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Medicaid Eligibility For Home Care — Part 2 of 2

October 1, 2014

(2) Nursing Home Transition and Diversion Waiver

In addition to the new managed care home care program, there is also a home care program commonly known as “Nursing Home without Walls” or “Nursing Home Transition and Diversion Waiver.” This is a skilled nursing care home care program for those whose medical condition would normally require nursing home placement. We have been advised that typically a Medicaid recipient will receive substantially more hours of home care aides and nurses under this program than under the Managed Home Care program. We have been advised that the initial process is to be evaluated by a home care provider. On the website, there is substantial information about managed home care along with a list of home care providers that can handle this evaluation.

Once you have received an evaluation and are determined medically eligible for home care coverage, and if you are financially eligible, then the next step would be to apply for Medicaid coverage for Home Care. We have been advised that at the time of the application for Medicaid, you must indicate whether you are applying for managed care home care or for the Nursing Home Transition and Diversion Waiver. The basis for this decision is what level of care your medical evaluation has determined that you need. Therefore, it is important that you discuss with the home care agency conducting the evaluation which home care program they recommend that you apply to receive.

Financial Eligibility Rules for Home Health Care Medicaid Coverage In order to qualify for Medicaid covered home care and participate in one of the above programs, you must be both medically eligible and financially eligible. In 2014, a single person cannot have more than $14,550 in non-exempt assets. For a married couple, the healthy spouse is entitled to keep a minimum spousal allowance of $74,820 up to a maximum of $117,240 of the couple’s combined life savings. Income Rules for Home Health Care Medicaid Coverage For 2014, a single person is entitled to keep $829 of his/her monthly income. The healthy spouse is entitled to keep at least $2,931 of the couple’s combined income. If the healthy spouse has income of his/her own above $2,931, then the Medicaid Agency will “request” a contribution of 25% of all income above $2,931.

No Transfer Penalty for Home Care If your assets exceed the financial eligibility levels, you can transfer them to another person or to an Irrevocable Trust. There is no transfer penalty. You can transfer your excess life savings and become immediately eligible for Medicaid covered home health care. Transfer Penalty Reinstated for Nursing Home Care Although there is no transfer penalty for home care Medicaid eligibility, the transfer penalty does apply if you subsequently enter a Nursing Home. The Medicaid Agency is entitled to look at all your financial transactions for the 5 years immediately preceding your Medicaid application for Nursing Home coverage. The Medicaid Agency can review your bank statements and question each of your deposits and withdrawals for the past 5 years. Therefore, if you have transferred assets to qualify for Medicaid Home Care coverage and enter a Nursing Home within 5 years from the date of the transfer, those transferred funds may need to be returned to you before you apply for Medicaid Nursing Home coverage. Therefore, it is critical that the recipient of transferred funds does not spend those funds.

In conclusion, the new managed care options for home care coverage make applying for Medicaid covered home health care a viable option for families. There are no transfer penalties and the healthy spouse can now keep more generous life savings and income. The Koldin Law Center, P.C. handles Medicaid applications for Home Care, Assisted Living and Nursing Home Care Medicaid coverage. Applying for Medicaid is a very challenging time for both the applicant and the family. Substantial assets can be lost if you do not know your legal rights. The Koldin Law Center, P.C. closely monitors the medicaid laws and court cases to make certain our clients are well-informed of their options.

At the Koldin Law Center, P.C. with offices in Syracuse , New York, we have over 40 years of experience helping individuals plan for immediate crisis and long term care. You should never assume that it is too late. Quite often you have legal options to save some or all of your life savings. The Koldin Law Center, P.C. can help you make the right decisions when you have a health care crisis. There is something you can do.

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