1. It can be extremely challenging to get qualified for Long Term Medicaid. It is important to know that there are additional requirements that must be met after Medicaid coverage is established.
2. This article will cover two of those requirements that are most often faced by Long Term Care (LTC) Medicaid beneficiaries and their families. LTC Medicaid can be established for nursing home care, a waiver program, or the PACE program.
3. Annual Review. Each year, the LTC Medicaid beneficiary is required to produce evidence of all the assets they own. In a case where there is a community spouse, only the assets belonging to the Medicaid beneficiary are counted. Assets that the community spouse has or has acquired since the date their spouse was granted Medicaid eligibility are not counted. The Medicaid recipients bank statement is usually all that evidence that is needed. A notice is sent by mail to the responsible
person and to the facility that the annual review is due. If no one responds to that notice, a new Medicaid application will be required.
4. Change of Circumstances. Whenever a Medicaid beneficiary has a change in income or assets, the Medicaid reviewing agency (Department of Children and Families DCF) must be notified. INCOME decreases must be reported to reduce the Medicaid recipient’s monthly financial obligation to the facility. Income increases should be evaluated to make sure the income eligibility cap is met. The current eligibility cap is $2829/mo. for an individual and that amount changes at least annually. If
the Medicaid recipient’s income is over the eligibility cap, then a Medicaid compliant Trust needs to be established and used to hold income amounts over the eligibility cap amount to maintain the Medicaid eligibility. ASSET changes should be reviewed with an attorney who handles Medicaid cases to determine asset protection measures that can be taken to maintain the Medicaid coverage and protect the assets in question. Some examples of Medicaid beneficiary assets that change post eligibility might be selling real estate (homestead or non-homestead), inheritance, or recovery in a lawsuit. If DCF is not notified and later finds out, Medicaid will be terminated, and DCF will file a
claim for repayment for the period that the Medicaid beneficiary was in possession of assets more than the resource limit ($2000.00). Unreported transfers of assets may not only result in future Medicaid disqualification but may also cause criminal liability.
Diana Mangsen focuses her practice as an elder law attorney in Clearwater, Palm Harbor, Largo, Dunedin and the Tampa Bay area.
For more information, visit our website at
https://www.mangsenlaw.com/
or call (727) 888-6282.