MO HEALTHNET

F/K/A MEDICAID

AND

VETERANS ADMINISTRATION

Martha C. Brown, CELA220 W. Lockwood, Suite 203

St. Louis, MO 63119T (314) 962-0186F (314) 962-1298

American Parkinson Disease Association

Symposium 2014

What was called “Medicaid”Most common program

Medicaid to pay for medical services“Card for services”/”straight” Medicaid

Payment source for health care received

MO HEALTHNET

53 Different Medicaid programsAll have different eligibility rules

Every state’s rules are different

Not always logical

MO HEALTHNET

Must be disabled/be medically eligible

Must be financially eligibleIncome/assets

Important distinctionRules differ for couples and singles

MO HEALTHNETNURSING HOME

PROGRAM

Single personAssets of less than $1,000 ($999.99)

Married coupleAssets of less than $2,000 ($1,999.99)

$2,000 if both spouses are institutionalized

NURSING HOME PROGRAM

FINANCIALLY ELIGIBLE

Some assets not counted regardless of valueCharacter of assets, not the value of assets

Medicaid planning is changing character of counted assets into exempt assets

EXEMPT ASSETS

Some assets that aren’t counted House Car Personal property Prepaid burial plan

EXEMPT ASSETS

First $543,000 of house equityFigure increases each year

Household furnishings

EXEMPT ASSETS (HOUSE)

One carRegardless of value

EXEMPT ASSETS (CAR)

Regardless of value, except:Unusual value of change designation from exempt asset to countable resource

EXEMPT ASSETS (PERSONAL PROPERTY)

Must be irrevocable … or have $1,500 cash surrender value life insuranceCannot have both assets

Spouse cases - $1,500 exemption each

Burial plot

EXEMPT ASSETS (PREPAID BURIAL PLAN)

If marriedWedding rings

Can keep half of couple’s assets to $234,280.00Division of Assets

EXEMPT ASSETS (OTHER MISC.)

Community spouse is allowed to keep up to 50% of $234,280 of couple’s countable assets

If assets are more than $234,280, then assets must be spend down to $234,280 before a division of assets can be made

DIVISION OF ASSETS

State of Missouri has the right to recover moneys paid through Medicaid at the death of the recipient

State recovers on Medicaid payments made after recipient is 55

ESTATE RECOVERY

Recover moneys from only the following: Recipient’s home

If no surviving spouseFrom a Special Needs Trust that provides for Medicaid to be paid at death of trust beneficiary

The Medicaid recipient’s probate estate

ESTATE RECOVERY(CONTINUED)

Birth certificatesList of all assets with the applicant’s name on the titleRemember…total must be less than a $1,000.00 (single) and $2,000 (couple)

WHAT TO BRING WHEN APPLYING FOR MO

HEATHNET

If any gifts have been made, you must report on Medicaid application

If gifts were made more than 5 years ago;Do not count (Called “Lookback Period”)

GIVING MONEY AWAY

Gifts to a disabled childGifts to a trust for a disabled personLots of rules for this exception

Give house to a child who lives with parent for 2 years or more, but would have to go to nursing home if child did not live with the parent

EXCEPTION TO “LOOKBACK PERIOD”

“Personal Care ContractPay a person under a written contract to provide services

Must follow specific rulesRecommend getting legal advice

EXCEPTION TO “LOOKBACK PERIOD”

Non-Service Connected Aid & Attendance Benefit

VETERANS ADMINISTRATION

Veteran or widow(er) of Veteran who:Served 90 consecutive days of Active Duty with one day during War Time periodWar Time Periods as declared by Veterans Administration

Received a discharge other than dishonorable

Has been declared by a physician that they need assistance of another individual to perform activities of daily living

BASIC ELIGIBILITY CRITERIA

Veteran or widow(er) of Veteran who:Has out-of-pocket medical expenses that exceed his/her total yearly gross income

Have less than $80,000 for a couple; $30,000 for a single personNot declared amounts

No Lookback Period for assets given away to be eligible for the benefit

BASIC ELIGIBILITY CRITERIA(CON’T)

Rates: Maximum BenefitsSingle Veteran: $1,732.00.00Married Veteran: $2,054.00Surviving Spouse: $1,113.00

*Figures change yearly

AID & ATTENDANCE 2014

Veteran and Veteran/SpouseVA Form 21-526

Application for Veteran filing for Non-Service Connected Pension

Surviving SpouseVA Form 21-534

Application for Surviving Spouse filing for Non-Service Connected Pension

AID & ATTENDANCE APPLICATION

Only recurrent medical expenses are considered in off-setting projected household income

Does not include any expenses for which claimant was reimbursed

Keep all receipts/documentation of medical expense for at least 3 years

VA FORM 21P-8416 MEDICAL EXPENSE REPORT

Examples of medical expensesHospital expensesDoctor’s office feesDental feesPrescription drug costsMedical insurance premiumsMonthly Medicare deductionNursing home costsHome health servicesIncontinence supplies

VA FORM 21P-8416 MEDICAL EXPENSE REPORT

Martha C. Brown, CELA220 W. Lockwood Avenue

Suite 203Saint Louis, Missouri 63119

(314) 962-00186

QUESTIONS?