Medicaid is complicated. But with 70% of seniors needing long-term care and Medicaid as the largest payer, there is a good chance you or someone you know will need assistance in your life. Unlike Medicare which relies on medical need, Medicaid is income-based. if you have accumulated assets, you need to know about Medicaid. Read on to learn about the many Medicaid services in Indiana and asset protection.
Indiana Medicaid Basics
Medicaid is a joint medical coverage plan between the federal and state governments. The Center for Medicare and Medicaid Services (CMS) oversees Medicaid. Each state governs its Medicaid program. Unlike Medicare which eligibility is age and medical specific, Medicaid coverage depends on income. As of June 2017, nearly 22% of Indiana residents received Medicaid.
There are many Medicaid and Social Service plans available to Indiana seniors and their family members including:
Hoosier Healthwise covers low income parents, caretakers, pregnant women, and children up to age 19.
Hoosier Care Connect covers seniors 65 and over, blind, or disabled people not eligible for Medicare. The health plan provides most of the Medicaid benefits through a group of doctors, pharmacies, and hospitals. Covered services include dental, chiropractic and podiatry (foot) care, eye care (excluding surgery), mental health and substance abuse, transportation,
Medicaid for Employees with Disability (M.E.D) covers disabled employees.
Healthy Indiana Plan (HIP) covers low income adults ages 19-64, 138% below the federal poverty level, and not eligible for Medicare or other medical assistance.
Traditional Medicaid covers low income Medicaid, Medicare, and refugee individuals. Coverage is typically limited to long-term care. However, Traditional Medicaid coverage may include medical and surgical services, hospitalizations, doctor visits, prescription drugs, dental and vision, and family planning. Traditional Medicaid also covers home and community-based services (HCBS) waivers.
Waiver services allow members to stay in their community and keep them out of an institution like a nursing home. The Aged and Disabled Medicaid Waiver helps disabled people remain in the community. The waiver covers alternative living to a nursing home. Applicants must be eligible for full Medicaid to qualify. Examples of covered services include Adult Day Care, Assisted Living, home modifications, homemaker services, health care coordination, meal delivery and supplements, personal emergency response systems (PERS), respite, and transportation.
The Community Integration and Habilitation Waiver (CIH Waiver) is a needs-based for anyone whose primary caregiver is 80 or over or is no longer available, suffers abuse in an institution or home placement program, or is at emergent risk of other health or safety concerns.
Medicare Savings Program covers payments not covered by Medicare. Medicare Part B premiums and Medicare Part A and B expenses are also covered.
HoosierRx helps pay Medicare Part D premiums to a limit of $70 a month. The program has annual income limits of $18,330 for a single person and $24,600 for a married couple living together.
Presumptive Eligibility for Pregnant Women (PEPW) provides short-term prenatal services pending a Medicaid application.
Three Medicaid programs provide coverage for serious disorders including mental and emotional health, and substance abuse while allowing members to stay in the community.
The Care for the Elderly and Disabled (CHOICE) program helps disabled seniors 60 and over stay in their home or community. The CHOICE program cannot be used with Medicare or other Medicaid programs. Examples of services covered by the CHOICE program include Adult Day Care, Case Management, home modification, Home Health aide, Personal Emergency Response System (PERS), skilled Nursing care, and transportation.
Deaf and Hard of Hearing Services (DHHS) helps eligible members as defined by the Americans with Disabilities Act (ADA) and their families with consultation and education.
The Family Caregiver program recognizes helps caregivers of seniors 55 and over. The program also helps seniors 55 and over who care for grandchildren. The program covers home and community services.
The Money Follows the Person (MFP) program helps people move from institutions to home and community settings.
The Older Americans Act programs helps seniors age 60 and over with home and community services. Funds are limited for the Older Americans Act programs. Examples of program services are Adult Day Care, caregiver support, case management, home modifications, legal assistance, Personal Emergency Response Systems (PERS), and transportation.
Traumatic Brain Injury Medicaid Waiver (TBI Waver) helps eligible individuals with home and community services. Eligibility includes someone who suffered a traumatic brain injury and requires a nursing home or intermediate setting for the intellectual disabled. A special income limit is also required.
Resource Limits, Income, and Assets
Indiana Medicaid uses the term resources for assets. Resources and income limits determine Medicaid eligibility in Indiana. These limits also decide the amount the individual must contribute to expenses. In general, most Medicaid programs allow a single person to retain assets of $2000 and a married couple to retain $3000. Examples of resources or assets include:
Certificates of Deposit
Individual Retirement Accounts (IRA’s)
Whole Life Insurance
Income limits are another source Medicaid uses to determine eligibility. Combined income is considered for married couples. Income includes pensions, social security benefits, money from rental property, interest on loans and mortgages, dividends, beneficiary benefits from life insurance, some forms of capital gains, and spousal income with the following acceptable deductibles:
Health insurance premiums
Costs to care for incapacitated adult or child
Paid costs related to court order support
Medicaid and Long Term Care
Low income is the primary requirement for Medicaid eligibility. Medicaid is the primary payer of long term care services. However, Medicare pays the first 100 days of a nursing home stay. Some people are dual eligible for both Medicare and Medicaid. In this care, Medicare pays for eligible benefits before Medicaid. Long term care includes institution and community services that help restore or preserve health and well being. Examples of long term care include a nursing home, home health care, custodial care, Assisted Living, and Adult Day Care. Indiana offers a Long Term Care Insurance Program (ILTCIP). The ILTCIP is a joint insurance program between the State of Indiana and private insurance companies. The Indiana Long Term Care Insurance program (ILTCIP) provides asset protection for Medicaid members in a nursing home. However, the ILTCIP does not protect income.
Asset Protection and Look Back Period
A challenge for seniors on Medicaid in a nursing home is asset protection. The limited amount of assets or resources allowed by Medicaid can impact an estate plan. In addition, there are strict asset transfer rules under Medicaid. For example, Medicaid looks back 3 years from the time of application to make sure no assets were transferred below fair market value. Medicaid looks back 5 years for trusts. Assets transferred within these time frames leads to ineligibility. A person may reapply after waiting out the time frame.
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