WG Alexander & Associates PLLC Adult Medicaid Overview for North Carolina North Carolina Medicaid Medicaid is a federal and state financial medical assistance program. Medicaid provides a wide range of medical services to the aged and disabled, and it is "needs" based. The federal government provides a significant portion of the financing for the Medicaid Program. In order for North Carolina to receive federal funding, the state must comply with the applicable federal statutes and regulations. There are three major components for Medicaid eligibility: medical, income, and resource eligibility. All three components of eligibility must be met before the state will approve a Medicaid Application. Medical Eligibility To medically qualify for the Medicaid program, a person must require a level of care that places him/her "at risk" of nursing home care. Your medical doctor initially determines the level of care you need. Your doctor's opinion is then reviewed by EDS who determines the level of care required. One must remember that your level of care can change upon re-evaluation. Financial Eligibility Medicaid applicants must meet both the relevant income and resource criteria. Different income and resource criteria apply depending on whether the applicant is married or single. The eligibility criteria for single and married applicants are as follows: Single Income Eligibility Criteria The single individual's gross monthly income must fall below their cost for care. Single Resource Eligibility Criteria The resource limit for a single individual is $2,000.00 in "countable" assets. Thus, to qualify, an individual must have no more than $2,000.00 in countable assets. However, it is important to understand that an individual can own "excluded" or "non-countable" assets. Married Income Eligibility Criteria The income limit for a married couple is determined differently than the single criteria. The Community Spouse is permitted to "take" a portion of the applicant's income to obtain a minimum monthly income of $1,650.00, and can take up to $2,610.00. The remaining income must be less than the applicants. Married Resource Eligibility Criteria The resource limit for married couples depends largely on the countable assets owned by both spouses as of the time of the Medicaid applicant's first period of continuous institutionalization of at least 30 days, and the current value of countable assets. If the current countable assets are less than $20,880.00, the the couple automatically qualifies; otherwise, a "Resource Assessment" will need to be completed to determine how much the applicant's spouse is entitled to keep. During the Resource Assessment, the state will total the countable assets and divide them in half. The resulting figure plus $2,000.00 is how much in countable assets the couple may own to be able to receive Medicaid assistance. Note, the maximum amount the community spouse may keep is $104,400.00. Once the marital assets have been "spent down" to the amount specified by Medicaid, the applicant then qualifies under the resource criteria for Medicaid. Note: Different limits apply if both spouse are seeking benefits. Excluded Assets In addition to the applicable amount of countable assets, a single or married applicant may own the following assets, also known as "excluded" assets, and be eligible for Medicaid benefits: real property which is the applicant and/or spouse's primary residence; an automobile; a prepaid irrevocable burial plan; burial plots; household good and personal effects; whole life insurance for which the face value for one insured is not over $10,000.00; term life insurance; and specific types of annuities. Veteran's Aid and Attendance Benefits There is a special program for Veteran's and Widows of Veterans called the Veteran's Aid and Attendance Pension Benefits. A Veteran can also qualify for medicines and medical supplies, as well as a personal needs allowance. Qualification is subject to income and net worth limits. Veteran Pension Amount A Veteran of the Widow of a Veteran may qualify for a special pension, the amount of which varies depending on the Claimant's marital status (married, single, widowed). For a Married person, the maximum net income* is $22,113.00 and the maximum monthly benefit* is $1,842. For a single person, the maximum net income* is $18,654 and the maximum monthly benefit* is $1,554. For a Widow, the maximum net income* is $11,985 and the maximum monthly benefit is $998. *These amounts may change each year based on the Cost of Living Index. Rules for Qualification There are two levels of of qualification. The Claimant must meet both levels of qualification. The first level is based on facts that cannot be changed (time in service, type of discharge, etc.). However, the second level allows for the claimant to make changes in order to meet the requirements. Those changes include gifting away assets, reducing income, increasing medical expenses, etc. First Level of Qualification 1. The Veteran must have served 90 consecutive days on active duty. 2. The Veteran must not have received a dishonorable discharge. 3. The Veteran must have served at least 1 day of active duty during a war period. There is no requirement that any service be performed in a combat zone. 4. The Widow must not have divorced the Veteran or remarried after the Veteran's death. 5. The Claimant must be certified by a doctor as needing assistance with their daily living activities. Second Level of Qualification 1. The household cannot have more than the Allowable Countable Assets - no more than $80,000 (but, the VA adjudicator has the discretion to decrease this figure, and it is often less than $80,000). 2. The Adjusted Household Income must be less than the VA Aid and Attendance (A&A) Pension Benefit. Planning for Veterans Aid and Attendance In order to qualify for the VA Aid and Attendance (A&A) Pension Benefit, the unreimbursed gross income and the net worth must be below the threshold limits. With proper planning, the Veteran or the Veteran's Widow can qualify for A&A Pension moneys and other assistance, while preserving family assets. The additional pension will help the family pay for long tern health care and avoid the depletion of the Claimant's assets. Unlike Medicaid, A&A can be used for all types of home healthcare and assisted living care. Also, unlike Medicaid, gifts can be made into an irrevocable trust without a sanction period resulting in ineligibility and with estate recovery. In other words, assets can be transferred just prior to qualification. A Bad Mistake: Not getting help. This is a complicated field with may pitfalls. Careful planning with a professional is essential. W.G. Alexander & Associates focuses on getting you qualified quickly while protecting your hard earned assets. The Worst Mistake: Procrastination Call today to make an appointment. (800) 431-8345