What Is Community Medicaid – What Does Community Medicaid Cover?

Community Medicaid is a specific type of long-term care Medicaid that allows recipients to stay in-home or in an assisted living facility. Community Medicaid benefits are often provided through waiver services like Home and Community Based Services (HCBS) or the Aged, Blind, and Disabled Waiver (ABD). In order to achieve Medicaid eligibility, one must meet the financial eligibility requirements as well as have a functional need for a nursing home level of care. One must be low-asset and low-income, although people who are over assets or over income can do a spend-down. Excess assets can be spent on things like medical bills or home improvements, and excess income can be spent on healthcare expenses through the Medically Needy Pathway. Once income has been spent down for the month, Medicaid coverage kicks in and Medicaid covers the rest of the health care expenses for the month. Income over the income limit can also be diverted to a Qualified Income Trust (QIT), also known as a Miller Trust. However, assets in a QIT may only be spent on healthcare expenses, like medical equipment, prescription drugs and health services. Like Medicaid long-term care services, some community Medicaid programs have a look-back period, which varies by state. Additionally, after the application process and enrollment in state Medicaid, the look-back period still applies, so Medicaid recipients cannot gift assets away. If you or a loved one are considering applying for Medicaid, it is important to visit an elder law attorney to utilize Medicaid planning and estate planning services. An attorney may be able to use these strategies to avoid estate recovery, which is when Medicaid seizes assets after a Medicaid beneficiary’s death. Quality Medicaid Care and its sister entity, the Elder and Estate Planning Law Firm are located in St. Louis, Missouri and can assist you and your loved ones with Medicaid applications, estate planning, and general elder law services.