ALLEN HAUGRUD

What is Medical Assistance?

Every state has its own Medicaid program and may differ considerably.

Minnesota calls its Medicaid program Medical Assistance. Medical Assistance provides health care coverage for financially eligible Minnesota residents who meet one or more of the following criteria:

Under 21 years old

65 years old or older

A parent of a dependent child

A caretaker of a dependent child

A pregnant woman

A person who is certified blind

A disabled person

To qualify, you must meet certain asset and income limits. You do not qualify if you have too many assets or too much income, and must pay for medical expenses out of your own pocket if you do not have insurance.

Medicaid And Medical Assistance Benefits

Medical Assistance pays for most medically necessary services, including home health care and long-term care services. Some of the services covered are:

Inpatient hospital services

Emergency room services

Skilled and intermediate nursing care

Laboratory and x-ray services

Eyeglasses

Dentures

Prosthetic services

Home health services must be medically necessary, ordered by a physician, provided in the recipient’s residence and documented in a written case plan.

 

Applying for Medical Assistance is often a difficult and confusing experience. Medical Assistance rules are complex, and most people going through the process are doing so on behalf of a loved one who is ill or injured. The personal stress combined with the intricacies of the system can present quite a challenge.

Medical Assistance is a need-based program. A recipient’s assets cannot exceed $3,000 and a person’s income must be less than 100% of the Federal Poverty Guidelines (FPG), which is currently $817 per month. If an individual’s income is over 100% of FPG there is a "spend down" option. A person can spend down to 75% of FPG which is currently $613 per month.

 

The Medical Assistance application process can be initially focused by asking a few questions.

 

Does the applicant live at home, in an assisted living, or in a nursing home?

Medical Assistance covers long term care for recipients who live in a nursing home. There are also Medical Assistance benefits available to people who are able to stay in their homes with assistance, or individuals who live in an assisted living facility. Those benefits are available through community-based programs. Elderly Waiver is the community based Medical Assistance program most utilized by elderly individuals. There are, however, programs available to recipients with disabilities who are under the age of 65.

 

The application process is largely the same for long term care and community based services. One important difference is that community based services like Elderly Waiver require that the applicant be screened in a Long Term Care Consultation, and determined capable of remaining in the community. If the applicant is married, the asset assessment date is set on the date the consultation takes place. Asset assessment will be discussed below.

 

Is the applicant married or single?

A single person applying for Medical Assistance will need to demonstrate eligibility with respect to both income and assets. This means that the applicant demonstrates a medical need, substantiated by outstanding medical costs. Their income must be such that after the permissible deductions, they are unable to pay for the cost of their care.

 

The asset limit for a single person is $3000.00. This includes savings accounts, checking accounts, stocks and bonds, certificates of deposit, contracts for deed, IRAs, and the cash surrender values of life insurance policies, among other things. There are also assets that are excluded. A person may have a home, a car, a protected amount of both life insurance and prepaid funeral expenses. There are a few other excluded assets, and the home and car both require active use by the recipient to maintain exclusion. Some assets are unavailable. An asset is unavailable when the recipient has failed after a reasonable effort to access property made unavailable either by joint ownership, pending legal action, continued unsuccessful effort to sell, or certain trusts. A Medical Assistance recipient who has more than $3000.00 in assets at the end of a month is no longer asset eligible for Medical Assistance, and will be assessed a period of ineligibility.

 

In a married couple, the income of the recipient is treated as if they were single. Assets, however, are evaluated much differently to allow the community spouse to maintain some assets up to a set limit. There is a minimum and a maximum asset limit for the community spouse, set each year to reflect changes in cost of living. The asset limit in each individual’s case is determined by the difference between assets held at the asset assessment date and assets held at the time of application. The asset assessment date in a long term care Medical Assistance case is set by the date marking the first period of institutionalization for the applicant. Institutionalization may mean a hospital or nursing home stay. If the couple is applying for Elderly Waiver or another community based program, the asset assessment date is set by the Long Term Care Consultation as discussed in the previous section.

 

Is the applicant a veteran?

Medical Assistance rules require that veterans applying for benefits must also apply for Veterans’ Aid and Attendance. Veterans’ Aid and Attendance is a pension available to veterans unable to care for themselves in their home. If approved, the veteran receives income that in turn reduces the burden on the state each month for the cost of care- at home or in a nursing facility.

 

Has the applicant transferred any assets during the lookback period?

Medical Assistance transfer rules are very complicated in an effort to prevent people transferring their assets in order to become eligible. In order to properly prepare for a Medical Assistance application, we must discuss any transfer of assets made since February 8, 2006. A transfer is any uncompensated or undercompensated exchange made to obtain or maintain Medical Assistance. This may mean granting a life estate in one’s home, annuitizing an annuity, or simply making gifts. Each individual applicant must very carefully examine any qualifying exchange to properly apply. After a transfer amount has been determined, it is divided by a divisor representing the average cost of care for nursing level care in Minnesota. The resulting figure is the number of months, after application, the person must privately pay for the total cost of their monthly care until Medical Assistance will begin to contribute.

 

Medical Assistance Is Administered By Counties

The Minnesota Department of Human Services is responsible for the administration of the Medical Assistance Program. The responsibility of working with eligible individuals (e.g., applications), is delegated to county agencies. A health care program manual containing Medical Assistance instructions is issued to various county financial workers by the Minnesota Department of Human Services, and available over the internet at the website for the Minnesota Department of Human Services.

Medicaid And Medical Assistance Can Help In Your Home

Community and Home-based waiver programs were established under the Social Security Act of 1981. Waiver programs were established to correct institutionalized bias in Medicaid programs. Waivers allow states to offer home and community-based services to people who may otherwise be institutionalized. Minnesota has waiver programs that not only help seniors, but infants, those suffering brain injuries and debilitating illnesses, too. For example, Minnesota has a Medicaid waiver designed specifically for individuals over 65 years old called the Elderly Waiver program. This Community Alternative for Disabled Individuals (CADI) Waiver is a program designed for disabled individuals under 65 who require nursing home level of care, but choose to reside in the community.

 

Medicaid And Medical Assistance Can Be Confusing

These topics cover only the most basic concepts of Medical Assistance application. Each case is different and subject to detailed, specific rules.

For a detailed and substantive understanding of Medicaid, Medical Assistance eligibility and waiver programs, call so we can discuss your needs.

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