Often, older individuals need a moderate level of care, but do not necessarily need to leave their home and enter an assisted living facility or a skilled nursing facility. With a moderate amount of care provided by in-home care, the individual can remain in the home and in the community, living comfortably with the assistance of home health care.
If an individual has care needs, but those needs do not require a nursing home level of care, a move out of the home. In this case, home health care from a home health agency. If the individual has a low level of countable assets or is considered low income, Medicaid eligibility should be investigated. Medicare does not pay for long term services and supports in the home, but Medicaid Home and Community Based Services (HCBS) will pay for in-home care or personal care in the home, for long-term care as long as the personal care is needed. HCBS services can also pay for adult day care.
There are many Medicaid programs with many asset limit and low-income limit requirements. Medicaid eligibility for HCBS Medicaid assistance are exactly the same as the Medicaid eligibility requirements for a nursing home level of care in a skilled nursing facility (often referred to as long-term care Vendor Medicaid). As such, all of the planning tools used (and described throughout the QMC Medicaid University articles) can be applied to planning for home personal care services or a personal care assistance in the home. The eligibility requirements and long-term care planning options are exactly the same from a financial perspective as those used when contemplating nursing home care.
For single or widowed individuals, the asset limit is exactly the same (in Missouri, the Medicaid eligibility limit is currently $6,000). The same Medicaid application form is used. If the individual is over the assets limit. the same tools are available to shorten the time when the Medicaid applicant reaches Medicaid eligibility, including payment of debt, payment on a home mortgage, home modifications, or purchase of a burial plan. Irrevocable trusts can be used. For a variety of reasons, Medicaid compliant annuities do not fit well with HCBS services.
Any gifts made by the prospective Medicaid applicant are subject to a penalty period, calculated in accordance with the size of the gift made.
For married couples, the spouse without the care needs is considered the Community Spouse, even though both spouses are living in the community, and a Division of Assets can be filed.
There is one difference between Vendor Medicaid and HCBS Medicaid, and that is with the treatment of income. For home health Medicaid, there is technically an income limit. However, through the use of a “Miller Trust” the income limit is modified and all those in need are able to meet the Medicaid eligibility limits regarding income.
When a person applies for home Medicaid services, a state social worker will be assigned to ensure that the applicant is indeed in need of in in home health aide. Activities of daily living is part of the case management and will be assessed and the level of need required will be calculated.
All of these planning techniques require the guidance of a professional to achieve all planning goals. QMC’s expertise can be invaluable in bringing paid home care into the home. Additionally, many elder law attorneys are well versed in this planning. Estate planning modifications may be employed to reach all goals.
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