Long Term Care and Home and Community Based Services Medicaid
Are you disabled? Is your monthly income below $2,982 before taxes? Do you or a loved one need nursing home level care? If so, you may want to think about applying for Medicaid. Medicaid provides certain eligible individuals with assistance needed to perform activities of daily living through the Long-Term Care (LTC) and Home and Community Based Services (HCBS) Programs. This article sheds some light on those programs.
Let’s start with LTC Medicaid. LTC Medicaid is for individuals who are disabled and need nursing home level care, which is defined as being unable to perform or needing significant supervision performing at least three to four of the following activities of daily living: dressing, transferring, mobility, bathing, eating, and toileting. The inability to perform these activities is functionally assessed by the Colorado Department of Health Care Policy and Financing.
If you meet these age and medical requirements, you must then meet income and asset requirements to be eligible for LTC Medicaid. Currently, this means having less than $2,982 in income per month and less than $2,000 in assets if you are single. If you are married, you can have up to $3,000 in assets. Income includes work earned from a job or unearned income such as social security retirement benefits but does not include certain things such as reverse mortgage payments. Income for LTC Medicaid is also measured individually, meaning your spouse’s income is not included in the calculation. Assets include things such as cash in checking or savings accounts, stocks, bonds, retirement funds and revokable (whole) life insurance policies, but do not include your primary house or vehicles that together are worth less than $7,000. Most personal property also does not count as an asset. Assets are measured by household, meaning your spouses’ assets will also count toward the asset threshold.
If you meet these income and asset requirements, you may receive long term care in a nursing facility without having to pay the out-of-pocket costs normally associated with such care. Instead, individuals with LTC Medicaid pay their gross monthly income minus a $110.36 deduction for personal needs to receive nursing facility care. This means that your monthly income will go toward the cost of your care, except for $110.36, which you will receive as a personal needs allowance. In certain circumstances, you may be eligible for other deductions that allow you to keep more money.
The second program to consider is Home and Community Based Services (HCBS). HCBS offers several programs for individuals with different functional impairments. However, the HCBS program that is most ubiquitous for older adults is the Elderly, Blind, and Disabled (EBD) Waiver program. This program is for adults that need nursing home level care but are physically and financially better off receiving that care at home or in their community. Under the HCBS-EBD program, if you have a functional need demonstrated via a Single-Entry Point evaluation or home visit, you may receive things such as nurse assistance, meal preparation, and assistance with bathing and dressing,.
The HCBS-EBD Waiver program has two categories. The first category is for adults 65 or
older. If you fall within this category, you need to meet the same medical, income, and asset requirements as in an LTC Medicaid application. However, unlike LTC Medicaid, the HCBS-EBD Waiver Program, like other HCBS programs, does not require individuals to pay any portion of their income toward the cost of their care. The HCBS-EBD program is also available to adults between the ages of 18 and 64, but only if they are blind or physically disabled, or if they have HIV or AIDS. There are also some children’s HCBS waiver programs.
If you feel like you could benefit from one of these programs, contact Benefits in Action at 720-221-8354. Our experienced counselors will provide a free consultation to help you determine whether LTC or HCBS is a potential fit for you and, if so, can help you with the application process if you need assistance.
To learn more, visit our website at www.benefitsinaction.org/
