Medicaid Eligibility and Aging in Place
By Benny Lamm, Senior Planning Services
Many senior citizens prefer to remain in their homes. They don't want to have to enter a nursing home, nor do they want to move in with a family member, at least not before they absolutely have to. Home care is the logical answer for an aging individual who is having trouble completing all of the tasks necessary to live alone, but who wishes to stay at home nonetheless.
The Recent Debate about Home Care
Recently, it has come to light that many private in-home caregivers aren't receiving the same minimum wage considerations as other businesses. Private caregivers--that is, those who are hired directly by the individual, not through a company--are working long hours, performing tasks that are often very difficult or personal, and yet are not being compensated appropriately for it. While many organizations have brought in-home caregivers together to give them fair wages and benefits, private caregivers don't always have those options. As this issue receives more and more national attention, it has become evident that in-home caregivers need the same benefits offered to other professionals. Unfortunately, this leaves seniors in need of in-home care in the position of having to pay increased rates.
Using Medicaid for Home Care
Medicaid HCB S services provides in-home care for aging individuals who need extra help to stay at home. The goal of this program is to allow seniors to stay in their homes, avoiding moving into nursing homes for a little bit longer. Unlike the Medicare model, these services aren't just based on medical need for temporary conditions. Instead, they're intended to help maintain quality of life for an aging individual for as long as possible. Services include:
- In-home health care
- Basic cleaning and laundry tasks
- Simple meal preparation or delivery
- Transportation to and from medical appointments
- Personal care services, including dressing and bathing
- Minor modifications, like adding a wheelchair ramp or widening a doorway
- Durable medical equipment
There are two factors that determine eligibility for Medicaid home care; medical need and financial need. For the medical need factor, an evaluation will be made to determine whether or not the applicant is in need of the services they're requesting. An individual who is no longer able to complete daily tasks such as personal care or cooking is considered to be in need of in-home care.
For financial eligibility, the requirements vary greatly by state; however, in order to qualify in any state, most individuals will need to have few assets and low income. The state of New York, for example, requires that an individual applicant have less than $14,850 in liquid assets and an income of less than $845 per month in order to qualify. This asset limit is relatively high compared to the asset limit in CT, which is only $1,600. The income limit in CT is significantly higher, at $2,199.
Assets above this limit can be spent down on qualifying purchases to bring the Medicaid applicant under the asset limit. This can get complex and the help of a Medicaid planning expert is often recommended. Any income above these state brackets can be placed in a pooled income trust, or a Miller fund—depending on the state, which will not hinder Medicaid eligibility.
In some states, a family member can be paid through Medicaid to serve as a caregiver. Often, once eligibility is determined, a senior is able to choose their own caregiver, who will then be paid through Medicaid funds. This is taxable income, so it's important that the caregiver report those funds appropriately.
Veterans Benefits offers unique opportunities for in-home care for veterans and their spouses. This coverage amount is not dependent on being injured during their service, but helps cover needed services as a veteran ages. Under this program, the veteran and/or their spouse are both covered for in-home care services. Eligibility criteria are based on one’s active duty status, whether one was honorably discharged from service in the army, and other program criteria.
For a senior looking for a solution other than a nursing home, in-home care provides a valuable way to maintain quality of life while still staying in their own home. While there are strict income and resource limits, many seniors will find that they meet these eligibility requirements, allowing them easy access to the care they need.
Aging in place is a popular option when an individual is in the early stages in LTC. It is important to note, though, that in home care is not for everyone and is not always the best option for those that require the level of care one typically receives at a nursing home or assisted living facility.