The Iowa Medicaid program for Iowa residents covers a variety of healthcare related services for low-income and low asset Iowans. Medicaid eligibility requirements vary from Medicaid program to Medicaid program, but all programs are based on a lack of ability to private pay for health insurance and being under the asset limits. In the state of Iowa, the Medicaid program is managed by the Iowa Department of Health and Human Services (HHS). Iowa HHS administers many programs for low-income and low asset families, including processing Medicaid applications and managing the application process.
The most relevant programs for Iowan seniors are Medicaid’s home and community based services (HCBS) and nursing home care (in long-term care facilities) and health coverage related to those care services. Medicare does not cover these care services such as long-term care, in-home services, and personal care services, so the federal and state Medicaid services provide these programs for those who cannot afford them. Under these programs, Medicaid will pay providers and nursing homes directly for those who meet eligibility criteria and achieve enrollment. For those who exceed the applicable income limit, the Iowa Medicaid member is often required to “spend down” a portion of their Social Security and other income as a co-pay before the member services begin. For home and community based services, Medicaid will pay the caregiver (or caregiver agency). This process involves an HCBS waiver from other services in order to allow the Iowa Medicaid member to remain in-home. The HCBS Elderly Waiver can also be used at the assisted living level of care, allowing individuals to reside in a more independent setting while still receiving care services.
In the case of married couples, when one spouse enters long-term care and requires Medicaid coverage, Iowa Medicaid will set aside a certain amount of assets, which protects the non-applicant spouse (also known as the community spouse) from becoming impoverished. In addition to this community spouse resource allowance, key exempt assets for both married couples and individuals are the primary residence, one vehicle, and personal belongings. However, while the primary residence is exempt from the asset limit, it is not exempt from the Iowa Medicaid’s estate recovery program. Following an Iowa Medicaid beneficiary’s death, Iowa HHS will attempt recovery of care costs through whatever assets of the deceased remain, usually the home. With proper Medicaid planning strategies and by working with a Medicaid planning professional, strategies can be employed to prevent estate recovery while preserving financial eligibility. Please contact QMC to learn more about ways to receive assistance for care at home, in assisted living, or in a nursing home today.