Articles Posted in Medicaid & Medicare

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AdobeStock_165010797-300x200Elder law attorneys are often asked by clients about the difference between Medicare and Medicaid. While the names of these government-sponsored programs sound very similar, each has a distinct purpose and serves a specific audience. 

MEDICARE is a federal health insurance program. No matter what your income is, you can obtain Medicare benefits if you are 65 and over, or have a qualifying disability. The program is not free – you must pay part of the costs through deductibles for hospital stays and you must pay monthly premiums for coverage.

MEDICAID is a federal and state financial assistance program for people over 65, people with disabilities, children, pregnant women and parents of eligible children. To be eligible for Medicaid benefits, individuals from these groups must also have low income. Because it is run jointly by the state and the federal government, rules and eligibility requirements vary state by state. 

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caution-cropped-300x291On March 31st, a change to Medicaid eligibility that was brought about by the onset of COVID-19, is scheduled to come to an end.

A federal policy that had allowed states to temporarily suspend redetermination – the process by which renewal of Medicaid benefits for recipients is reconfirmed – will stop.

Further, the Medicaid continuous coverage requirement will no longer be contingent to the end date of the COVID public health emergency.

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Dollarphotoclub_86843572-300x200Transfers of assets generally raise a red flag when it comes to applying for Medicaid. They can trigger a penalty period, or a period of ineligibility.

The good news is the Connecticut Department of Social Services (DSS) will allow certain types of Medicaid asset transfers. For example, a family caregiver can be compensated for providing care to a loved one if the care they provide is necessary.

The rationale is this: DSS recognizes that when family members pitch in and provide needed care for a loved one, they are helping that person delay or avoid placement in a nursing home.

Making a caregiver agreement

Although your loved one can’t just give away his or her money to qualify for Medicaid, he or she can pay a family member who is providing care without jeopardizing eligibility for Medicaid. An individual must demonstrate a functional need for assistance with one or more activities of daily living. The type of care provided must be spelled out in a caregiver agreement, and certain conditions must be met. Continue reading

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AdobeStock_158377229-300x200Applying for Medicaid benefits can be overwhelming.

Between the paperwork, the ever-changing rules and regulations, and the inevitable waiting game that you’re up against, there’s a lot you need to know.

Here is information to get you started and hopefully, to make it easier for you.

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Worried womanIf you want Medicaid in Connecticut to pay for your long-term care, one thing you should NOT do is give away your assets – unless you think you won’t need Medicaid within the next five years.

When you apply for Medicaid for long-term care in either a nursing facility or in your home, you are required to provide financial records for the past five years. This is called the “look back” period. Continue reading

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Medicare-300x169While Medicare does not pay for long-term care, it will cover up to 100 days of care in a skilled nursing facility (SNF). There are, however, some fairly stringent and somewhat confusing qualifications patients must meet before Medicare will extend this benefit. Unfortunately, because there is some nuance to the rules, many patients find themselves having to pay for SNF care they assumed would be covered.

To help you navigate the ins and outs of Medicare’s SNF benefit, we put together a quick cheat sheet that explains the basics and a few of the details that are not always so obvious.

The Basic Requirements: Hospital Stays, Observation, and Skilled Care

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Safe and moneyBy Lara Schneider-Bomzer

Purchasing annuities is a good way for married couples to protect assets, but doing it wrong could mean huge penalties. Here is what you need to know about annuities as it relates to Medicaid planning in Connecticut:

If your spouse is residing in a nursing home or is in need of home care, chances are you’ve read our blogs about the ways to protect your assets and qualify your spouse for Medicaid benefits. But not all strategies apply to all couples.

Just as a refresher, under the Medicaid rules, the Institutionalized Spouse (IS) may only have a maximum of $1,600 in assets in his name.  The Community Spouse (CS) may have a house, a car and up to half of a maximum of $130,380, called the Community Spouse Protected Amount (CSPA).  While there are income requirements for the IS, the CS may have as much income as she receives with no limit.

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Ask-the-question-300x200Many a well-intentioned family member has taken on the responsibility of caring for an aging parent only to realize that they’ve committed to more than they can handle on their own.

And many more people will need to step into a caregiver role in the coming years.

The U.S. Census Bureau projects that the population of people 65 and older will grow by approximately 50% over the next 30 years!

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Mature Couple Calculating Coin In The PiggybankIf you haven’t heard of the Medicare Savings Program, today may be your lucky day. You could save thousands of dollars a year on medical costs courtesy of the State of Connecticut and Medicaid.

The Medicare Savings Program covers

  • out-of-pocket expenses for premiums,
  • deductibles
  • co-pays
  • and subsidizes your prescriptions drug costs if you are an eligible Medicare beneficiary.

Do you meet the criteria?  Continue reading

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StethoscopeMoneyA federal court ruled that hospitals may retain a patient in their building under “observation status” rather than formally admitting them, and that such “observation status” does not count as a hospital stay for nursing home Medicare qualification purposes.

Medicare (not to be confused with Medicaid or Title 19) provides a limited nursing home benefit. If a nursing home resident spends three nights in a hospital and then is discharged to a nursing home for some type of rehabilitation services, the nursing home resident is entitled to Medicare benefits at the nursing home for up to 100 days. Medicare will pay the entire bill for the first 20 days and, for the next 80 days, Medicare will continue to pay a portion of the bill and the nursing home resident must pay a portion. In 2021, the nursing home resident must pay $185.50/day and Medicare pays the balance (many nursing home residents have a Medicare supplemental insurance policy to cover the $185.50/day). The Medicare benefit can save a nursing home resident tens of thousands of dollars.

So what does “observation status” have to do with all of this?

Under Medicare regulations for hospitals, if a hospital admits a patient and Continue reading

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