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"Some people have too much income to qualify for Medicaid. This amount is called excess income. Some of these people may qualify for Medicaid if they spend the excess income on medical bills. This is called a spend down."
Medicaid rules and criteria are state-specific. Please consult a Medicaid Planner for your state or an elder law or estate planning attorney who is experienced with Medicaid rules.
It means the person has too much in assets to qualify for Medicaid, so it has to be used, I.e. spend down until the assets are low enough to qualify for Medicaid. However there are many state rules regarding how to achieve spend down, for example, you can’t “gift” anything to family or friends. Medicaid will look back as far a 5 yrs to look for “gifts”.
Please get consultation with an elder care attorney near you. Medicaid has many rules that are confusing and they vary by state. So to get the accurate info, please contact an elder care specialist attorney. You’ll get a lot of well meaning advice here, but this forum is used by many different states and even overseas, so you’ll just get confused, since you need to find out about your states rules from an elder care attorney. Again, not just any attorney…get one specializing in elder care near you to get best advice.
Assets can also be spent down by placing the person in Long-term care in a facility that excepts Medicaid. The resident has to need 24/7 care. About 3 months beforevthe assets are gone Medicaid is applied for. My Mom paid privately for two months which gave me time to get her on Medicaid.
To be eligible for Long Term Care Medicaid, the person may have no more than a set amount of "countable" assets (e.g., bank and investment accounts, IRA, etc.). The primary residence and one car are not counted as assets. In most states the asset limit is $2,000. "Spend down" is the process of spending the person's assets until they reach the asset eligibility level in their state. Money or other assets can not be given away or transferred within 5 years of the Medicaid application or it will affect when the person becomes eligible. Any assets sold must be sold at fair market value. Any money spent for benefit of the applicant is OK during spend down, which would include money paid for care, housing costs, medical bills, etc. Money can also be used to set up a funeral/burial trust.
There are many aspects of Medicaid "spend down." Is this for "extra help" with regard to Medicare drug coverage OR to qualify for Medicaid long term nursing home coverage or just general Medicaid coverage to be a "dual eligible" (one gets both Medicare and Medicaid coverage? I will assume you mean Medicaid long term nursing home coverage.
Yes, as others have said, best to get with an licensed elder care attorney in the state where your loved one (LO) resides and is trying to quality for Medicaid long term nursing home coverage as there are different State rules, limits, etc.
States have different asset limits, generally around $2K. This means funds (cash, checking, IRA/retirement pots of money, and perhaps the equity value of the house) have to be spent down and then Medicaid can be applied for. If married, there are "spousal impoverishment" rules, to protect the spouse NOT entering the nursing home. And yes, once the Medicaid long term nursing home qualified person passes away, the State may be able to come after some portion or all of the equity value of the primary residence.
Social Security, any pension funds, or other monthly income after qualifying for Medicaid long term nursing home coverage goes to the nursing home, except for small amount (maybe $80 for the person to buy personal items); but the overall asset limit must remain under your State's asset limit month to month. This means often one has to spend some money to remain under that asset limit.
There is a very important "5-year look back" provision when applying for Medicaid long term nursing home coverage. In that window, one cannot hide, gift, transfer assets. Certain expenses are allowed in that window, such as prepaying for funerals within reason. A $50K funeral will likely NOT pass your States lookers. Minor cash gifts -- $25 to a grand kid -- would be ok, Trying to shift large sums to kids/grandkids will NOT pass the State lookers.
Your area agency on aging or State Medicaid office can help. The business manager of the long term nursing home facility will generally know the rules and can help. Hope you can get with an elder care attorney as getting it done correctly is important. Some assets might be protected in certain circumstances and the lawyers where you are/your LO is will know.
Just popping in on this one in case it’s being asked in the case of a married couple, as no one “needs to go broke” My mother upon entering a NH burned through a long term care insurance policy (before buying one of these expensive products, be very sure it’s worth it, many are not) then went to private pay (that couldn’t last at all) then to Medicaid. The cost to enroll in Medicaid was nothing. My mother’s small SS check went to the NH. Dad had to sell one car. After that he kept their home, all of their checking and savings accounts, all his SS, and all of his retirement pension. They were never well off but they were okay financially and his life as far as money changed none. There was no spend down required by Medicaid in their case. Medicaid isn’t always the bogeyman it’s so often made out to be
Novotnykm: Per Google - "When dealing with Medicaid spend down rules, consider the following key points:
Medicaid spend down rules require individuals to "spend down" their income and assets to qualify for Medicaid coverage. The spend down amount is the difference between the individual's income/assets and the Medicaid eligibility threshold. Certain expenses, such as medical bills, can be used to meet the spend down requirement. Different states may have variations in their Medicaid spend down rules and thresholds. It's important to understand the specific guidelines in your state to navigate the spend down process effectively."
Spend down is a process where individuals reduce their assets or income to meet Medicaid eligibility requirements. This often involves paying for medical expenses out of pocket until their financial resources are low enough to qualify for Medicaid benefits.
It is, essentially, your share of cost for your medical expenses before Medicaid pays. It is determined based on your income and assets. So, if you can't afford the services that you need, Medicaid will determine an amount which you can afford to pay, and they will cover expenses which exceed that amount.
Spend down is not the share of costs for care. As others have written here, "spend down" refers to the process of spending the person's assets until they reach the cap that allows them to be eligible for Medicaid. You are correct in your description of "share of cost" which based on income but you are confusing it with spend down.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
Source: https://www.oms.nysed.gov/medicaid/resources/medicaid_spend_down.pdf
Medicaid rules and criteria are state-specific. Please consult a Medicaid Planner for your state or an elder law or estate planning attorney who is experienced with Medicaid rules.
Please get consultation with an elder care attorney near you. Medicaid has many rules that are confusing and they vary by state. So to get the accurate info, please contact an elder care specialist attorney. You’ll get a lot of well meaning advice here, but this forum is used by many different states and even overseas, so you’ll just get confused, since you need to find out about your states rules from an elder care attorney. Again, not just any attorney…get one specializing in elder care near you to get best advice.
To be eligible for Long Term Care Medicaid, the person may have no more than a set amount of "countable" assets (e.g., bank and investment accounts, IRA, etc.). The primary residence and one car are not counted as assets. In most states the asset limit is $2,000. "Spend down" is the process of spending the person's assets until they reach the asset eligibility level in their state. Money or other assets can not be given away or transferred within 5 years of the Medicaid application or it will affect when the person becomes eligible. Any assets sold must be sold at fair market value. Any money spent for benefit of the applicant is OK during spend down, which would include money paid for care, housing costs, medical bills, etc. Money can also be used to set up a funeral/burial trust.
Yes, as others have said, best to get with an licensed elder care attorney in the state where your loved one (LO) resides and is trying to quality for Medicaid long term nursing home coverage as there are different State rules, limits, etc.
States have different asset limits, generally around $2K. This means funds (cash, checking, IRA/retirement pots of money, and perhaps the equity value of the house) have to be spent down and then Medicaid can be applied for. If married, there are "spousal impoverishment" rules, to protect the spouse NOT entering the nursing home. And yes, once the Medicaid long term nursing home qualified person passes away, the State may be able to come after some portion or all of the equity value of the primary residence.
Social Security, any pension funds, or other monthly income after qualifying for Medicaid long term nursing home coverage goes to the nursing home, except for small amount (maybe $80 for the person to buy personal items); but the overall asset limit must remain under your State's asset limit month to month. This means often one has to spend some money to remain under that asset limit.
There is a very important "5-year look back" provision when applying for Medicaid long term nursing home coverage. In that window, one cannot hide, gift, transfer assets. Certain expenses are allowed in that window, such as prepaying for funerals within reason. A $50K funeral will likely NOT pass your States lookers. Minor cash gifts -- $25 to a grand kid -- would be ok, Trying to shift large sums to kids/grandkids will NOT pass the State lookers.
Your area agency on aging or State Medicaid office can help. The business manager of the long term nursing home facility will generally know the rules and can help. Hope you can get with an elder care attorney as getting it done correctly is important. Some assets might be protected in certain circumstances and the lawyers where you are/your LO is will know.
Best of luck with this. Here is a good article posted on this site: https://www.agingcare.com/articles/can-medicaid-take-your-house-147803.htm
Medicaid spend down rules require individuals to "spend down" their income and assets to qualify for Medicaid coverage.
The spend down amount is the difference between the individual's income/assets and the Medicaid eligibility threshold.
Certain expenses, such as medical bills, can be used to meet the spend down requirement.
Different states may have variations in their Medicaid spend down rules and thresholds.
It's important to understand the specific guidelines in your state to navigate the spend down process effectively."
Disclaimer: Not my authoring.
It is determined based on your income and assets.
So, if you can't afford the services that you need, Medicaid will determine an amount which you can afford to pay, and they will cover expenses which exceed that amount.