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Medicaid Changes to Affect Seniors

Because health care – particularly long term care – can be expensive for elders and others with special needs, it is critical that anyone looking for Medicaid qualification take action before June 14, 2011.  As a geriatric care manager, we help elders and special needs individuals as well as their caregivers to navigate Medicare, Medicaid and the other entities that provide safety nets for those who qualify. 

There are changes in store for Medicaid that may affect who qualifies and how they qualify after June 14 of this year.  I had the benefit of sitting in recently on a presentation by an elder law attorney in the Chicago area, Janna Dutton, who helped shed some light on the subject.

Medicaid is mandated by the federal government, but the details of how it applies and how it is financed are the domain of state government.  I will be talking in this posting about what we know now about Illinois law as well as what we do not know.  So, let’s start with an individual who is seeking to apply for Medicaid in Illinois. 

First, of course, that person must be a legal resident, but that part is simple.  For Illinois, a resident simply is someone in Illinois (for no specific duration) with no intention of leaving.  There is no duration of residency required.  To qualify for Medicaid, however, an individual cannot own a home outside Illinois, not even a vacation home.  And the individual must be over age 65 or be eligible for Social Security Disability benefits.

Presently, a person will qualify for Medicaid only if they have no more than $2,000 in liquid assets, but this does not include a home (which can be valued at no more than $750,000 if the applicant plans to return home after their stay in a nursing home).  State government has a “look back” period of 36 months prior to application.  That is, they will “look back” three years at an applicant’s finances to see if there were any expenses or “gifts” that may appear to be efforts to deplete funds for the sake of qualifying for Medicaid.  Any suspect monies expended will be added back to existing assets.  Anything over the qualifying amount then will be spent before Medicaid contributes to the person’s care. 

Exceptions may include “gifts” that have been a longstanding pattern of giving by the applicant (for instance, dollar amounts consistently given to grandchildren upon marriage, graduation, etc.)  The date from which the spend-down starts presently is the date of the gift that forced assets to exceed the $2,000.  Asset qualifications for applicants may be what will most change after June 14.  After June 14 it may be as much as a 60-month look back, and the ineligibility may start at the date of application rather than the gift. 

The financial scrutiny also extends to accounts that may be held jointly with a caregiver or relative.  The joint account will be considered the exclusive asset of the applicant unless there have been regular deposits to this account by the non-applicant.  For this and all accounts, the responsibility for documenting paperwork is that of the applicant.

This is some of what we know, but it is what will change after June 14, 2011, that we cannot fully know.  I recommend you seek counsel from a qualified Illinois attorney, and I particularly recommend you go to Janna Dutton’s website for helpful information and advice about this and other elder law issues.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago.  Please email your questions to Charlotte Bishop.


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