What Medicaid Is
Medicaid is a government-subsidized program that assists the underprivileged with medical bills. It can limit or even eliminate the costs of in-office visits, emergency treatments and prescription drugs. While it is most commonly used by senior citizens or people 65 years of age and older, it is also accessible to pregnant women and small children if these individuals lack the financial means to access coverage on their own.
Income Limits and Medicaid Spend-Down
For each demographic that is accommodated by the Medicaid program, there are set income limits according to the number of people in the household and the average cost of living in the areas in which applicants are submitting their Medicaid applications. Income limits are set on a state by state basis and not all states have income limits in place.
If an applicant earns above the spending limit for his or her household size and average living costs, this person may still have the ability to qualify for this coverage due to the Medicaid Spend-Down rule. The Medicaid Spend-Down rule accounts for justified, above-average medical costs that make ongoing access to acceptable health coverage unfeasible. If you want to appeal a Medicaid application decision based upon the Spend-Down rule, you will need to supply evidence of ongoing expenses that offset your income relative to the amount that you earn over the established spending limit.
The living costs that will have the greatest bearing on whether or not you qualify for coverage under the Medicaid Spend-Down rule are your medical expenses. Due to this fact, you should collect all of your current medical bills, receipts for prescriptions and any documentation showing monies charged or paid for home health care, medical equipment that is classified as durable, special transportation for medical services and even spending on over the counter medications. The better that you document these expenses, the greater your chances of qualifying will invariably be.
Your Personal Assets
It is important to note that people with high-value personal assets will need to exhaust these things before submitting their Medicaid applications. Government-issued coverage of this type is solely reserved for people who lack liquid capital and salable assets that can be used for the purpose of funding their health care. Thus, although you might have a fairly nominal monthly or yearly income, you may have too much value in the form of assets that can be sold or overage leveraged for paying medical fees. Medicaid is able to consider your income and asset history for up to five years or 60 full months.
There are, however, instances in which it is perfectly acceptable to transfer assets in order to "spend down" and achieve eligibility for Medicaid. It is vital to note that an applicant must never transfer assets solely for the purpose of qualifying as this could result in a penalty, an application denial and the inability to qualify for this coverage for a set period of time. There must be specific benefits gained from a transfer by either the individual who is transferring the assets in question or the person who is receiving them. Given that this process can be confusing and the related mistakes can have considerable consequences, it is important for aging adults and other Medicaid applicants to seek the advice of a legal professional before making any major decisions concerning the ownership of their assets.
It is acceptable to make transfers if:
- These are made for some other reason apart from the desire to obtain Medicaid eligibility.
- They are transferred to a third-party or current spouse for the sole benefit of this individual.
- The transfers are made to a disabled person or to establish a trust for a disabled person.
- The transfer is made by the applicant's spouse to a third-party for his or her benefit.
Planning Ahead For Medicaid Applications
People who intend to submit Medicaid applications will have the best opportunity to gain an approval by planning early and taking actions concerning their assets in advance of this process. If you are living with a chronic or degenerative illness and know that your medical needs and expenses are likely to undergo significant increases in future years, talking with an attorney is advised. This professional will likely suggest the creation of a trust for assets prior to the five-year or 60-month look-back period.
It is important to determine whether or not you live in a state that has enforced income caps. Understanding what the income limits for eligibility are in your area is a vital part of planning for the application process. People who live in income cap states may be able to save more of their income by setting up income trusts well in advance of submitting their Medicaid applications. It is additionally vital to determine which assets will be counted in your state and which of these will be overlooked.
To learn about Medicaid appeals visit:
To sign up for Medicaid in New Jersey visit: