What You Need To Know About Post-Medicaid Eligibility

What You Need To Know About Post-Medicaid Eligibility

Qualifying for Medicaid assistance to pay for skilled nursing home care or a waiver program, is unfortunately not the end of the process. The Department of Children and Families (DCF) has additional requirements which, if not met, will result in future disqualifications of the Medicaid recipient. Some of those requirements are summarized below and should be kept in mind by the “responsible person” and the nursing home.

The first requirement is the annual review. Each year DCF requires the applicant, through the responsible person or nursing home, to produce evidence of all assets owned by the Medicaid recipient as of the anniversary date of the original approval date. Only the assets of the institutionalized spouse, and not the community spouse, are counted. In fact, the community spouse could win the lottery after qualification, and the institutionalized spouse would still maintain Medicaid eligibility. Usually a bank statement is all that is needed, since the institutionalized spouse would have spent down his or her assets or disposed of them in some way prior to the original qualification. DCF will notify the responsible person or nursing home by mail of the annual review. Should that person fail to respond, DCF will require a new application.

The next post-Medicaid eligibility requirement focuses on the use of the Qualified Income Trust (QIT). This type of trust is used to allow the applicant to qualify for Medicaid if his or her income exceeds the income cap for the year of qualification. For the 2024 calendar year, the income cap is $2,829.00 per month. DCF requires a review at least once a year of the financial dealings within the trust by reviewing the bank statements during the year. DCF wants to make sure that the amount representing the excess over the income limit is deposited each month into the trust and that it is paid out to the nursing home, community spouse, or used to pay for health insurance. DCF also wants to make sure that all increases in Social Security, Pension and/or other income are deposited in the trust. This usually becomes part of the patient responsibility unless it is diverted to the community spouse and/or used to pay health insurance. Lastly, DCF will verify that none of the money has been used for items other than those mentioned above.

A final DCF requirement is called a change of circumstances. Whenever there is a change of circumstances, DCF requires the responsible person to notify the department within ten days of said event. This can be in the form of receipt of an inheritance by the institutionalized spouse, recovery from personal injury litigation, or a divorce. Sometimes the institutional spouse sells his or her home and receives cash proceeds. If DCF is not notified and later finds out, Medicaid will be terminated. In addition, a recovery claim will be sent to the responsible person seeking repayment for the period of time that the institutionalized person was in possession of assets in excess of the resource limit or, if transferred, then for the period of ineligibility resulting from the transfer. Obviously, if the institutionalized person receives disqualifying assets, it is incumbent upon the responsible person to seek the help of a qualified elder law attorney to assist in preserving Medicaid benefits. Unreported transfers may not only result in future Medicaid disqualification but may also cause criminal liability. The above post-Medicaid eligibility requirements are not exclusive but represent the most common requirements needed to retain hard fought Medicaid benefits.

If you have any questions concerning Medicaid Eligibility, call our office for a free telephone consultation: (305) 274-0955.