Betsy abramson disability rights wisconsin august 2009
Download
1 / 31

Betsy Abramson Disability Rights Wisconsin - PowerPoint PPT Presentation


  • 344 Views
  • Uploaded on

Betsy Abramson Disability Rights Wisconsin August 2009. FINANCIAL ELIGIBILITY FINANCIAL ELIGIBILITY FOR WISCONSIN’S LONG TERM CARE PROGRAMS WISCONSIN’S LONG TERM CARE PROGRAMS. Medicaid Eligibility Handbook. http://www.emhandbooks.wi.gov/meh-ebd/ Ch. 15 – Income

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Betsy Abramson Disability Rights Wisconsin' - ryanadan


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Betsy abramson disability rights wisconsin august 2009 l.jpg

Betsy Abramson

Disability Rights Wisconsin

August 2009

FINANCIAL ELIGIBILITYFINANCIAL ELIGIBILITY FOR WISCONSIN’S LONG TERM CARE PROGRAMS WISCONSIN’S LONG TERM CARE PROGRAMS


Medicaid eligibility handbook l.jpg
Medicaid Eligibility Handbook

  • http://www.emhandbooks.wi.gov/meh-ebd/

  • Ch. 15 – Income

  • Ch. 16 – Assets

  • Ch. 17 – Divestment

  • Ch. 18 – Spousal Impoverishment

  • Ch. 28 – Home and Community-Based Waivers

  • Ch. 29 – Family Care Long-Term Care


General medicaid eligibility medicaid waiver eligibility l.jpg
General Medicaid Eligibility≠ Medicaid Waiver Eligibility

  • Different income limits.

    Three different sets: Category A, Category B,

    and Category C

  • Asset limits

    • If have a spouse who is not applying for waivers

      or in an institution, “spousal impoverishment” protections available 

  • NOTE: Estate Recovery applies.


Income limits category a l.jpg
INCOME LIMITS: Category A

  • SSI, SSI-E, Section 1619 benefits, widow/widower’s benefits, “503” cases and disabled adult children.

  • NOTE: Automatically $ eligible for COP-Waiver

  •  No cost-share liability towards cost of services.


Income limits category b l.jpg
INCOME LIMITS: Category B

Special income limit of 300% of federal SSI benefit rate.

$674 X 3 = $2,022 per month in 2009.

May have a cost-share. Depends on income deductions and allowances, medical/remedial expenses, and whether a “spousal impoverishment” situation


Income limits category c l.jpg
INCOME LIMITS: Category C

Income above the $2,022/month but

Many many Income deductions and medical/remedial expenses bring down their “countable income” below current “medially needy” MA income limit: $591.67

EXAMPLE: Individual with $2,422 month has spenddown of: $2,422.00 - $591.67 = $1,830.33 per month

The spenddown is their cost-share.


What is unearned income 1 2 l.jpg
What is Unearned Income? 1/2

  • Income from Trusts

  • Sick Benefits

  • Unemployment Compensation

  • Retirement Benefits

  • General Relief and Charity

  • Gifts

  • Land Contract

  • Loans

  • Interest Income …..and…..


What is unearned income 2 2 l.jpg
What is Unearned Income? 2/2

  • Social Security Benefits

  • Lump Sum Payment

  • Money for School

  • Child Support

  • Profit-Sharing

  • Income Received by Member of Religious Order

  • Federal Match Grants for Refugees

  • Gambling Winnings

  • Payments to Native Americans


Income exemptions l.jpg
INCOME EXEMPTIONS

  • Major Exemptions:

    • First $20 disregarded

    • Part of wages:

      • Only counts: [(Total Monthly Wages – $65) / 2]

        = Wage amount counted

      • Example: If wages = $465/month, then:

        [($465 – $65) / 2] = only $200 counts

  • Many others: Some examples: Adoption, Agent orange, Combat…..Kinship….Payments to Nazi Victims…..Susan Walker Payments…VA Allowances….W2 Payments, American Recovery and Reinvestment Act of 2009.


Assets l.jpg
ASSETS

  • Limits:

    $2,000 for individual

    $3,000 for couple if both applying

    If only one spouse applying:

    See: Spousal Impoverishment


Exempt assets examples l.jpg
EXEMPT ASSETS – Examples:

(These don’t count against the limit)

  • Primary residence  up to $750,000 equity

  • One auto,  if used for transportation by applicant or household member

  • Personal possessions and home furnishings 

  • Wedding and engagement rings

  • Equipment used for self-support

  • Life Insurance up to $1,500; otherwise…

  • Term insurance in any amount (no cash value)

  • Burial – see next


Exempt assets l.jpg
EXEMPT ASSETS

Burial Assets:

  • Up to $3,000 in irrevocable burial trust

    • Interest can also be made irrevocable and thus exempt

  • Pre-paid burial spaces in any amount

    Plots, caskets, values, crypts, mausoleums, urns, niches, headstones, plaques, opening/closing arrangements. And for other family members!

  • $1,500 separately identifiable revocable burial fund. If so, offsets funds permitted in IBT.

  • Life-insurance funded burial arrangements


Divestment l.jpg
Divestment

  • Giving away or transferring non-exempt assets, or the home in some situations, for less than FMV.

  • Lookback period: FIVE YEARS

  • Penalty Period: Starts when assets otherwise spent down.

  • Ex.:

    • Giving grandchildren large gifts at b-days, holidays?

    • Giving money to adult kids for downpayment?

    • Paying for a kid’s wedding?

    • Contributing to grandkids’ college?

    • Bailing adult kids out of debt, trouble?


Divestment lots of specific rules l.jpg
Divestment: Lots of specific rules

  • Annuities…

  • Life estates…

  • Promissory Notes, Loans or Mortgages…

  • Partial Month Divestments…

  • Partial Refunds…

  • CCRC entrance fees

  • Intent*

  • Undue Hardship*

    *See next slides


Intent to divest l.jpg
“Intent” to Divest?

Not divestment if can prove:

  • Had made other arrangements to provide for LTC

  • Life expectancy at transfer was less than 5 years

  • No expectation of LTC needed for next 5 years

  • Had pattern of charitable giving or to family members (prior to look-back period) AND annual gifts less than 15% of gross income.

  • Ffor educational or vocational goals of family

  • Is support of dependent relatives living with them


Divestment undue hardship l.jpg
Divestment: Undue Hardship

  • Penalty period waived if imposition deprives individual of:

    • Medical care such that health or life would be endangered; or

    • Food, clothing, shelter or other necessities of life

  • Generally must request within 20 days of notice

  • Special Required Documentation

    • Notice of discharge from facility or

    • Costs of needed LTC services compared to income and assets


Divestment warning l.jpg
Divestment: WARNING!

  • Complicated

  • Significant potential consequences

  • Client should get good legal advice from experienced knowledgeable counselor


Spousal impoverishment l.jpg
Spousal Impoverishment

  • Old days (pre-1989): Spouse without LTC needs went broke, too.

  • Now: protects income and assets of spouse who:

    - is not in institution

    - not on COP/CIP/ FC, etc.

  • Only for legally married spouses. Not partners. Not adult kids.


Spousal impoverishment assets l.jpg
Spousal Impoverishment Assets

  • Don’t count exempt assets.

  • Then, regardless of “name on title”



Spousal impoverishment income l.jpg
Spousal Impoverishment – Income

  • Non-MA spouse keeps ALL income in own name

  • Can get allocation from MA spouse’s income to bring “her” income up to lower of: $2,739 or $2,428.33 plus excess shelter allowance

  • Excess Shelter Allowance: amount above $728 for mortgage/rent, taxes, maintenance fees and utility allowance


Example george and laura l.jpg
Example: George and Laura

  • George on Family Care; Laura not

  • George’s income:

    $ 845 Social Security

    $ 1200 Pension

    $ 1000 Monthly speaker’s fees

    TOTAL: $2045/month

    Laura’s income

    $ 600 Social Security

    $ 400 Librarian pension = TOTAL $1,000/month

    Mortgage and utilities are $1,228


Laura s allocation l.jpg
Laura’s allocation

  • ESE is $1,228 - $728 = $500

  • Laura gets some of George’s income, to BRING HER UP to lesser of: $2,739 or [$2,428.33 + $500] so, $2,739

  • George’s: $2,045 - $45 for him= $2,000 available

  • George can allocate to Laura $1,739:

    Now Laura has: $1,739 + her $1,000 = $2,739

  • Note! If George didn’t have $1,739, State doesn’t subsidize.


Estate recovery and liens l.jpg
Estate Recovery and Liens

Applies to benefits rec’d in

  • All ages: NHs since 10/91

  • Inpatient hospital benefits after 7/95 if “institutionalized recipients”

  • Age 55+: Skilled nursing, home health aide, therapies, private duty nursing, personal care (since 4/2000)

  • Waiver (COP, CIP, Brain Injury, FC) since 2/2000


Methods of recovery l.jpg
Methods of Recovery

  • Happens after death of recipient

  • ONLY AFTER DEATH

  • Claims in Probate Estates

  • Liens on homes


When no recovery or lien l.jpg
When no recovery or lien

  • If is a surviving spouse

  • If a surviving disabled child

  • If surviving minor child

  • If surviving blind child


Estate recovery after l.jpg
Estate Recovery After:

  • Cost of administering the estate

  • Funeral Costs

  • Costs of last illness


Heirs can keep l.jpg
Heirs Can Keep:

  • Decedent’s wearing apparel and jewelry

  • Household furniture, furnishings and appliances

  • Other tangible personal property under $3,000 – not cash of $3,000


Waivers of claim undue hardship l.jpg
Waivers of Claim: Undue Hardship

  • Heir or beneficiary would become eligible or remain eligible for SSI, FS, AFDC, MA

  • Estate contains real estate used as part of heir or beneficiary’s business

  • Heir or beneficiary is receiving general relief or veterans benefits based on need.


Liens l.jpg
Liens

  • On homes, but NOT PLACED on home of a recipient in community

  • NOT PLACED ON HOME OF RECIPIENT IN COMMUNITY !!!

  • Prior notification required

  • Only if recipient not reasonably expected to return home and if none of these in home:

    • Certain caregiving adult child at least 24 months before

    • Sibling who continuously lived there at least 12 months before admission


Examples l.jpg
Examples

  • Fred and Wilma

  • Will and Grace

  • Homer and Bart


ad