Search      Tips on Searching Find Legal Help On Insurance Related Resources Health insurance for college students (Separate Website) By: National Health Law Program - HealthCareCoach.com The Medicaid Program (Title 19) (Separate Website) By: Iowa Department of Human Services Health Insurance Premium Payment (HIPP) Program (Separate Website) By: Iowa Department of Human Services more...

In General. Many people rely on Medicaid, also known as Title 19, to pay for their nursing home care. People may generally receive Medicaid payment for their nursing home care if their income is $1,869 or less per month and their nonexempt resources are $2,000 or less. In some instances, people with incomes between $1,869 and $3,737 per month may be eligible for Medicaid if they can establish a medical assistance income trust, also known as a Miller Trust. All non-exempt resources are considered countable toward the $2,000 limit. Resources that may be exempt include a car, homestead, household goods, and prepaid burial accounts. People who do not have a spouse must meet the general income and resource Medicaid eligibility requirements. Medicaid eligibility is much more complicated for married people. The Medicaid program allows the spouse who lives outside of the nursing home, called the community spouse, to have more than $2,000 in resources without disqualifying the spouse who lives in the nursing home from receiving Medicaid. Apply for Medicaid Immediately. Many people fail to apply for Medicaid when they enter a nursing home and wait until most of their assets are gone. This is a big mistake. To receive maximum Medicaid benefits, married individuals should generally go to the Department of Human Services (DHS) and apply for Medicaid when one spouse enters a nursing home. DHS will decide how many assets each spouse can keep. This will fix the amount of assets the community spouse can keep. All non-exempt resources of the couple are considered to be available to pay nursing home costs, regardless of which spouse owns them. DHS will assign one-half of the non-exempt assets to each spouse, provided the community spouse is assigned a minimum of $24,000 and a maximum of $101,640. DHS will notify the nursing home resident that Medicaid is not available to pay expenses until the resident spouse has reduced the value of his assets to $2,000. Appeals May Allow More Assets to be Kept. Couples who have more than $24,000 in assets should not assume that the initial DHS decision regarding the attribution of resources is the best decision for them. By appealing the initial DHS decision, an administrative law judge may set aside additional assets for the community spouse so that those assets, together with the couple's income, could produce income of up to $2,541 per month. The amount of additional resources set aside depends on the couple's income and life expectancy.   

Benefits of Appealing Initial DHS Decision Ben and Vicki Hill are both 84. They each receive $750 in Social Security benefits. They also jointly own a $60,000 home, a $10,000 car, and $60,000 in savings. Ben enters a nursing home and applies for Medicaid to pay nursing home expenses: Initial DHS decision: Home - exempt Car - exempt Vicki can keep $30,000. Ben is assigned $30,000 and must spend $28,000 before Medicaid will pay for his nursing home expenses.    Final DHS decision after appeal: Home - exempt Car - exempt Vicki can keep the $60,000 because of her age and limited income. Ben is eligible for Medicaid to pay for his nursing home care.

After the final attribution of resources, all of the resources assigned to the community spouse must be placed in the name of the community spouse in order for the resident spouse to maintain eligibility for Medicaid. All exempt resources, such as the home and car, should also be transferred to the community spouse.

In addition to financial eligibility for Medicaid, there are many rules regarding transferring assets and eligibility for Medicaid. The rules regarding eligibility for Medicaid are often complex and confusing. Please contact the Legal Hotline for Older Iowans to receive advice about your particular situation.