As an Elder Law Attorney for nearly 20 years, I am often asked the question “How do I qualify for Medicaid?”  While this seems like a very simple question, there is no simple answer.  There are multiple types of Medicaid and each type has its eligibility nuances.

Medicaid in the Market Place

If you are looking for Medicaid in the market place, you need to provide documentation that includes your income.  This is needed because you will pay a premium for this Medicaid based on the income that you receive.  This type of Medicaid is used for health insurance coverage.

Medicaid Community Based Home Care Services

If you are in need of care services at home, you are looking for Medicaid Community Based Home Care Services. These services require a lot more to qualify. Beginning October 1, 2020, the laws governing qualification for this benefit changed. An applicant must provide verification of financial assets for 1 to 30 months, depending on when you apply. Starting January 1, 2021, the applicant will have to provide three (3) months of financial documentation with an additional month added each of the following months until April 2023, at which time an applicant will be required to provide thirty (30) months of documentation. This is referred to as the “look back” period.

In addition, for 2020, applicants cannot have assets in excess of $15,750 (2020), with some exceptions. Income also cannot exceed $895 plus the cost of their supplemental health insurance premiums. Any excess income will be paid either to a pooled income trust or to Medicaid.

Additionally, an applicant must also have a need for assistance with activities of daily living. Depending on the applicant’s medical diagnosis, the need for assistance has to be anywhere from two or more activities in order to qualify for the benefit.

Medicaid Nursing Home Services

Finally, when seeking Medicaid Nursing Home Services, an applicant is required to provide sixty (60) months of verification of financial assets. In addition, for 2020, applicants cannot have assets in excess of $15,750, with some exceptions. The applicant also only gets a monthly income allowance of $50, plus the cost of a supplemental insurance premium. The balance of monthly income will be either shared with a spouse or turned over to the nursing home directly, depending on the amounts.

Community Based Medicaid

Additionally, for Community Based Medicaid (as of October 1, 2020) and for nursing home Medicaid, certain transfers (gifts) made during the lookback period will be subject to a penalty, making the applicant ineligible for Medicaid benefits.

Clearly, the Medicaid arena is complicated and difficult to navigate. It is also best to seek assistance from an elder law attorney to help you determine if you qualify for Medicaid. We can assist you and help you understand what you need to do and if your situation falls under any of the exceptions that exist.