Related Est. Theres no pattern. This blog post is the eighth chapter of a series entitled How to Qualify for Medicaid in Pennsylvania. This post focuses specifically on how to qualify by spending down. This is not a good way to run a system. The Medicaid spend-down is a state-run program for people whose income is higher than would normally qualify them for Medicaid, but who have high medical Qualifying for Medicaid can be confusing and complicated, but this guide helps explain it easily. Archie will therefore qualify financially for Medicaid once the combined value of their countable assets falls below $88,000. Title to that residence may be transferred penalty-free to: A caregiver child, that is, a son or daughter who resided in the applicants home for at least two years before institutionalization, and who provided care which permitted the applicant to reside at home rather than in an institution. | Extensive efforts have been made and are continuing to be made to ensure that Medicaid recipients know what to expect, Lesnick said. Cindy Gillespie, who started the unwinding process as Arkansas Department of Human Services secretary under former Gov. is seen on June 1, 2023. This exemption is not limited to the applicants own self- settled special needs trust, however. Updating the diagram developed in earlier posts, a spend- down for an applicant who is single or widowed could look like this: For an applicant with a community spouse, a spend-down could look like this: Jerry, a widower, has two daughters. You cant just tell somebody, Just look out for this, and then you know theyre good, Hawkins said. Dont worry. WebIf you need Medicaid coverage and your income is above the Medicaid income guidelines in your state, your state may offer a Medicaid spend-down for aged, blind, and disabled Some days, she said, its been too much to handle. She also re-titles the remaining $80,000 of CDs into her name. I understand a lot of peoples perspective that, like, Oh, youre just living off the government and youre just collecting food stamps and youre just collecting Medicaid. I work my ass off for what I can provide, James said. Downtown Marvell, Ark. Getting qualified for Medicaid is mostly about reducing countable assets to an amount below the applicable limit. When Jerry had full mental capacity, he signed a durable power of attorney that named Laura as his agent. Their May appointments went off without a hitch, but shes waiting to see what happens. Your Iola Hoskins, a bus driver for 35 years and Medicaid recipient, was hospitalized early in the pandemic for Covid-19. Because countable assets on date of admission total $160,000, Edith is entitled to keep half $80,000 as her community spouse resource allowance (CSRA). You can order a copy of the complete guide. WebSpend Down What is Spend Down? Procedural terminations account for at least 80 percent of people whove lost Medicaid in seven states. The Medicaid unwinding process was set in motion by the year-end spending package signed by President Joe Biden in December. A single individual applying for Nursing Home Medicaid in 2023 in NE must meet the following criteria: 1) Have income under $1,215 / month 2) Have assets under $4,000 3) Recall from the section on Gifts and the Look-Back Period that the law imposes a transfer penalty only if the transfer is made for less than fair consideration. Asa Hutchinson, said the people going through the renewal process for the first time since the pandemic are, by definition, a more difficult population to reach because the state hasnt heard from them in three years. If I did not have that person to just be able to call and say, hey, can you look this person up and tell me whats going on Caplener trailed off and sighed. But thats exactly what appears to be happening as data trickles in from states that began culling their Medicaid rolls in April and May. He said the state isnt trying to catch people sleeping.. If the applicants sibling has an equity interest in the residence, and has resided there for at least one year immediately before the applicant was institutionalized, there is no penalty for deeding the applicants interest to that sibling. These three other exemptions have their uses, but whether or not they will be approved in any particular instance is highly dependent upon the specific facts of the case. Spend down means to deduct qualifying medical expenses from your income to bring it to a level that would make you eligible for Medicaid. Still, Achor, who now co-owns a pharmacy with his wife, said he has faith in Arkansas renewal process and supports the compressed time frame. I am worried that people will fall through the cracks, yes. The couples combined assets on the date of Archies nursing home admission are: The house, car, and Ediths IRA are all exempt assets. Below you can find specific case studies of what spending down can look like depending on marital status. But interviews with nearly 30 Medicaid recipients, lawyers, patient advocates, health care providers, insurance agents and state eligibility workers across Arkansas reveal how the states compressed timeline is making it harder to keep people like Boose from falling through the cracks. Laura closes the savings account and moves its balance into checking. When we have issues, we dont receive the cards, or were trying to get information about our case, we have problems with no one answering the phone, or no one wants to really talk to you.. No penalty applies to asset transfers made in return for fair market value. In the time it takes for Edith to spend down assets, Archie incurs a nursing home bill in the amount of $10,000. Liability for Care Costs and Applicants' Children. Edith buys irrevocable burial reserves for each of them at $15,000 each, the maximum amount for the county in which Archie receives nursing home services. Gavin Lesnick, a spokesperson for DHS, said in an email that some people who have lost coverage for procedural reasons may have chosen to disregard their renewal packets because they knew they were no longer eligible for Medicaid. Governor Sanders has said outright, I am here to fix Arkansas. His doctor expects that Archie will need nursing home care for the rest of his life. Many nursing home residents need to spend down to qualify for Medicaid because their countable assets exceed their applicable limits. The spend-down program allows people to have Medicaid coverage if their medical expenses reduce their income to an amount that qualifies them for Medicaid. The event featured legal aid on many issues including Medicaid renewals. Theres so many pitfalls. The amount withheld from Jerrys 401(k) is adequate to pay his taxes for the year, and he even receives a $6,000 federal tax refund. Now Jerrys immobility and dementia have both progressed to the point that Laura can no longer safely care for him at home. Pharmacists whose patients stopped picking up their prescriptions are calling to figure out if their insurance is the issue. Seven in 10 Arkansans who have lost their insurance have been dropped for procedural or administrative reasons, according to state figures. But since the law permits an exempt transfer of the house to Laura, it makes sense to do that now with the rest of the Medicaid planning.). Should we create a system thats complicated and difficult to follow? The good news is that spending down doesnt have to To qualify for Medicaid, Jerrys countable assets will have to be spent down below $2,400, because his monthly income of $3,100 exceeds $2,523, the 2022 figure for Health centers, pharmacies and patient advocates are grappling with how to help people get their insurance reinstated and figure out why so many people are losing coverage for non-eligibility-related reasons. Sarah Huckabee Sanders has embraced her predecessors plan to complete the work in about half the time other states are taking, an aim many fear will lead to eligible people mistakenly losing coverage. If you need some clarity on what exactly a "durable power of attorney" is, and why it's important to have one, watch the short video below. More than a third of people in Phillips County where Marvell is are in poverty, and many rely on Medicaid. Three Medicaid eligibility workers who were granted anonymity to speak freely about their work told POLITICO that they have seen those glitches with the states new eligibility system, which was developed by the consulting firm Deloitte as part of a $340 million contract and launched in December 2020. Besides transferring assets directly to a child who meets one of these criteria, a penalty-free transfer can also be made to a trust for that childs benefit. I am here for the people of Arkansas. Well then, damn it, step up and make it better for all of us., Erica Horne was dropped from Medicaid in May. Arkansas Rep. Brandon Achor, a Republican, knows what happens when people lose their Medicaid. There is no penalty for transferring the house to Laura, funding Noras trust, or gifting away the tax refund, because they are all exempt transfers. Assets may be freely transferred between spouses with no penalty. Lesnick, at the Department of Human Services, said that all states will identify system issues as part of the unwinding process, and that the department sends out correct notices as soon as issues are identified. For others, it means rationing medications for long-term illnesses, skipping autism therapy or shaving their childs head for lice because they cant afford to go to the doctor. And its costing families tens of thousands, and even hundreds of thousands, of dollars in asset protection. Without Medicaid, you will be in a life or death situation, said Hoskins. Publication Name. Trevor Hawkins (left), an attorney with Legal Aid of Arkansas, helps attendee Tracy Hubbard during the event in Marvell on June 1. For me, Medicaid is Mrs. Daisy counting out dollar bills three feet from me deciding whether she gets insulin this week or her kid gets an inhaler, Achor said. When you have people who are severely mentally ill you look at psychosis, particularly paranoia and they dont understand what people are asking from them the letter just gets thrown in the trash, said Amanda Myers Atchley, program coordinator at Arisa Health, a behavioral health center in West Memphis, who gets three to five emails a week from the billing department telling her one of their patients has lost coverage. Transfers made exclusively for a purpose other than to qualify for Medicaid. As many as 15 million people nationwide are expected to lose coverage as states check eligibility for the first time since the beginning of the pandemic. Income Spend-Down When an elderly individual or married couple has monthly income in excess of the Medicaid eligibility requirement for their state, this does You cant just tell somebody, Just look out for this, and then you know theyre good, said Trevor Hawkins, an attorney with Legal Aid of Arkansas. In 2025, Medicare spending is projected to If not for Lauras care, Jerry would have had to reside in a nursing facility. Its really like being a detective a lot, because theres so many different issues that can happen.. Upon admission, Jerry owns the following assets: Jerry receives $2,150 a month from Social Security, and $950 a month from his pension. Jerrys income goes to the nursing home, except for a $45 monthly deduction for his personal needs and a deduction to pay his health insurance premiums. In the many powers of attorney I see in my line of work, one problem recurs over and over again. Many people qualify by simply spending their excess assets, usually on nursing home care. No state is removing people from their Medicaid rolls as quickly as Arkansas, where Republican Gov. are calling on the Centers for Medicare and Medicaid Services, has touted Arkansas plan to complete the redetermination process. In 2023, a single individual applying for Nursing Home Medicaid in NC must meet the Whats happening in Arkansas is unique in its speed but the states early efforts are a cautionary tale for the roughly 93 million Americans on Medicaid who are expected to go through the renewal process during the next year. The state Department of Human Services hosts weekly meetings with insurers, providers and community groups to monitor the unwinding process and established a Medicaid Control Center to track the flow of applications and renewals. Transfers as to which it can be shown that the transfer or intended to dispose of the asset at fair market value or for other valuable consideration. Estate Recovery What Happens After Death? While there are sometimes ways around those requirements, Medicaid recipients are not always told about them. She can deed her interest in the house to the other sister with no penalty. Megan Messerly/POLITICO. When we have issues, we dont receive the cards, or were trying to get information about our case, we have problems with no one answering the phone, or no one wants to really talk to you, Gates said. The trust is an exempt asset, and can pay for things to enhance the recipients life, such as medical equipment, therapy, private nurses or aides, entertainment, and so on. Tsai told POLITICO the agency anticipates having similar meetings across the country. Many nursing home residents need to spend down to qualify for Medicaid because their countable assets exceed their applicable limits.Now that you know what assets are countable, and what the limits are, you should be able to calculate how much you are over the limit. A federal The process of reducing an individuals assets to qualify for Medicaid is referred to as spending down.. That applicant would have a good argument that the transfer of assets to his granddaughter for tuition was made with no thought of spending down to qualify for Medicaid. The kids coverage has since been restored. How to Spend Down to Qualify for Medicaid in Pennsylvania, This blog post is the eighth chapter of a series entitled How to Qualify for Medicaid in Pennsylvania. This post focuses specifically on how to qualify by spending down. You can order a copy of the complete guide here. The son or daughter must meet the definition of disabled used by the federal government to award Social Security disability or SSI benefits, or meet the federal governments definition of legal blindness. But there are alternatives. In the unfolding pandemic, economic crisis and reckoning on race, governors and mayors are shaping our shared future. Anthem Blue Cross Blue Shield, a Medicaid insurer, implemented a program to flag people in pharmacists systems who are at risk of losing coverage and pay the pharmacy $10 to get in touch with that person. Child support challenges are one of the many types of paperwork problems patient advocates, health insurance agents and providers said they are seeing. Since then, Horne, who said she suffers from lupus and rheumatoid arthritis and is pre-diabetic, has been rationing her remaining medications, which she can no longer afford on the $17 an hour she earns as a caregiver to her two adult, twin sons, who are disabled. A case in which an applicant paid her grandsons college costs six months before applying for Medicaid, when she was already age 92 and living in an assisted living facility, would look much different to a caseworker or judge. (Example: Spending money from your checking account on nursing home care at the facilitys usual rate.) (Example: You deed your house to your son and he gives you a check for its value, as shown in an independent appraisal.). Katie James, a 35-year-old server from Hot Springs, got notice that her four kids lost their Medicaid in April after she failed to get paperwork back from McDonalds in time to prove her income. Laura arranges Jerrys admission to a nursing home 10 minutes away from Jerrys residence. I am here to make life better for Arkansans. Trust for a son or daughter who is disabled, blind, or under 21. Others receive the letters but are confused by the wording, dont know what to do with them or throw them away. Shakina Gates is a mother of three and a Medicaid recipient. Certain assets can take applicants over the asset limit for Medicaid, requiring applicants to spend down until they meet the asset threshold. Some asset transfers apply only to the personal residence of the applicant (or community spouse). Whats that got to do with me, the kids dad? she said on a 90-degree June day inside a stuffy, unairconditioned community center in Marvell, where Legal Aid attorneys tried to help people who had recently lost their Medicaid. It is a system that is created to just make it hard for people to get the services they need, said Neil Sealy, executive director of the progressive advocacy group Arkansas Community Organizations. Laura gives the attorney paperwork to show that Nora receives SSI benefits, thereby confirming that Nora is disabled according to federal standards. She also liquidates Jerrys 401(k), withholding 20% of its value for estimated taxes, and puts the remainder into Jerrys checking account. During that 12 months, a federal tax refund may be gifted away without penalty. After resting for a week, Laura books an appointment with an elder law attorney to see if he can help with Medicaid qualification. In the beginning, when all of this was unraveling and we were hearing all of this, I kept telling my boss, I got it. Meet 5 Arkansans who are worried about their familys Medicaid. Then a couple of weeks ago, I had a day that, all of a sudden, I was like, I dont have it. An acceptable way to spend down is to pay for goods and services that you need, or that have a legitimate purpose, such as nursing home care, legal services for Medicaid planning, the withholding of taxes, and normal household expenses. (Remember that the rules allow transfers of assets between spouses.). But what constitutes a transfer made exclusively for a purpose other than to qualify for Medicaid? The reason surprised her even more. The POA gives Laura broad authority to act on Jerrys behalf, including the power to make unlimited gifts to family members and create trusts. I got it. Susan Caplener, outreach and patient services coordinator for Mid-Delta Health Systems, a Federally Qualified Health Center in Clarendon, 30 miles east of Marvell, said about 50 or 60 of the clinics patients have lost coverage in the last two months. Sibling with an equity interest. Dynamic List Data. More than 1 million people have lost their health insurance, according to data KFF has compiled from 20 states. Worries about disenrollments are particularly acute in the Arkansas Delta, one of the most picturesque parts of the state green in every direction to the horizon, peppered with corn, rice and soybean fields, and crisscrossed by myriad rivers and also one of the poorest. So an applicant who must spend down to $2,400 may transfer a countable asset worth $100,000 to his or her spouse. Data obtained by Legal Aid of Arkansas through a public records request shows the state has received more than 50,000 new applications since. If you dont cooperate, they turn off everything.. A single individual applying for Nursing Home Medicaid in 2023 in WI must meet the following criteria: 1) Have income under $2,742 / month 2) Have assets under That means the government hasnt determined someone makes too much money to qualify for Medicaid, but rather that the person failed to respond to a letter or provide extra information to renew their coverage. and that future You have to rely upon this, said Horne, a lifelong Republican who used to work in insurance and marketing. Other exemptions. In 2023, the Medically Needy Income Limit (MNIL) in KY is $235 for an individual and $291 for a couple. I got it, Caplener said. The attorney reviews Jerrys power of attorney and confirms the exact amounts of his assets and income. Transfers that would result in a period of ineligibility, however the Department of Human Services determines that denial of eligibility would cause undue hardship.. Pool photo by Al Drago. When the state began the unwinding process in February, it had about 8,500 applications in its queue. For example, if an applicant can prove that her son receives Social Security disability benefits, there will be no doubt that a transfer to that son is exempt. More than a third of people in Phillips County where Marvell is are in poverty, and many rely on Medicaid. Suppose an applicant paid for a year of his granddaughters college tuition four years ago when he was healthy, employed, and age 61, but then recently suffered a sudden, massive stroke that landed him permanently in a nursing home at the relatively young age of 65. The Fifty Meet 5 Arkansans who are MO HealthNet for the Elderly, Blind, and Disabled with a Spend Down allows consumers who have income above the income level for MO HealthNet Other findings in the report include: Medicare costs are expected to grow by 7.5 percent a year between 2022 and 2031. He gathers evidence, including a letter from Jerrys doctor, to verify that Laura meets the definition of a caregiver child for purposes of making an exempt transfer of Jerrys residence to Laura. As many as 15 million people, including 5 million children, are expected to lose Medicaid in the coming months. Before pharmacy school, he worked as a pharmacy technician in North Little Rock. Who are the power players, and how are they driving politics and influencing Washington? It applies to transfers made to a trust for any disabled individual under age 65, so long as the trust is established for the disabled individuals sole benefit. Under Pennsylvania Medicaid guidelines, a sole benefit trust has certain specific requirements, and should be drafted by a lawyer experienced in this area of the law. Caplener then has the patients bring to her whatever documents are needed so she can scan and email them to the Medicaid office, which is about 16 miles away. Theres so many pitfalls. This is not an effort that these individuals were undertaking inside with any kind of cavalier attitude. (Note that Jerry could still have qualified if the house had been kept in his name because it is an exempt asset. Federally Qualified Health Centers are checking to see whether people with upcoming appointments have lost coverage. People should be concerned. Some have worked with their local Medicaid office to get lists of people who have lost coverage to help with outreach. Seven in 10 Arkansans who have lost their insurance have been dropped for procedural or administrative reasons, according to state figures. Most of the exempt transfers allowed by Medicaid law are unambiguous. Laura continues to reside in Jerrys house, returnsto work, and visits Jerry regularly. The announcement followed a Monday letter to governors from HHS Secretary Xavier Becerra, saying he was deeply concerned with the number of people losing coverage. Providers are trying to be proactive. Horne said she only got someone from her county Medicaid office on the phone after she leapfrogged them and complained to someone at the state level. In many cases, people are told to reapply instead of asking for their case to be reopened or reconsidered. While all states are removing people from their Medicaid rolls, several Republican-led states appear to be moving at breakneck speed and no state is moving as quickly as Arkansas, where Republican Gov. MARVELL, Ark. That means that if you spend money, and get fair market value for what you spend, there is no penalty. But I have faith that the system honors the need, and that if their need is there and they recognize they have been dropped, that they recognize the resources they have to be re-enrolled, Achor said in an interview at his pharmacy just outside of Little Rock. Tip Sheet. A son or daughter who is disabled, blind, or under 21. Jerrys transfer and spend-down of assets looks like this: Jerry now qualifies for Medicaid benefits to pay for nursing home care, where all of his physical and medical needs are met. The Biden administration worried that millions may mistakenly lose health insurance on its watch is urging governors to consider policies to limit accidental coverage losses, and Democrats in Congress are calling on the Centers for Medicare and Medicaid Services to take stronger action. Not only do you lose $25,000 a year in income, you lose good benefits, too. I say that across the country and for any state, Tsai said in an interview. *All of a beneficiarys monthly income, with the exception of a personal needs allowance of $95.97 / month, Medicare premiums, and a Monthly Maintenance Needs Many people qualify by simply spending their excess assets, usually on nursing home care. Likewise, if you transfer title to something you own, and receive fair market value in return, there is no penalty. Medicaid law contains several other transfer exemptions that are hard to define with any precision: Most of the exempt transfers allowed by Medicaid law are unambiguous. I had to leave my career to stay home with my boys because theres a shortage of caregivers in the state. Archie, age 78, recently suffered a massive stroke. We are urging and asking states to do everything in their power to keep eligible people covered, Daniel Tsai, CMS deputy administrator and director of the Center for Medicaid and CHIP Services, told reporters on Tuesday. Sanders has touted Arkansas plan to complete the redetermination process in six months, which was passed by the legislature in 2021 and signed into law by former Republican Gov. Being a mother with young children, its frustrating, said Shakina Gates, a 38-year-old mother of three who lives just outside of Marvell in Poplar Grove. The number one problem is inadequate gifting provisions. Theyll do a mass update every so often and sometimes it accidentally closes the cases, said one eligibility worker, granted anonymity to speak openly about their work. Twaniesha Boose was surprised to get a call from her doctor recently canceling her appointment because her Medicaid was terminated. Right now, were in the whirlwind of chaos.. A 65-year-old retiring this year can expect to spend an average of $157,500 on health and medical costs over down from half about 25 years ago. What am I going to do? My phone never stopped ringing.. CMS officials were in Arkansas last week meeting with patient advocates. One way to get below the asset limit is to transfer excess assets in a way that will not result in the ineligibility period discussed in the chapter on gifts. In the case of a transfer made exclusively for a purpose other than to qualify for Medicaid, the state will normally presume that a transfer during the look-back period was a gift. The community spouse. Theres a trapdoor wherever you step.. An applicant who resides in a nursing home because of a disabling accident or condition, and is not yet 65, can qualify easily by creating such a trust and putting excess assets into it.