Two Sides to Long Term Care Medicaid


JG Medicaid Consulting LLC

Posted on

Sep 01, 2019


Colorado - Western Slope

The Long Term Care Medicaid program for the elderly and disabled can help pay for in-home care, assisted living situations, or even skilled nursing facilities. For this reason, the Long Term Care (LTC) program has both functional and financial requirements that must be met by the applicant to be eligible. Potential clients must meet a nursing home level-of-care determined by the county in which they live. The client must also meet financial criteria in which income and resources are reviewed to be sure limits are not exceeded.
The nursing home level-of-care criteria will be determined by a county-approved case manager. The case manager will meet with the client and family to find out exactly what the applicants physical limitations are and even his or her mental capacities, such as dementia or Alzheimers. Family, caregiver, and doctor input is also collected to make the functional assessment complete. The documentation from the case manager is required by the financial technician for the county to complete the application process.
The financial eligibility process is usually the most complicated to clients and families because of the amount of paperwork involved. This is where a Medicaid consulting agency can help. These agencies can offer clients another option besides working with the county directly or a costly attorney.
Some basic information regarding financial eligibility in 2019 (*) is:

Applicant must be 65 or over and receiving SSA benefits, OR
If under 65, the applicant must have been deemed disabled by SSA and now receiving SSDI.
For single individuals, a $2000 resource limit applies.
If married, the couples combined resources cannot exceed $126,420 if only one person is applying. If both people apply, the resource limit is $3000.
An applicants gross monthly income (income prior to any deductions) cannot exceed $2313.

However, if gross income is between $2313 - $8117, an income trust may allow client LTC benefits if State approved.
If the applicant has gross income over $8118/mo, LTC is not available due to being over the income limit.

(*) Amounts listed are for 2019 and are subject to change annually.
For Long Term Care Medicaid, giving resources away will create a period of ineligibility (POI) aka a penalty period. The penalty, based on the total amount of gifts, will begin when the client is otherwise eligible and must be served in its entirety before the applicant can receive LTC benefits. The best way to avoid this scenario is for the applicant (and spouse) to use the funds for their own needs and care in this rainy day time of their lives.
All income and resources must be reported at the time of application. Examples of various income types include but are not limited to:

SSA benefits (SSA, SSDI, SSI)
VA benefits (disability, pension, survivor)
Railroad Board pension
PERA annuities
Dividends, interest
Gas and oil royalties
IRA disbursements
Promissory not income
Private disability income (from insurance companies)
Long Term Care insurance payments
Rental income

Examples of various resource types include but are not limited to:

Bank accounts (checking, savings, CDs)
IRAs, 401k
Investments (stocks, bonds, mutual funds)
Property (home, secondary property/rental properties, land, time shares)
Home sale proceeds
Life insurance case values
Vehicles (cars, trucks, ATVs, boats, trailers, campers)
Trusts (any type of Trust must be reported)
Prepaid funeral/burial policies (cremations, funerals, plots)

Long Term Care Medicaid is a very useful program for many people and should be among the first options reviewed by a family looking for extra help for their family member.

This article was submitted by Joell Grey, owner of JG Medicaid Consulting. She can be reached at 970-216-4999 or

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