Overview of Missouri Medicaid
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Transcript Overview of Missouri Medicaid
MO HEALTHNET
F/K/A MEDICAID
AND
VETERANS ADMINISTRATION
American Parkinson Disease Association
Symposium 2014
Martha C. Brown, CELA
220 W. Lockwood, Suite 203
St. Louis, MO 63119
T (314) 962-0186
F (314) 962-1298
MO HEALTHNET
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 programs
All have different eligibility rules
Every state’s rules are different
Not always logical
MO HEALTHNET
NURSING HOME PROGRAM
Must be disabled/be medically
eligible
Must be financially eligible
Income/assets
Important distinction
Rules differ for couples and singles
NURSING HOME PROGRAM
FINANCIALLY ELIGIBLE
Single person
Assets of less than $1,000 ($999.99)
Married couple
Assets of less than $2,000 ($1,999.99)
$2,000 if both spouses are
institutionalized
EXEMPT ASSETS
Some assets not counted regardless
of value
Character 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
(HOUSE)
First $543,000 of house equity
Figure increases each year
Household furnishings
EXEMPT ASSETS
(CAR)
One car
Regardless of value
EXEMPT ASSETS
(PERSONAL PROPERTY)
Regardless of value, except:
Unusual value of change designation
from exempt asset to countable
resource
EXEMPT ASSETS
(PREPAID BURIAL PLAN)
Must be irrevocable … or have
$1,500 cash surrender value life
insurance
Cannot have both assets
Spouse cases - $1,500 exemption
each
Burial plot
EXEMPT ASSETS
(OTHER MISC.)
If married
Wedding rings
Can keep half of couple’s assets to
$234,280.00
Division of Assets
DIVISION OF ASSETS
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
ESTATE RECOVERY
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
(CONTINUED)
Recover moneys from only the
following:
Recipient’s home
If no surviving spouse
From a Special Needs Trust that provides
for Medicaid to be paid at death of trust
beneficiary
The Medicaid recipient’s probate estate
WHAT TO BRING WHEN
APPLYING FOR MO HEATHNET
Birth certificates
List of all assets with the
applicant’s name on the title
Remember…total must be less than a
$1,000.00 (single) and $2,000 (couple)
GIVING MONEY AWAY
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”)
EXCEPTION TO
“LOOKBACK PERIOD”
Gifts to a disabled child
Gifts to a trust for a disabled person
Lots 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 Contract
Pay a person under a written contract to
provide services
Must follow specific rules
Recommend getting legal advice
VETERANS ADMINISTRATION
Non-Service Connected
Aid & Attendance Benefit
BASIC ELIGIBILITY CRITERIA
Veteran or widow(er) of Veteran who:
Served 90 consecutive days of Active Duty with
one day during War Time period
War 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
(CON’T)
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 person
Not declared amounts
No Lookback Period for assets given away to
be eligible for the benefit
AID & ATTENDANCE 2014
Rates: Maximum Benefits
Single Veteran: $1,732.00.00
Married Veteran: $2,054.00
Surviving Spouse: $1,113.00
*Figures change yearly
AID & ATTENDANCE
APPLICATION
Veteran and Veteran/Spouse
VA Form 21-526
Application for Veteran filing for Non-Service
Connected Pension
Surviving Spouse
VA Form 21-534
Application for Surviving Spouse filing for
Non-Service Connected Pension
VA FORM 21P-8416 MEDICAL
EXPENSE REPORT
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 expenses
Hospital expenses
Doctor’s office fees
Dental fees
Prescription drug costs
Medical insurance premiums
Monthly Medicare deduction
Nursing home costs
Home health services
Incontinence supplies
QUESTIONS?
Martha C. Brown, CELA
220 W. Lockwood Avenue
Suite 203
Saint Louis, Missouri 63119
(314) 962-00186