Lincoln 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 aged 65 years or older, blind, disabled or others who meet eligibility requirements. Each state manages their own Medicaid program. The Nebraska Department of Health & Human Services manages Nebraska Medicaid.
Medicaid generally pays Medicare copayments and deductibles. It may also cover the costs of nursing facilities, prescription drugs, inpatient/outpatient hospital services, rural health clinics, laboratory work, dentistry, eye care, diagnostic testing and physician’s assistants services.
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 the benefits of Nebraska Medicaid, you must live in Nebraska, be a US citizen or documented alien, have a Social Security number and provide other information. For information or to apply for benefits:
Nebraska Department of Health and Human Services
Nebraska 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 July 2017. Contact the Nebraska Department of Health & Human Services or go to www.accessnebraska.ne.gov for the most up to date information.
Income may include Social Security, Railroad Retirement, pensions, interest, dividends and other sources and is counted before any Medicare payments are made. Resources may include bank accounts, CDs, bonds, stocks and more. If an individual’s income or resources exceed these limits, certain deductions may still qualify him or her for some assistance. Others whose income is over the guidelines would be expected to pay a portion of their medical expenses, considered 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 regarding a single person’s income vary depending upon whether the person will be remaining in his or her home or going to a nursing home.
If the person will be remaining in their home and has less than $1005 in monthly income, Medicaid will pay their medical expenses without any cost to them.
A single person is allowed to retain up to $4,000 in resources and still be eligible for Medicaid. Certain resources may be exempt:
- The home is exempt as long as the person remains in his or her home (up to $560,000 value). If the single person later moves into a nursing home permanently, they would need to sell the home and spend the proceeds on their 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.
- Up to $4,987 in an irrevocable burial trust or in an irrevocable burial insurance plan is exempt. It cannot be withdrawn. In addition, they are 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
The rules relating to a couple’s resources also vary greatly depending upon their situation. Different rules are in effect depending upon whether one or both members of the couple will remain in their home. If one spouse remains at home and the other moves into a nursing facility, spousal impoverishment regulations may apply.
If the couple will both be remaining in their home and they have less than $1,353 in monthly income, Medicaid will pay their medical expenses without any cost to them.
A couple is allowed to retain up to $6,000 in resources and still be eligible for Medicaid. Certain resources may be exempt:
- As long as one member of the couple remains in the home, the home is exempt (up to $560,000).
- 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 $4,987. In addition, each spouse is allowed to purchase a casket, vault, headstone and burial space and 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. The Spousal Impoverishment Protection Law may apply in order to keep the community spouse from losing all of their income and assets to pay for the nursing home spouse’s care.
Most resources (such as bank accounts, stocks, bonds, etc.) are considered joint assets. Combined resources are split 50-50 between both spouses if between $24,180 and $120,900. If the community spouse’s resources are below $24,180, resources are allocated from the nursing home spouse to the community spouse. If the community spouse’s resources are above $120,900, all resources excessive of that amount go to the nursing home spouse. Once resources are spent down, the spouse in the nursing home is eligible for Medicaid.
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 $2,030/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 $609/month, the amount over $609 can be added to that $2,030/month minimum up to a maximum of $3,023/month.
Medicaid Waiver Program
The Aged and Disabled Medicaid Waiver Program offers an array of services to support people in their home or in an assisted living facility. Individuals 65 or older may be eligible if they (a) are eligible for Medicaid, (b) agree to participate in needs identification and choose to accept support services, (c) have needs at a nursing facility level of care, and (d) can be safely served at home or in an assisted living facility at a cost not more than Medicaid would pay for nursing home care.
Funded services may include assisted living services, home care and chore activities such as meals and laundry, home delivered meals, home modifications, personal response systems, respite care for family caregivers, independence skills management, adult day care, nutrition services and transportation.
For more information contact:
Aging Partners
aging.lincoln.ne.gov
800-247-0938
402-441-7070