Applying for assistance to pay for your medical needs can be a nerve-wracking experience. Your questions aren’t on the list of FAQs, and you wonder if it’s even worth trying to apply.
These and other discouraging thoughts assail even the most proactive people. To get the clarity you need to go forward, it’s important to find a trustworthy, accurate source of information.
Legacy Navigation puts all the details in one place to save you the headache. Here you’ll find up-to-date guidance about what makes seniors eligible or ineligible for Medicaid assistance.
Table of Contents
- How Do I Qualify for Medicaid as an Elderly Person?
- 3 Must-Know Financial Requirements for Seniors Qualifying for Medicaid
- 3 Non-Financial Requirements Every Senior Should Know About for Medicaid Eligibility
- What Disqualifies a Person From Getting Medicaid?
- Common Misconceptions About Seniors Qualifying for Medicaid
- Application Requirements: What Seniors Need to Qualify for Medicaid
- Take Control of Your Medicaid Planning With Legacy Navigation
How Do I Qualify for Medicaid as an Elderly Person?
There are various factors affecting eligibility, though it is sometimes possible to qualify even if you don’t meet certain criteria. This is because some states offer optional coverage that is more extensive than the mandatory coverage required by the federal government.
When you apply for Medicaid, you’re documenting your qualifications so they’ll be officially recognized. But to people not well-versed in the intricate details of the whole system, it might feel more like asking a dubious question: Do I qualify?
Legacy Navigation is here to help you in the application process so you can fully understand the extent of your qualifications and the maximum coverage you can legally attain. Contact us today for assistance from our Certified Medicaid Planners™.
3 Must-Know Financial Requirements for Seniors Qualifying for Medicaid
#1: Income
Your income must lie at or below 138% of the federal poverty level, which is a measurement of income updated every year by the Department of Health and Human Services. It is updated to account for inflation and varies based on your household size.
Income included in the comparison may be earned or unearned, such as:
- Wages, tips, and earnings from self-employment
- Alimony, pensions, and Social Security benefits
- Unemployment benefits
- Cash gifts from loved ones
Though it varies by state, some portions of income may not be counted toward the determination of Medicaid eligibility, including:
- Some VA assistance, such as the Aid and Attendance pension or the Housebound Allowance
- Holocaust restitution payments
- Deductions determined by the state (e.g., the $20 general income deduction or the $65 earned income deduction)
If you are married and applying for Medicaid or a Medicaid waiver, your spouse’s income is not included. It is required, however, for the application for Aged, Blind, and Disabled Medicaid.
#2: Assets
Asset limits vary by state, but are typically $2,000 for an individual and $3,000 for a couple. Just as with income, assets may be countable or uncountable. Countable assets include:
- Cash
- Stocks, bonds, and investments
- Bank accounts
- Retirement accounts (IRAs, 401ks)
- Real estate in which you don’t reside
Uncountable assets include:
- The home in which you live
- Personal belongings and furnishings
- Irrevocable burial trusts
- Automobiles
If you are married, your assets are considered to be jointly owned.
#3: The “Look-Back” Period
The length of time varies by state, but the look-back period refers to the (usually) five-year period directly preceding the application date. If income or assets were gifted or sold for less than fair market value, Medicaid assumes it was done to meet the asset limit and enacts a penalty period of Medicaid ineligibility.
The only exception to this rule is if the applicant can prove a three-year pattern of giving no more than $4,000 per year. In this case, there is no penalty.
3 Non-Financial Requirements Every Senior Should Know About for Medicaid Eligibility
#1: Age and Residency Rules
To be a Medicaid recipient, you must be a U.S. citizen or an eligible non-citizen (e.g. legal resident, refugee, or asylee), and live in the state in which you are applying. You cannot be enrolled in Medicaid in two states at a time.
Age requirements depend on the program you are applying for. For Medicaid for the elderly, blind, and disabled, you must be 65 years or older if you are not afflicted with a disability or blindness.
#2: Medical Need and Level of Care Criteria
Depending on the program you are applying for, you must demonstrate a need for medical assistance or financial assistance to meet medical needs:
- Nursing home care and waiver services: Applicants must show a need for a nursing home level of care.
- Assistance with home modifications: Applicants must prove they are unable to live at home without modifications.
- Long-term care services via regular Medicaid: Applicants must show a functional need with Activities of Daily Living (ADLs).
#3: State-by-State Variations in Rules
Medicaid is a state-run program, so each state has its own requirements and regulations. Traversing the landscape can get confusing and overwhelming. For answers to specific questions about eligibility in your state, you may appreciate the help of someone who is intimately acquainted with the intricacies of Medicaid policies all over the country.
Legacy Navigation is qualified to provide Medicaid planning services in 46 states and knows about the different qualifications for each.
What Disqualifies a Person From Getting Medicaid?
Regardless of your eligibility, some factors can automatically disqualify you from receiving Medicaid benefits, including:
- Owing a debt to the state, such as unpaid taxes or fines
- Fraud or misrepresentation
- Financial changes after you submit your application
Failure to demonstrate the financial and non-financial qualifications described earlier makes applicants ineligible for Medicaid, but there are ways to secure some benefits without meeting the income requirements. These include the Medically Needy Pathway, Asset Spend Down, and Medicaid Planning.
Legacy Navigation will help you determine whether you qualify for Medicaid, so you can be confident about applying.
Common Misconceptions About Seniors Qualifying for Medicaid
Some seniors may not consider applying for Medicaid on erroneous grounds, simply because they believe some common misconceptions about eligibility. Here are a few:
- I have too much in savings. While savings accounts are generally considered a countable asset, you can set up an irrevocable family trust and transfer your savings to it. This must be done five years before applying for Medicaid, and there are strict requirements concerning what you may use the money in the trust for.
- I’ll lose my home. The applicant’s primary residence is not counted among the assets that determine eligibility. If you are married and have to go to a nursing home, your spouse may continue to live in the home. If you do not need nursing home care, you may continue to live in the home and receive Medicaid-funded in-home care.
- I missed the deadline. Medicaid enrollment is open year-round. There is no deadline past which your application will be rejected. There is a deadline for renewal, however, and you can lose your coverage if you miss it.
- I can’t give any assets/money to my children without a penalty. The look-back rule doesn’t preclude gifts within the five years prior to application. Some gifts may be allowable if they are in accordance with the prudent person principle and the applicant can demonstrate it wasn’t a move made to qualify for Medicaid.
Everyone’s circumstances are different, carrying subtleties that can make determining eligibility for Medicaid a headache. This is one kind of difficulty Legacy Navigation is fully prepared to handle. Contact us today with your questions.
Application Requirements: What Seniors Need To Qualify for Medicaid
When you apply for Medicaid, be sure to have the following information and/or documents handy:
- Proof of identity and citizenship
- Social security number
- Proof of income
- Records of medical care/diagnoses
- Documentation of each of your assets
- Any additional documents required by your state
You might be wondering which documents are sufficient as proof. Legacy Navigation can help ensure you have gathered all the necessary documentation to successfully apply for Medicaid.
Take Control of Your Medicaid Planning With Legacy Navigation
You can trust the Certified Medicaid Planners™ at Legacy Navigation to advocate for you as you apply for Medicaid coverage. We also offer financial planning and asset protection services, which often go hand in hand with pursuing health insurance benefits.
Contact us today to discuss how we can make the convoluted queries and cumbersome paperwork involved in Medicaid enrollment a breeze.
