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 Medicaid - What If This System Is Necessary General Requirements The general requirements to enable you to obtain Medicaid coverage are as follows:
Each state has its own certain exceptions and/or restrictions which may also govern eligibility. Financial Requirements There are also strict financial rules which govern the provision of Medicaid, assuming that you meet the initial general requirements. Additionally, each state has modified or altered some of these requirements and you must consult state law to determine that you qualify. Generally, the financial rules are taken from the Supplemental Security Income Rules (hereinafter referred to as "SSI"), which is a portion of the Social Security Administration payments for those living below the poverty level in America. There are exceptions for those who are blind or disabled who are receiving SSI. These rules have certain restrictions on "income" and "resources" owned by a person seeking to receive Medicaid. The restrictions on each of these are complicated, but ought to be studied to determine if you, or your parent, qualifies. "Income" Income is defined under the SSI rules as any type of payment which continues on a regular basis. The types of payments included as "income" are wages, pensions, SSI, interest dividends, royalties, rent receipts, and other similar types of payments. Many states often include the value of certain other regular items, such as food or housing or other items. Naturally, the valuation of these services is subject to much contention. Income set by SSI standards varies by state, but to give you a general idea of what the income limits are one can examine the federal limit in 1995 for a single person at $478 per month, or for a couple, at $707 per month. Needless to say, this is an extremely low amount of income above which, as a general rule, would prohibit one from qualifying for Medicaid. To find out your state's restrictions or limits and what is counted or not counted as "income," you should call your local Medicaid office. However, certain "income" is not included in calculating your "income" to see if you qualify for Medicaid.
Remember, these are general rules that are subject to state law changes, and also to interpretation depending upon your circumstances. If you wish to, consult with an attorney to review each individual situation for qualification under Medicaid. As much of the income paid by other persons, or repaid in the form of loans, or payments from trusts is excluded, there is an enormous amount of planning which can be done before age 65, or before this situation arises, to be able to take advantage of the Medicaid system. "Resources" There is a second limitation on the eligibility requirements of Medicaid, which must be met before one can receive coverage under Medicaid. This is the limitation on the amount of "resources" a person may have, since Medicaid contemplates payments for you or your parent may be excluded by virtue of the resources accumulated by you, or your spouse, over the years. Generally, to receive SSI, you cannot have more than $2,000 in savings or resources, or $3,000, if you are married. Additionally, you can set aside up to $1,500 for burial expenses, or $3,000, if you are married. These same standards, with state law variations, apply to determine if you may receive Medicaid. It is important to understand what is meant by "resources." "Resources" includes:
One of the most important considerations is whether you can own a home or other property and still be eligible to receive Medicaid. Certain property is not included in the calculation of "resources" for Medicaid purposes:
As you can see, these are pretty substantial exceptions, and may enable one's parents who may have a difficult time considering themselves low income, to actually qualify for Medicaid payments. Once again, it is easy to see that these requirements are subject to interpretation, as well as differences in state law, and so if there is a close question, it may be worth the expense to consult with a lawyer about how these rules have been interpreted by courts over the years. Joint "resources" are also often the subject of much interpretation in determining eligibility. The general rule is there is a presumption that all of the money or property in joint accounts or names is yours. It is your burden to prove otherwise, and this can be done if one understands the property laws in one's state. Certain trusts are treated as "resources" while other trusts may not be. This is a critical area, and an area which can really help families whose parents suffer from a long-term, disabling illness qualify for Medicaid. Drafting of the trust is of particular importance, and as a result, we would not recommend this area by tackled without the help of a qualified attorney. You might desire to consult the Trusts section to familiarize yourself with trusts in an effort to determine if this is an area that may assist you in preparing for the possible application of this area to you or your parents. So that you can understand the types of trust provisions required to make certain that your trust will not be counted as "income" or "resources" the following are not permitted:
These are very general statements, and much more detail is required to be analyzed to fully understand how the provisions of your trust ought to be crafted. Also, there are always exceptions in the law. Thus, this area almost always should be handled by an attorney if you want to have the security of knowing that your trust will not disqualify you from Medicaid treatment.
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