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Medicaid Eligibility: How do you know for sure? 

Medicaid eligibility overview:
 

In order to determine your Medicaid eligibility, a single person is still permitted to own several things including a home, a car, some personal belongings and a small amount of savings (perhaps $2000 plus some money set aside for funeral expenses) and can have a small amount of income (a few hundred dollars a month or less in most states). In considering Medicaid eligibility, any payments received from a job, Social Security, a pension or other retirement fund, savings and investments must all be considered. 

If a person is married, their spouse may still be able to remain in the home after the individual enters a nursing home.  The Medicaid eligibility rules are a little bit more generous in this respect.  The healthier spouse frequently can keep their house, car and personal belongings, and half of the couple's assets, but usually not exceeding more than about $95,000 and usually not less than $19,000 (in 2004). Spouses can also frequently keep their own income and sometimes a portion of their partner’s income depending upon the healthier spouse’s needs as well as the particular state’s limits.  You will need to check with the Medicaid laws in your state.  Some states will allow spouses to keep up to the maximum, regardless of whether it is considered to be half of their assets or not. 

Other standards used to determine Medicaid eligibility consider the individual’s disability and medical needs, other public assistance, whether they have life insurance and many other issues that are deemed to be important according to a specific state’s Medicaid law.  If your parent or loved one is eligible for Supplemental Security Income (SSI), they are usually automatically Medicaid eligible. 

The federal government sets wide federal guidelines and then each state creates its own unique and sometimes bewildering set of rules and exceptions. Many states have various special programs to help individuals who do not quite meet the financial requirements under that specific state’s Medicaid law.  Some states even allow for special programs that will help individuals stay in their homes and receive community-based home care services in order to keep a person from having to go into a nursing home. 

The following is an example of why it's important to understand your specific state Medicaid law.  Some states will allow a spouse who remains in the community to keep whatever assets are necessary to continue generating income to pay their regular bills.  For example, a person receives $300 a month in Social Security and has $200,000 in the bank earning 3% (or $500 a month) might be still allowed to keep the entire bank account, so that they have money to live on while the other spouse qualifies for Medicaid.  Many people are not aware of this provision and will simply wait until the $200,000 is virtually depleted before applying for Medicaid eligibility for their spouse.  In some other states, a spouse can refuse to contribute to nursing home bills and can keep all their own income. 

While Medicaid eligibility is generally limited to US citizens, there are exceptions and sometimes "emergency Medicaid" may be available to citizens from other countries as well. 

To find out if your parent or loved one meets the requirements for Medicaid eligibility, go to www.benefitscheckup.org , www.govbenefits.gov  or www.cms.hhs.gov (then click on" Medicaid" and then "Medicaid information for consumers"). You can also call your local medical assistance office for help determining your loved one's Medicaid eligibility.

Information from How to Care for Aging Parents 

Additional Information and webpage by Paul Susic MA Licensed Psychologist Ph.D. Candidate                                      

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