Medicaid Eligibility is complex and varies from state to state. Therefore, many myths about financial and personal factors determining a senior’s eligibility status have been established. Yet, despite many inaccurate beliefs about the program, with the right knowledge and planning resources, Medicaid can often fund nursing homes and long-term care for seniors who believe themselves to be ineligible.
Below are five common misconceptions about Medicaid eligibility and the truth about these claims.
It was a miracle her husband was nearby when it happened.
Suzanne was pulling a bottle of coke from the fridge when she suddenly stopped short. Her left foot, planted between the fridge and its open door, refused to move back to where it belonged. The fridge door hung wide open as she stared in horror at her worn sneaker, attached to an immovable leg.
To make matters worse, her lips refused to form the words she wanted to say to alert her husband.
Thankfully, he took in her clumsy position and terrified expression and reached out to grab her unsteady hands. Her husband quickly pulled a chair over, and Suzanne sank into it weakly.
It was a miracle that he realized what was going on and dialed 911 immediately.
When the EMTs arrived, they immediately recognized a mini-stroke had occurred. At the Emergency Room, a medication that halts the progression of the stroke thankfully prevented the symptoms from progressing.
The Shock Factor
Looking back, there were signs.
Suzanne was diabetic and overweight, which resulted in her limiting her physical activity due to discomfort. She always drove to social events and usually placed steady supermarket and household orders online.
Although she wasn’t aware of it, her blood pressure was also high, another common risk of stroke and heart disease.
Heart Disease and Stroke are common and understandable fears for seniors and their caregivers. When they hit, it is usually with no warning and its symptoms and recovery are often extensive.
At the heels of February – which is American Heart Month – let’s explore the common signs and prevention tips for heart attacks and strokes.
The Risk Factors
It’s often unpleasant and sometimes practically difficult for aging individuals and their caregivers to remain consistent about physical checkups. However, it is an investment well worth it.
Aside from common risk factors usually detected at routine physical examinations, there are lifestyle factors that contribute to the risk levels as well.
How to keep the winter a safe and healthy season for aging loved ones.
Snowflakes drift past the windowpanes, and the warmth hissing from the radiator invites hot cocoa drinks and soft tones.
Winter is a time of cozy togetherness, of holidays and family time – and also of unique hazards.
For the senior population in particular, the cold and stormy season brings many health and safety concerns to the fore. It’s important to be aware of common pitfalls and take the necessary precautions to protect ourselves and our aging loved one during this season.
Temperature Drops and Hypothermia
As we age, our body works harder to regulate its internal temperature. This means that older individuals have a bigger risk of developing frostbite and hypothermia.
What is Hypothermia?
Hypothermia is the term used when a person’s body temperature, which is normally at 98.6 degrees, drops below 95 degrees. Symptoms of Hypothermia include:
➤ Shivers
➤ Confusion
➤ Sleeping Difficulty
➤ Muscle Stiffness
Practical tips to prevent Hypothermia:
➤ Be sure that the indoor thermostats are set to around 78 – 80 degrees Fahrenheit when the weather gets cold.
➤ Seniors should not spend extended periods of time outdoors in the cold weather, even if they feel okay. Body temperatures can drop suddenly in the freezing weather and the results can be fatal.
➤ If the weather is stormy and the area is prone to outages, make sure your elderly loved one has a plan of action in the event the heat stops working in the house. It is also a good idea to have a power outage emergency kit in a handy spot including flashlights, a cell phone, and a list of emergency phone numbers.
What to do when one’s assets are above the Medicaid limits.
Medicaid eligibility criteria will vary by state, each having a set amount of income and assets allowed for an elderly individual or couple looking to obtain Nursing Home Medicaid or HCBS Waivers.
Despite the limits in place, the Medicaid spend-down option allows seniors to legally qualify for Medicaid approval if their assets can be ‘spent down’ in accordance with the Medicaid spend-down allowances.
Medicaid Spend-down//Defined
In a nutshell, spend-down means that the state allows Medicaid applicants to subtract specific non-covered medical expenses and living costs from their countable assets to lower their asset total and qualify for Medicaid.
This program is also referred to as Surplus Income, Excess Income, Share of Cost, or Medically Needy.
*Although most states do, some states do not participate in this program.
What may be included in Medicaid spend-down?
If your loved one’s income and assets exceed the Medicaid limits, here are the specific details about expenses and assets that may be removed from the asset total, to hopefully amount to less than the state limits.
Income Spend-down
Spending down income is pretty straightforward and means that if an elderly applicant’s income exceeds the state’s limit, and his monthly medical bills add up to the exceeded amount or more, his net income will meet the eligibility criteria and thereby allow him to be approved for Medicaid.
Sam is 69 years old and the proud owner of a home, a car, and a great life insurance policy. In addition, he still receives a monthly income of $3,500 from the supermarket he had founded. His physical health has deteriorated to the extent that it is clear to his spouse and children that he requires nursing home-level care. A quick online search reveals that the current income and asset limits in New Jersey for seniors are $2,742 income per month and a total of $2,000.00 in assets.
Unaware of the various options available to applicants in NJ and other states who are above the income limit, such as setting up a QIT, Sam’s family assumes that he is ineligible for Medicaid.
Recalling that their aunt – who only owned a car and several stocks and bonds – was unable to be approved for Medicaid when she required care, convinces them not to even waste their time applying.
Thus, they continue spending upward of $2,000 each month for a live-in caretaker, while pushing through the days and weeks until they’d be forced to pay the astronomical fees involved in nursing home care.
The Complexity of Medicaid Eligibility Criteria
What Sam’s family, among many other families struggling with the costs involved in caring for an aging, loved one, fails to realize is that there are different types of care available through Medicaid and that each category of income and assets are evaluated differently.
Why is Medicaid recertification important and how do you navigate the process?
After a lengthy application and approval process, your aging loved one has finally been approved for Medicaid. A huge financial burden is lifted, and you are now free to focus on other vital aspects of their elderly, such ashiring a caregiver,Implementing safety precautions, anddeciding what level of care is best for their specific needs.
You can stop submitting endless amounts of paperwork to your application. You should heave a sigh of relief. But, you should not discard any communication you receive from Medicaid. Eligibility for Medicaid is recertified periodically. And although it is usually a simple process, Medicaid recertification is important to take care of in a timely manner to ensure there is no gap in coverage.
The Medicaid application process sometimes requires legal advice and the assistance of an attorney. Senior Planning Services does not provide any legal advice or services. You may wish to consult with an attorney concerning your Medicaid application.
