Betsy Abramson

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FINANCIAL ELIGIBILITYFINANCIAL
ELIGIBILITY FOR WISCONSINS LONG TERM CARE
PROGRAMS WISCONSINS LONG TERM CARE
PROGRAMS

• Betsy Abramson
• Disability Rights Wisconsin
• August 2009

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Medicaid Eligibility Handbook

• http//www.emhandbooks.wi.gov/meh-ebd/
• Ch. 15 Income
• Ch. 16 Assets
• Ch. 17 Divestment
• Ch. 18 Spousal Impoverishment
• Ch. 28 Home and Community-Based Waivers
• Ch. 29 Family Care Long-Term Care

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General Medicaid Eligibility? Medicaid Waiver
Eligibility

• Different income limits.
• ?Three different sets Category A, Category B,
  
• and Category C
• Asset limits
• If have a spouse who is not applying for waivers
• or in an institution, spousal impoverishment
  protections available ?
• NOTE Estate Recovery applies.

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INCOME LIMITS Category A

• SSI, SSI-E, Section 1619 benefits,
  widow/widowers benefits, 503 cases and
  disabled adult children.
• NOTE Automatically eligible for COP-Waiver
• ? No cost-share liability towards cost of
  services.?

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INCOME LIMITS Category B

• Special income limit of 300 of federal SSI
  benefit rate.
• 674 X 3 2,022 per month in 2009.
• May have a cost-share. Depends on income
  deductions and allowances, medical/remedial
  expenses, and whether a spousal impoverishment
  situation

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INCOME LIMITS Category C

• Income above the 2,022/month but
• Many many Income deductions and medical/remedial
  expenses bring down their countable income
  below current medially needy MA income limit
  591.67
• EXAMPLE Individual with 2,422 month has
  spenddown of 2,422.00 - 591.67 1,830.33 per
  month
• The spenddown is their cost-share.

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What is Unearned Income? 1/2

• Income from Trusts
• Sick Benefits
• Unemployment Compensation
• Retirement Benefits
• General Relief and Charity
• Gifts
• Land Contract
• Loans
• Interest Income
  ..and..

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What is Unearned Income? 2/2

• Social Security Benefits
• Lump Sum Payment
• Money for School
• Child Support
• Profit-Sharing
• Income Received by Member of Religious Order
• Federal Match Grants for Refugees
• Gambling Winnings
• Payments to Native Americans

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INCOME EXEMPTIONS

• Major Exemptions
• First 20 disregarded
• Part of wages
• Only counts (Total Monthly Wages 65) / 2
• Wage amount counted
• Example If wages 465/month, then
• (465 65) / 2 only 200 counts
• Many others Some examples Adoption, Agent
  orange, Combat..Kinship.Payments to Nazi
  Victims..Susan Walker PaymentsVA Allowances.W2
  Payments, American Recovery and Reinvestment Act
  of 2009.

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ASSETS

• Limits
• 2,000 for individual
• 3,000 for couple if both applying
• If only one spouse applying
• See Spousal
  Impoverishment

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EXEMPT ASSETS Examples

• (These dont count against the limit)
• Primary residence ? up to 750,000 equity
• One auto, ? if used for transportation by
  applicant or household member
• Personal possessions and home furnishings ?
• Wedding and engagement rings
• Equipment used for self-support
• Life Insurance up to 1,500 otherwise
• Term insurance in any amount (no cash value)
• Burial see next

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EXEMPT ASSETS

• Burial Assets
• Up to 3,000 in irrevocable burial trust
• Interest can also be made irrevocable and thus
  exempt
• Pre-paid burial spaces in any amount
• Plots, caskets, values, crypts, mausoleums,
  urns, niches, headstones, plaques,
  opening/closing arrangements. And for other
  family members!
• 1,500 separately identifiable revocable burial
  fund. If so, offsets funds permitted in IBT.
• Life-insurance funded burial arrangements

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Divestment

• Giving away or transferring non-exempt assets, or
  the home in some situations, for less than FMV.
• Lookback period FIVE YEARS
• Penalty Period Starts when assets otherwise
  spent down.
• Ex.
• Giving grandchildren large gifts at b-days,
  holidays?
• Giving money to adult kids for downpayment?
• Paying for a kids wedding?
• Contributing to grandkids college?
• Bailing adult kids out of debt, trouble?

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Divestment Lots of specific rules

• Annuities
• Life estates
• Promissory Notes, Loans or Mortgages
• Partial Month Divestments
• Partial Refunds
• CCRC entrance fees
• Intent
• Undue Hardship
• 
  See next slides

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Intent to Divest?

• Not divestment if can prove
• Had made other arrangements to provide for LTC
• Life expectancy at transfer was less than 5 years
• No expectation of LTC needed for next 5 years
• Had pattern of charitable giving or to family
  members (prior to look-back period) AND annual
  gifts less than 15 of gross income.
• Ffor educational or vocational goals of family
• Is support of dependent relatives living with them

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Divestment Undue Hardship

• Penalty period waived if imposition deprives
  individual of
• Medical care such that health or life would be
  endangered or
• Food, clothing, shelter or other necessities of
  life
• Generally must request within 20 days of notice
• Special Required Documentation
• Notice of discharge from facility or
• Costs of needed LTC services compared to income
  and assets

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Divestment WARNING!

• Complicated
• Significant potential consequences
• Client should get good legal advice from
  experienced knowledgeable counselor

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Spousal Impoverishment

• Old days (pre-1989) Spouse without LTC needs
  went broke, too.
• Now protects income and assets of spouse who
• - is not in institution
• - not on COP/CIP/ FC, etc.
• Only for legally married spouses. Not partners.
  Not adult kids.

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Spousal Impoverishment Assets

• Dont count exempt assets.
• Then, regardless of name on title

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Practice Examples
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Spousal Impoverishment Income

• Non-MA spouse keeps ALL income in own name
• Can get allocation from MA spouses income to
  bring her income up to lower of 2,739 or
  2,428.33 plus excess shelter allowance
• Excess Shelter Allowance amount above 728 for
  mortgage/rent, taxes, maintenance fees and
  utility allowance

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Example George and Laura

• George on Family Care Laura not
• Georges income
• 845 Social Security
• 1200 Pension
• 1000 Monthly speakers fees
• 
  TOTAL 2045/month
• Lauras income
• 600 Social Security
• 400 Librarian pension TOTAL 1,000/month
• Mortgage and utilities are 1,228

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Lauras allocation

• ESE is 1,228 - 728 500
• Laura gets some of Georges income, to BRING HER
  UP to lesser of 2,739 or 2,428.33 500 so,
  2,739
• Georges 2,045 - 45 for him 2,000 available
• George can allocate to Laura 1,739
• Now Laura has 1,739 her 1,000 2,739
• Note! If George didnt have 1,739, State doesnt
  subsidize.

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Estate Recovery and Liens

• Applies to benefits recd in
• All ages NHs since 10/91
• Inpatient hospital benefits after 7/95 if
  institutionalized recipients
• Age 55 Skilled nursing, home health aide,
  therapies, private duty nursing, personal care
  (since 4/2000)
• Waiver (COP, CIP, Brain Injury, FC) since 2/2000

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Methods of Recovery

• Happens after death of recipient
• ONLY AFTER DEATH
• Claims in Probate Estates
• Liens on homes

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When no recovery or lien

• If is a surviving spouse
• If a surviving disabled child
• If surviving minor child
• If surviving blind child

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Estate Recovery After

• Cost of administering the estate
• Funeral Costs
• Costs of last illness

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Heirs Can Keep

• Decedents wearing apparel and jewelry
• Household furniture, furnishings and appliances
• Other tangible personal property under 3,000
  not cash of 3,000

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Waivers of Claim Undue Hardship

• Heir or beneficiary would become eligible or
  remain eligible for SSI, FS, AFDC, MA
• Estate contains real estate used as part of heir
  or beneficiarys business
• Heir or beneficiary is receiving general relief
  or veterans benefits based on need.

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Liens

• On homes, but NOT PLACED on home of a recipient
  in community
• NOT PLACED ON HOME OF RECIPIENT IN COMMUNITY !!!
• Prior notification required
• Only if recipient not reasonably expected to
  return home and if none of these in home
• Certain caregiving adult child at least 24 months
  before
• Sibling who continuously lived there at least 12
  months before admission

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Examples

• Fred and Wilma
• Will and Grace
• Homer and Bart