Question and Answer

1. Long-term care Medicaid covers what types of care?
   • Traditional nursing home care (A few nursing homes have waiting lists but most are available on demand.)
   • In-home personal care assistant through the Waiver program (There is a waiting list for this care.)
   • Attendance at Adult Day Health Care Centers through the Waiver program (There is a waiting list for this care and centers are not available in all areas of Louisiana.)

   There is also a new facility in Lafayette, LA partially covered by Medicaid that has private rooms and accommodations similar to that provided for assisted living residents.  Medicaid covers all but $1000 of the monthly fee and the family or spouse must pay this amount.
   

2. If I am a Medicaid recipient in a nursing home, will the care I receive be any different than the care received by the private-pay patient?
   There is absolutely no difference in care given to Medicaid patients and private-pay patients.  Federal and state laws prohibit this practice and no evidence has been seen or reported to substantiate any differentiation in care.
   
   
   
3. Are there some long-term care facilities that do not accept Medicaid patients?
   Yes, there are.  Long-term care Medicaid does not cover any of the traditional assisted living facilities in Louisiana.  Some private nursing homes do not accept Medicaid patients.   However, most nursing homes accept both private-pay and Medicaid payments.
   
   
4. How can I find out if I am eligible for long-term care Medicaid?
   Many of the regions in the state require that the applicant for long-term care Medicaid already be a resident of a nursing home or be accepted into the Waiver program before an application can be made.  Other regions may allow application prior to admittance into a facility or care program.   Medicaid offices generally provide basic guidelines of eligibility but will not usually determine eligibility prior to the application process.  It can be very costly to apply for Medicaid before you are eligible as you can be subjected to long penalty periods of ineligibility.  Senior Financial Protection provides guidance in the right time to apply for Medicaid so that the penalty periods are avoided.
   
   
5. What are exempt assets/resources?
   Exempt assets are those whose value is not considered for Medicaid eligibility.  Examples of exempt assets for Louisiana long-term care Medicaid are:
   • Home property with 160 contiguous acres or less
   • One vehicle if it can be used by family or spouse to meet applicant’s needs
   • Life insurance with a face value of $10,000 or less
   • Household furnishings, appliances, and electronics
   • Personal belongings
   • Burial plot, headstone, tombstone or crypt, or mausoleum space
   • Pre-need burial contract if irrevocable

   (These assets are exempt from consideration for eligibility only.  They could be considered for possible estate recovery under certain conditions.)
   

6. What are non-exempt assets/resources?
   Non-exempt assets are those whose value is considered for Medicaid eligibility.  Examples of non-exempt asset for Louisiana long-term care Medicaid are:
   • Checking accounts, savings accounts, Money Market and/or investment accounts
   • CDs
   • Stocks and bonds
   • IRAs, pension and retirement funds, 401Ks
   • Any property and/or buildings not contiguous to home property
   • Annuities if they are not set up according to Medicaid standards
   • Boats, motors, trailers, RVs, campers
   • Contents of safety deposit boxes
   • Additional vehicles
   • The cash value of life insurance policies over $10,000 in face value
   • Usufruct accounts and usufruct of property other than home property
   
   
   
7. What is the maximum amount of non-exempt assets/resources that can be owned by an individual to qualify for long-term care Medicaid in Louisiana?
   An individual can own no more than $2000 in non-exempt assets/resources to qualify for Medicaid.  Senior Financial Protection can develop and implement strategies to enable the individual with excess resources to qualify for Medicaid.
   
   
8. What is the maximum amount of non-exempt assets/resources that can be owned by a married couple to qualify one spouse for long-term care Medicaid in Louisiana?
   The stay-at-home spouse can own no more than $99,540 in non-exempt assets/resources and the institutionalized spouse can own no more than $2000.  Louisiana is a community property state and the total value of non-exempt assets/resources owned jointly or by either spouse individually are all considered for long-term care Medicaid eligibility purposes.  Here, too, Senior Financial Protection can help married couples save more of their assets while qualifying for Medicaid.
   
   
9. What is the Medicaid asset/resource limit when both spouses go into a long-term care facility at the same time?
   The asset/resource limit is $3000 when a husband and wife enter a nursing home at the same time.
   
   
10. Does Louisiana long-term care Medicaid recognize the provisions of pre-nuptial agreements?
    No, the provisions of the pre-nuptial agreements are not recognized in Louisiana for Medicaid purposes.  The assets/resources of both spouses are considered for eligibility purposes regardless of the conditions stated in a pre-nuptial agreement.
    
    
11. What is considered income by long-term care Medicaid?
    Medicaid considers the gross and not the net amount of income received by the Medicaid applicant from the following sources:
    • Social security and SSI checks
    • VA pensions and military retirement income
    • Teachers’ retirement, state and federal retirement, railroad retirement, retirement or pension income from private companies
    • Annuity payments received by applicant
    • Wages and earnings from employment
    • Business earnings (minus business expenses)
    • Investment income or interest earnings
    • Dividends from stocks, bonds, or life insurance companies
    • Farm income
    • Rental or lease income
    • Reverse annuity mortgage
    • Gas and/or oil royalties
    
    
    
12. What is the income limit for an individual to qualify for long-term care Medicaid?
    Louisiana is an income cap state and the long-term care Medicaid guidelines for 2006 say that an individual cannot earn more than $1809 gross per month to qualify.  HOWEVER, THOSE INDIVUALS WITH MORE INCOME THAN THE CAP CAN QUALIFY IF CERTAIN CONDITIONS ARE MET.   ONLY THE INCOME OF THE APPLICANT IS CONSIDERED IN DETERMINING ELIGILITY.  THE LEGAL SPOUSE’S INCOME IS NOT CONSIDERED FOR ELIGIBILITY PURPOSES.
    
    
13. What is the income that the stay-at-home spouse gets to keep when the other spouse is in the nursing home?
    The total amount that the stay-at-home spouse gets to keep is based on the Monthly Maintenance Needs Allowance that is presently set at $2488.50 for 2006.  Depending on the amount of income received by the stay-at-home spouse, all or a portion of the Medicaid applicant’s income can be diverted to the stay-at-home spouse to assist with living expenses, up to the $2488.50 limit.  Example: Mr. A in the nursing home has $1,200 in income.  Mrs. A at home has income of $600.
    
    

    Monthly Maintenance Needs Allowance:	$2488.50
    Mrs. A’s Social Security	600 $1888.50   In this case, Mrs. A would receive all of Mr. A’s $1200 in monthly income.

    
    

    However, if the stay-at-home spouse has personal income equal to or greater than the $2488.50 maximum, the Medicaid applicant’s income would go toward his care.
    Example:  Mr. B in the nursing home has $1,200 in monthly income.  Mrs. B at home has personal income of $3500 per month.  Since Mrs. B’s $2,500 of monthly income exceeds the Monthly Maintenance Needs Allowance, Mr. B’s income of $1,200 would not be received by Mrs. B but would be turned over to the nursing facility for his care.
    

14. What is the 36-month “look-back period” for Medicaid eligibility?
    Any donations or transfers of assets/resources for less than fair market value made during the 36-months prior to Medicaid application is considered in determining Medicaid eligibility.  Depending on the value of the assets/resources that were transferred during this 36-month timeframe, a period of ineligibility could result.
    Example: Mr. C donated a ToledoBend camp appraised at$60,000 at the time of transfer in April 2003.  When Mr. C applied for Medicaid in March 2005, because the camp was donated during the 36-month period prior to Medicaid application, Mr. C had to provide verification to Medicaid of the date that the donation was made and its appraised value at the time of donation.  The $60,000 was divided by the $3,000 divisor to determine the period of ineligibility and in this case it is 20 months of Medicaid ineligibility from the date of transfer April 2003.  Therefore, Mr. C is ineligible for Medicaid assistance from April 2003 to January 2005 based on this transfer.  The penalty period for the camp transfer had ended when Mr. C made his application for Medicaid in March 2005. (The Deficit Reduction Act signed by President Bush on February 8, 2006 changes the look-back period for Medicaid eligibility to 60 months or five years.  It also delays the start of the penalty period in most cases to the time the Medicaid application is made.  The State of Louisiana is expected to adopt these provisions on a state level.)
    
    
15. Does it matter when I apply for Medicaid?
    Yes, it does.  If an applicant has made a donation or transfer of assets/resources for less than fair market value during the 36-month “look-back” period and applies for Medicaid, a penalty period of ineligibility could result.  However, if the applicant waited until the 36-month “look-back” period had expired before applying for Medicaid, the penalty period would not go into effect.  This is an example of applying for Medicaid too early in the process.  Example:  Mr. C donated his camp on FalseRiver to his son in April 2003 and it was appraised at $120,000 at the time of donation.  He applied for long-term care Medicaid in January 2004.  Mr. C’s application was rejected and he was subjected to a 40-month period of ineligibility ($120,000 divided by $3000) from the date of the April 2003 donation.  Therefore, he was not eligible to reapply for Medicaid until September 2006.  If he had waited to apply for Medicaid until the 36-month “look-back” period had expired, he could have been eligible effective May 2006
    
    However, applying for Medicaid too late can result in the unnecessary expenditure of funds for nursing home care.  Example:  Mr. C donated his ToledoBend camp to his son that was appraised at $60,000 at the time of transfer.  Mr. C went into the nursing home in March 2005 but he paid for the care and did not apply for Medicaid until May 2006.  He met all other conditions of eligibility so that he would have been eligible for Medicaid immediately since he did not apply until the 20-month penalty ($60,000 divided by $3,000) for the donation had expired.  Mr. C is unable to recoup the13 months of private payments he had made unnecessarily.(Proposed changes in Medicaid policy could affect the validity of this example.  We will update the example as policy changes are made.)