Conquering The Medicaid Application - Part 4: When Benefits Start
When Does Eligibility For Benefits Begin? Medicaid eligibility occurs when an applicant meets all three eligibility criteria, i.
e.
, medical, income and resources (assets), and an application is submitted.
Eligibility is categorical, i.
e.
, an applicant is or is not eligible.
Additionally, if an applicant is placed in an assisted living facility or nursing home, that facility must accept Medicaid as a payment source.
If the facility does not accept Medicaid as a payment source, the cost of care will not be paid by Medicaid, despite eligibility status.
As previously stated, Medicaid regulations provide that benefits can be made retroactive up to 90 days prior to the filing of Part 1 of the application, if the applicant meets all eligibility criteria for that time period.
However, due to the problems with the functional assessment also discussed previously, backdating is not being done.
Therefore, it is important to make the referral for the functional assessment as soon as possible and to handle the Medicaid application diligently.
If an applicant is a resident in a nursing home, the applicant's current monthly income, less $50 per month for the applicant's personal needs allowance, is paid to the nursing home as their patient payment.
This is the applicant's contribution to the cost of their care.
Medicaid will make up the difference between the patient's income and the Medicaid reimbursement rate for the facility.
While the application is being processed, the applicant should make the patient payment to the facility.
If there is a community spouse, I recommend trying to estimate the amount the community spouse will be entitled to receive from the applicant's income and pay the difference to the nursing home.
Adjustments can be made after benefits are approved.
In order to determine the community spouse's monthly income allowance, you will have to calculate the community spouse's Minimum Monthly Maintenance Needs Allowance (MMMNA), which is a fairly complicated calculation.
Generally, a basic allowance is permitted which is a set figure that is changed every year on July 1st.
This basic allowance is currently $1,821.
25.
The basic allowance can be increased by excess shelter expenses of the community spouse (i.
e.
, rent or mortgage, condominium association fees, property insurance, property taxes, utilities), as long as these expenses exceed 30% of the basic allowance.
Then, any "exceptional circumstances" can be added, i.
e.
, health insurance for the community spouse, out-of-pocket medical and prescription expenses including dental and vision for the community spouse only, etc.
The counties are pretty strict about what can be included in this section.
The maximum permitted for 2010 is $2,739.
00.
(The maximum is changed January 1st of every year.
) The community spouse's own income is then deducted.
The resulting figure is the community spouse's monthly income allowance which is deducted from the applicant's income and patient payment (to the extent the applicant's income is sufficient after deduction of the applicant's personal needs allowance and trust maintenance fee, if applicable).
Next: Application Denials | Appeals.
e.
, medical, income and resources (assets), and an application is submitted.
Eligibility is categorical, i.
e.
, an applicant is or is not eligible.
Additionally, if an applicant is placed in an assisted living facility or nursing home, that facility must accept Medicaid as a payment source.
If the facility does not accept Medicaid as a payment source, the cost of care will not be paid by Medicaid, despite eligibility status.
As previously stated, Medicaid regulations provide that benefits can be made retroactive up to 90 days prior to the filing of Part 1 of the application, if the applicant meets all eligibility criteria for that time period.
However, due to the problems with the functional assessment also discussed previously, backdating is not being done.
Therefore, it is important to make the referral for the functional assessment as soon as possible and to handle the Medicaid application diligently.
If an applicant is a resident in a nursing home, the applicant's current monthly income, less $50 per month for the applicant's personal needs allowance, is paid to the nursing home as their patient payment.
This is the applicant's contribution to the cost of their care.
Medicaid will make up the difference between the patient's income and the Medicaid reimbursement rate for the facility.
While the application is being processed, the applicant should make the patient payment to the facility.
If there is a community spouse, I recommend trying to estimate the amount the community spouse will be entitled to receive from the applicant's income and pay the difference to the nursing home.
Adjustments can be made after benefits are approved.
In order to determine the community spouse's monthly income allowance, you will have to calculate the community spouse's Minimum Monthly Maintenance Needs Allowance (MMMNA), which is a fairly complicated calculation.
Generally, a basic allowance is permitted which is a set figure that is changed every year on July 1st.
This basic allowance is currently $1,821.
25.
The basic allowance can be increased by excess shelter expenses of the community spouse (i.
e.
, rent or mortgage, condominium association fees, property insurance, property taxes, utilities), as long as these expenses exceed 30% of the basic allowance.
Then, any "exceptional circumstances" can be added, i.
e.
, health insurance for the community spouse, out-of-pocket medical and prescription expenses including dental and vision for the community spouse only, etc.
The counties are pretty strict about what can be included in this section.
The maximum permitted for 2010 is $2,739.
00.
(The maximum is changed January 1st of every year.
) The community spouse's own income is then deducted.
The resulting figure is the community spouse's monthly income allowance which is deducted from the applicant's income and patient payment (to the extent the applicant's income is sufficient after deduction of the applicant's personal needs allowance and trust maintenance fee, if applicable).
Next: Application Denials | Appeals.
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