parent to a child may be considered as uncompensated transfers for Medicaid eligibility purposes.

How do the rules differ for single and married persons with respect to the Medicaid program?
There are special rules under which a married individual may be able to retain a portion of the income of his or her spouse who is entering a nursing home. There are also special rules regarding retention of assets by the community spouse. A single person may retain a limited amount of resources.

What is the “Three-Year-Look-Back” rule?
If you apply for Medicaid, the Medicaid office will look at any transfers of cash or property you may have given away or sold to third parties (including family members or friends) in the previous three years of the date of your application. Such transfers may disqualify you for Medicaid eligibility. However, a qualified Medicaid attorney may be able to obtain Medicaid coverage on your behalf even if transfers were made within the three-year period.

Can a parent sell his or her home to his or her child for $1.00?
While a parent may sell his or her home to a child for a nominal amount, there are many disadvantages to such a sale. For example, such a sale may ultimately cause adverse tax consequences. In addition, the sale may be considered an uncompensated transfer for Medicaid purposes and result in a period of ineligibility. You should consult your attorney.

US Department of Health and Human Services, Centers for Medicare and Medicaid Services: http://www.cms.gov/
MedlinePlus, National Institutes of Health: http://www.nlm.nih.gov/medlineplus/medicaid.html


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