Medicaid Flashcards
1
Q
What are the three health coverage programs that Medicaid administers?
A
- Medicaid
- Children’s Health Insurance Program (CHIP)
- Basic Health Program (BHP)
2
Q
How is Medicaid administered?
A
- It is adminstered by each state, through a federal/state partnership
- Each state must operate Medicaid consistent with broad federal guidelines and requirements
- And then variations between state programs are allowed
- Medicaid is JOINTLY FUNDED
- Federal government and state government
3
Q
Medicaid eligiblily expansions due to Affordable Care Act
A
- States could choose to expand their Medicaid eligiblity to include families and/or individuals with income up to 133% of federal poverty limit
- Some states adopted this and some did not
4
Q
What is CHIP?
A
- Children’s Health Insurance Program
- Provides health insurance to children in families that do NOT qualify for Medicaid because their income is too high, but they still are not able to afford private health insurance
- Most states have accepted eligiblity to cover children in households earning up to 200% of the federal poverty limit
5
Q
What is BHP?
A
- Basic Health Program
- Offered to states wanting to provide BRIDGE insurance coverage for those households with incomes fluctuating ABOVE AND BELOW the relative poverty or Medicaid thresholds.
6
Q
Medicaid - LTC
A
- Medicaid for low-income elderly indivdiuals is the ONLY federal health insurance program that will pay for LTC, including nursing facilities (nursing home) and home health care.
- Some financial planning strategies may seek to spend down clients assets or place these assets in trusts so that client or client’s spouse can qualify for Medicaid, although Congress has enacted many provisions to prevent this
7
Q
Medicaid Eligibility - What are the two parts?
A
- Income eligiblity and
- Asset eligibility
8
Q
Medicaid - Income Eligiblity (first income test)
A
- There are two income eligiblity standards
- The first is the general income eligiblity standard (MAGI test)
- Applies to all households EXCEPT:
- The elderly and disabled
- Based on MAGI
- Those using this MAGI test DO NOT need to pass asset test
- Applies to all households EXCEPT:
- The first is the general income eligiblity standard (MAGI test)
9
Q
MAGI Calculation for General Income Eligilbity Test
A
AGI
+ Untaxed foreign income
+ nontaxable social security benefits
+ tax-exempt interest
= MAGI
10
Q
Medicaid - Income Eligiblity Test (For Elderly and Disabled)
A
- Only for elderly and disabled
- Uses same eligiblity standards as SSI (Supplemental Security Income)
- Individual (or couple’s if both spouses are applying) countable monthly income must be BELOW the federal benefit rate
- Special income rule for elderly individuals in need of LTC:
- Some states require income be below 300% of SSI income level
- Asset test still applies
- For MARRIED couples where only ONE spouse is applying for Medicaid to cover LTC:
- Only the applying spouse must meet the stringent income test
- Nonapplying spouse keeps income separate
11
Q
Medicaid Eligibility - Asset Test
A
- Only applies to elderly and disabled
- Asset limits:
- $2,000 for individual
- $3,000 for married couple
12
Q
Medicaid Eligibility - Asset Test (Household)
A
- Must also pass HOUSEHOLD test to qualify for Medicaid
13
Q
Medicaid Eligibility - Assets exempt from asset test
A
- One car used for household transportation
- An individual’s home
- Some PREPAID burial expenses
- Some personal effects (wedding ring, etc)
- For married couples:
- If only one spouse is applying for Medicaid, the other spouse, can keep some assets (spousal impoverishment protection)
- These assets would be in excess of exempt assets
- If only one spouse is applying for Medicaid, the other spouse, can keep some assets (spousal impoverishment protection)
14
Q
Medicaid Eligibility - Asset Test - Special Needs Trusts or Supplemental Needs Trusts
A
- Property held in trust that is NOT paid to the Medicaid recipient but rather held for the support of the Medicaid recipient is NOT counted asset or income to the Medicaid recipient/applicant
- Income from trust CANNOT be paid DIRECTLY to Medicaid recipient
- Medicaid recipient CANNOT control assets or income from trust
- A trustee can be directed by the trust document to pay expenses for support of Medicaid recipient
- Trustee has COMPLETE discretion over expenditures
- Trustee must be careful as to whicih expenses are paid and how much so as not to jeopardize other government benefits (food and shleter payments for SSI)
15
Q
Other Medicaid Eligibility and Effective Coverage Date
A
- Generally must be residents of the state in which they are receiving Medicaid
- Must be citizens of US or certain qualified non-citizens (permanent residents)
- Effective date of coverage
- Effective on the date of applicaiton OR
- First day of the month of applicaiton
- Benefits may also be covered RETROACTIVELY for up to THREE MONTHS prior to month of application (if indivdiudal would have been eligible during that period for Medicadi)
