Omaha ElderCare Resource Handbook
Medicaid
Medicaid is a program financed by individual states and the federal government to pay some health care costs for people with limited incomes and resources. It is available to low-income persons 65 years or older, blind, disabled, children 18 years or younger and others who meet eligibility requirements. Each state manages their own Medicaid program.
Medicaid generally pays Medicare copayments and deductibles. It may also cover hospital care, doctor visits, dental care, eye care, speech, hearing and physical therapy, laboratory and x-ray services, nursing home care, home health care services, prescription drugs, medical equipment, health aids, medical transportation and institutional care for mental diseases.
If you think you, your spouse or your dependent may be eligible for Medicaid, fill out an application. There are several programs with different qualifications and special considerations. To receive benefits, you must live in the state you are applying in, be a US citizen or documented alien, have a Social Security number and provide other information relating to income and resources.
For information on applying for benefits, contact:
Nebraska Department of Health & Human Services
Iowa Department of Health & Human Services
Nebraska and Iowa rules relating to Medicaid eligibility are based on several factors. The following is a brief explanation of Medicaid guidelines for the aged and disabled and is intended to give you a general understanding. Please note, many of the income and resource guidelines for Medicaid are adjusted every year. These numbers are correct as of June 2016. Contact your state Department of Health & Human Services or go to www.accessnebraska.ne.gov in Nebraska or dhsservices.iowa.gov in Iowa for eligibility.
Income may include Social Security, Railroad Retirement, pensions, interest and other sources and is counted before any Medicare payments are made. Resources may include personal property, bank accounts, CDs, bonds, stocks and more. If an individual’s income or resources exceed these amounts but they are considered medically needy, certain deductions may still qualify him or her for Medicaid on “spend down” basis. Others whose income is over the guidelines might be expected to pay a portion of their medical expenses, known as their “Share of Cost.” An individual may be found ineligible for Medicaid if they dispose of a resource or sell it for less than fair market value.
Single Person
The rules relating to a single person’s income vary depending upon whether the person will be remaining in his or her home or going to an alternative living arrangement. If the person will be remaining in his or her home and has less than $1010 in monthly income (including a $20 disregard fee), Medicaid will pay his or her medical expenses without any cost to the individual. If the person will be moving to a nursing home, they generally must use all their income to pay for care minus a few deductions.
A single person is allowed to retain up to $4,000 ($2,000 in Iowa) in resources and still be eligible for Medicaid. Certain resources are exempt:
- The home is exempt (up to $552,000 value) as long as the person remains in his or her home. If the single person later moves into a nursing home permanently, they would need to sell the home and spend the proceeds on care.
- One car is exempt regardless of its value.
- Property used to operate a trade or business is exempt.
- Up to $1,500 face value in life insurance policies is exempt. If the face value of the policies exceeds $1,500, the amount of which the policies could be cashed would be considered a resource. Term policies are disregarded if they do not accrue any cash value.
- Household goods and personal items are exempt.
Married Couple
The rules relating to a couple’s income and resources vary depending upon their situation. If the couple will be remaining in their home and has less than $1,355 in monthly income (including a $20 disregard fee), Medicaid will pay their medical expenses without any cost to them.
A couple is allowed to retain up to $6,000 ($3,000 in Iowa) in resources and still be eligible for Medicaid. Certain resources are exempt:
- The home is exempt (up to $552,000 value) as long as the couple remains in their home. If they both later move into a nursing home permanently, they would need to sell the home and spend the proceeds on care.
- One car is exempt regardless of its value.
- Property used to operate a trade or business is exempt.
- Each of the spouses can have up to $1,500 face value in life insurance policies. If the face value exceeds $1,500, the amount of which the policies could be cashed would be considered a resource. Term policies are disregarded if they do not accrue any cash value.
- Each of the spouses can have an irrevocable burial trust or an irrevocable burial insurance plan with a value up to $4,916. In addition, each spouse is allowed to purchase a casket, vault, headstone and burial space and can prepay for the opening and closing of their grave.
- Household goods and personal items are exempt.
Couple with One Spouse in Nursing Home
If only one spouse goes into a nursing home, the rules are different. The excluded resources remain the same as described above. Spousal impoverishment rules may apply.
Most resources are considered joint assets. Once resources are spent down, the spouse in the nursing home is eligible for Medicaid. Combined resources are split 50-50 between both spouses if between $23,844 and $119,220. If the community spouse’s resources are below $23,844, resources are allocated from the nursing home spouse to the community spouse. If the community spouse’s resources are above $119,220, all resources excessive of that amount go to the nursing home spouse’s care.
The community spouse gets to keep all of his or her income. The nursing home spouse is required to use most of their income to pay for their care except for a $50/month personal allowance ($90/month for Veterans). The combined income is split and if the community spouse gets less than $1,991.25/month, they may keep some of the nursing home spouse’s income up to that amount. If their housing expenses (rent, mortgage, insurance, property taxes, etc.) are more than $597.38/month, the amount over $597.38 can be added to the $1991.25/month minimum (up to a maximum total of $2980.50/month).
If the community spouse later requires Medicaid coverage, he or she would be treated like a single person for eligibility purposes.
Medicaid Waiver Program
The Aged and Disabled Medicaid Waiver Program offers an array of services to support people in their homes. Individuals aged 65 or older may be eligible if they (a) are eligible for Medicaid and have needs at a nursing facility level of care, (b) agree to participate in needs identification and choose to accept support services and (c) can be served safely at home at a cost no more than would be spent on nursing home care.
This waiver allows Medicaid money to be used to purchase non-medical services including service coordination, home care/chore services, assistive technology, emergency response systems, respite care for family caregivers, independence skills management, adult day care, home modifications, home-delivered meals, nutrition services and assisted living services.
For more information, contact: