Overview of Missouri Medicaid

Report
MO HEALTHNET
F/K/A MEDICAID
AND
VETERANS ADMINISTRATION
American Parkinson Disease Association
Symposium 2014
Martha C. Brown, CELA
220 W. Lockwood, Suite 203
St. Louis, MO 63119
T (314) 962-0186
F (314) 962-1298
MO HEALTHNET
What was called “Medicaid”
Most common program
Medicaid to pay for medical services
“Card for services”/”straight”
Medicaid
Payment source for health care
received
MO HEALTHNET
53 Different Medicaid programs
All have different eligibility rules
Every state’s rules are different
Not always logical
MO HEALTHNET
NURSING HOME PROGRAM
Must be disabled/be medically
eligible
Must be financially eligible
Income/assets
Important distinction
Rules differ for couples and singles
NURSING HOME PROGRAM
FINANCIALLY ELIGIBLE
 Single person
Assets of less than $1,000 ($999.99)
Married couple
Assets of less than $2,000 ($1,999.99)
$2,000 if both spouses are
institutionalized
EXEMPT ASSETS
Some assets not counted regardless
of value
Character of assets, not the value of
assets
Medicaid planning is changing character
of counted assets into exempt assets
EXEMPT ASSETS
Some assets that aren’t counted
 House
 Car
 Personal property
 Prepaid burial plan
EXEMPT ASSETS
(HOUSE)
First $543,000 of house equity
Figure increases each year
Household furnishings
EXEMPT ASSETS
(CAR)
One car
Regardless of value
EXEMPT ASSETS
(PERSONAL PROPERTY)
Regardless of value, except:
Unusual value of change designation
from exempt asset to countable
resource
EXEMPT ASSETS
(PREPAID BURIAL PLAN)
Must be irrevocable … or have

$1,500 cash surrender value life
insurance
Cannot have both assets
 Spouse cases - $1,500 exemption
each
Burial plot
EXEMPT ASSETS
(OTHER MISC.)
If married
Wedding rings
Can keep half of couple’s assets to
$234,280.00
Division of Assets
DIVISION OF ASSETS
Community spouse is allowed to
keep up to 50% of $234,280 of
couple’s countable assets
If assets are more than $234,280,
then assets must be spend down to
$234,280 before a division of
assets can be made
ESTATE RECOVERY
State of Missouri has the right to
recover moneys paid through
Medicaid at the death of the
recipient
State recovers on Medicaid
payments made after recipient is
55
ESTATE RECOVERY
(CONTINUED)
Recover moneys from only the
following:
Recipient’s home
If no surviving spouse
From a Special Needs Trust that provides
for Medicaid to be paid at death of trust
beneficiary
The Medicaid recipient’s probate estate
WHAT TO BRING WHEN
APPLYING FOR MO HEATHNET
Birth certificates
List of all assets with the
applicant’s name on the title
Remember…total must be less than a
$1,000.00 (single) and $2,000 (couple)
GIVING MONEY AWAY
If any gifts have been made, you
must report on Medicaid application
If gifts were made more than 5
years ago;
Do not count ( Called “Lookback Period”)
EXCEPTION TO
“LOOKBACK PERIOD”
Gifts to a disabled child
Gifts to a trust for a disabled person
Lots of rules for this exception
Give house to a child who lives with
parent for 2 years or more, but would
have to go to nursing home if child
did not live with the parent
EXCEPTION TO
“LOOKBACK PERIOD”
“Personal Care Contract
Pay a person under a written contract to
provide services
Must follow specific rules
Recommend getting legal advice
VETERANS ADMINISTRATION
Non-Service Connected
Aid & Attendance Benefit
BASIC ELIGIBILITY CRITERIA
Veteran or widow(er) of Veteran who:
Served 90 consecutive days of Active Duty with
one day during War Time period
War Time Periods as declared by Veterans
Administration
Received a discharge other than dishonorable
Has been declared by a physician that they
need assistance of another individual to
perform activities of daily living
BASIC ELIGIBILITY CRITERIA
(CON’T)
Veteran or widow(er) of Veteran who:
Has out-of-pocket medical expenses that
exceed his/her total yearly gross income
Have less than $80,000 for a couple; $30,000
for a single person
Not declared amounts
No Lookback Period for assets given away to
be eligible for the benefit
AID & ATTENDANCE 2014
Rates: Maximum Benefits
Single Veteran: $1,732.00.00
Married Veteran: $2,054.00
Surviving Spouse: $1,113.00
*Figures change yearly
AID & ATTENDANCE
APPLICATION
Veteran and Veteran/Spouse
VA Form 21-526
Application for Veteran filing for Non-Service
Connected Pension
Surviving Spouse
VA Form 21-534
Application for Surviving Spouse filing for
Non-Service Connected Pension
VA FORM 21P-8416 MEDICAL
EXPENSE REPORT
Only recurrent medical expenses are
considered in off-setting projected
household income
Does not include any expenses for
which claimant was reimbursed
Keep all receipts/documentation of
medical expense for at least 3 years
VA FORM 21P-8416 MEDICAL
EXPENSE REPORT
Examples of medical expenses
Hospital expenses
Doctor’s office fees
Dental fees
Prescription drug costs
Medical insurance premiums
Monthly Medicare deduction
Nursing home costs
Home health services
Incontinence supplies
QUESTIONS?
Martha C. Brown, CELA
220 W. Lockwood Avenue
Suite 203
Saint Louis, Missouri 63119
(314) 962-00186

similar documents