by Bill Miller | Apr 9, 2019 | Long-Term Care, Medicaid
What Does Medicaid Pay For if You Need Long Term Care?
One question people always ask when it come to long term care expenses, what does Medicaid Pay For? Long-term care is expensive care – but also very necessary for some people. However, planning for Medicaid to cover all your long-term care needs may lead to some unpleasant surprises! Not everyone qualifies for Medicaid. Those who do qualify may find that some services are restricted or not even covered at all. Let’s look at what Medicaid will – and will not – pay for when it comes to long-term care.
General Services Covered by Medicaid
Some services may be restricted to certain patients or in limited quantities. However, the following services might be available to Medicaid recipients, including people who need long-term care:
- Outpatient hospital visits for lab work, x-ray services, radiation treatment, or chemotherapy.
- Chiropractic care in some situations.
- Eye exams and glasses, once every three calendar years.
- Psychiatrists that are Medicaid providers.
- Emergency visits for serious problems. Otherwise, ER visits are limited to three non-emergency visits per year.
For a full list of available services, see the Alabama Medicaid website.
Services Related to Long-Term Care
Most people think of nursing homes when they think of long-term care. However, it is actually a “variety of services designed to meet a person’s health or personal care needs during a short or long period of time.”
In general, Medicaid will pay for medically-necessary care. For people who with long-term needs, Medicaid may cover the following:
- Home health services,
- Hospice care,
- Private duty nursing,
- Targeted case management,
- Residence at long-term care facilities like nursing homes.
Special programs may be available for people who need some form of long-term care.
What Does Medicaid Pay For – Waiver Programs
Medicaid offers home and community-based waiver programs for certain Medicaid recipients. An applicant or recipient who meets the medical and financial eligibility requirements and need long-term care may be qualified.
Services That May Not Be Covered by Medicaid
Generally, Medicaid generally refuses to pay for the following procedures unless they are considered to be medically necessary:
Cosmetic surgery, breast lifts, tummy tucks, and liposuction.
In addition, Medicaid does not pay for medical services provided to people incarcerated in jail or prison.
Learn More About Paying for Long-Term Care
For a free consultation with an experienced Alabama estate planning attorney, contact us at 256-251-2137. Miller Estate and Elder Law is located at 818 Leighton Avenue in Anniston, but we serve clients in Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
Additionally, you may want to read Don’t Go Broke Paying for Long-Term Care, a free e-book available for download at your convenience.
by Bill Miller | Feb 4, 2019 | Medicaid, Medicaid Qualification
Everything seemed to happen in a split second. One minute, 88-year old Mary Elizabeth was living at home and appeared able to care for herself. Then her son, Jason, received a call from the emergency room. Mary Elizabeth had suffered a devastating stroke and needed the kind of 24/7 nursing care best offered in a nursing home. She moved immediately from the hospital to a nursing facility, but financing her stay was a problem. Jason quickly learned about Nursing Home Medicaid Qualification and how quickly he could get her eligible.
The Basics of Nursing Home Medicaid Qualification
We’ve all heard of Medicaid, but may not understand the finer points of applying, qualifying, and finding the services we need.
Medicaid is federally funded, but state managed. Programs and eligibility requirements may vary from state to state. Alabama Medicaid offers a program for Institutional Medicaid – or Medicaid for nursing home residents.
Qualifying as a Nursing Home Resident
For Jason to get Medicaid for Mary Elizabeth, she has to meet the following criteria:
- Mary Elizabeth must be a U.S. citizen residing in Alabama.
- She must prove that her nursing care is needed for a medical condition.
- Mary Elizabeth must live in the nursing facility for at least 30 continuous days.
- She must have a monthly income below the current limit of $2,205 per month, although this amount may be adjusted in January of each year.
- Mary Elizabeth’s resources must be worth less than the limit Medicaid sets. At this time, the limit for an individual is $2,000. However, there are exceptions to this, particularly if the applicant is married.
But applying for government benefits can take months. Mary Elizabeth and Jason urgently need Medicaid coverage now.
Emergency Medicaid
It can take 45 to 90 days for a Medicaid application to be approved. However, Medicaid coverage may be granted to cover up to three months before the month in which the application was submitted. This applies if the applicant received medical care and if the applicant meets all other eligibility requirements.
One of the biggest obstacles to getting Medicaid immediately is that most people have more than $2,000 and are therefore “over resourced”. Medicaid requires that an applicant spend down their assets to $2,000 before they can qualify. There are planning strategies to protect some of your assets and still get qualified for Medicaid immediately.
Get a Decision on Medicaid as soon as Possible.
At Miller Estate and Elder Law, we work with families everyday who have loved ones in or going to a nursing home. We know the rules for Nursing Home Medicaid qualification. We can get you qualified quickly. Contact us at 256-251-2137 to schedule an appointment. We have offices in Birmingham and we have a new office located at 818 Leighton Avenue in Anniston. We serve clients in Gadsden, Hoover, Talladega, Oxford, Jacksonville, Vestavia Hills, and surrounding areas.
by Bill Miller | Nov 24, 2018 | Estate Planning, Medicaid, Medicaid Planning
Some things just don’t go together, like oil and water or peanut butter and sardines. Sometimes it’s not a big deal – or the resulting problem is minor. But when something as important as your Medicaid eligibility is involved, that’s a different story. For example, do-it-yourself estate planning and Medicaid don’t mix at all. Here’s why:
What is DIY estate planning?
DIY stands for do-it-yourself. Americans are fond of taking on DIY projects ranging from planting an herb garden to building an addition onto their homes. However, your estate plan may be a lot more complicated and last a lot longer than the deck you built last year.
Due to the Internet, exposure to do-it-yourself estate planning has increased. People can click a few buttons and have a Will ready for signing. But DIY estate planning cannot analyze your particular circumstances, personalize your estate plan, listen to your concerns, and give information specific to special situations.
And it’s unlikely that DIY estate planning can address the need to plan for Medicaid eligibility.
What happens if you need Medicaid
Planning for expensive medical treatments, including long-term care, must begin before you need that care. DIY typically does not take that into account. You need an attorney who can review the facts of your case, then use knowledge of the law and experience to find the best options.
For example, a website algorithm may not take into account the Medicaid five-year look back period. Medicaid case workers will review an applicant’s financial history for 60 months prior to the date of application. Someone who uses DIY estate planning may sign the Will, then give assets to family members to decrease the value of his or her estate. Property may be titled or transferred in such a way that Medicaid eligibility is not affected. If done improperly, transfers or gifts made within that look back period may decrease, delay, or even prevent Medicaid benefits.
A lawyer who knows Medicaid can offer advice on how to avoid such penalties.
Medicaid Rules and Requirements Are Complicated
Don’t let DIY estate planning stand in the way of receiving benefits you deserve. Schedule a consultation with one of the attorneys at Miller Estate and Elder Law. Our phone number is 256-472-1900. Miller Estate and Elder Law is now located at 818 Leighton Avenue in Anniston, but we serve clients in communities like Hoover, Vestavia Hills, Irondale, and Calera.
by Bill Miller | Nov 19, 2018 | Medicaid, Medicaid Planning, Medicaid Qualification
If you have ever spent any time in an emergency room, you know how stressful it is. You may find yourself sitting beside a loved one anxiously awaiting a diagnosis. Or maybe you will be the one in need of emergency care. Either way, you may find yourself wondering how to pay for future medical treatments and long-term care. Medicaid may be an option, but first you need to find out if you or your loved one is eligible for Medicaid. Understanding Medicaid and its eligibility requirements might help.
First, Medicaid is funded by the federal government, but administered by individual state agencies. The program supplies health care for people in need. However, not everyone can receive Medicaid. Applicants to the program must meet strict requirements to qualify.
Understanding Medicaid Medical Eligibility
Some people think Medicaid is only for elderly people. However, there are several programs within Medicaid that aid other groups, like pregnant women and children.
Eligibility requirements vary depending on the program you apply for. No matter which program you choose, however, you must show a medical need, be disabled, or be blind. For example, to qualify for the Medicaid for Elderly and Disabled program, you may need to prove that long-term nursing care is needed.
Applicants also must meet income and resource limits to qualify for Medicaid coverage.
Understanding Medicaid Financial Eligibility
Income is only one test used to determine Medicaid eligibility. Applicants must also prove their assets and resources are within limits in most Medicaid programs. Also, income, asset, and resource limits may vary. For example, Medicaid limits for 2018 are:
- Qualifying Through SSI: Aged, blind, or disabled individuals may earn $770 per month for one person, $1,145 for a couple. Resources cannot exceed $2,000 (single) or $3,000 (couple) per month.
- Nursing Home Medicaid: Individuals eligible for institutional care have an income limit of $2,250 per month and a $2,000 resource limit as of the first day of the month.
- Home and Community Based Waivers: The limit is $2,250 per month for income and $2,000 per month for resources.
This list does not include other programs, such as those for children, parents and caretaker relatives, pregnant women, among others.
Applying for Medicaid Is Hard. We Can Help.
The attorneys at Miller Estate and Elder Law understand the estate planning needs of their clients. Contact Bill Miller at 256-251-2137 to schedule an appointment. Though our office is now located at 818 Leighton Avenue in Anniston, we serve clients in Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
by Bill Miller | Oct 19, 2018 | Medicaid
As they age, many people prefer to remain independent and stay in their own homes, even if they need skilled nursing assistance. Although home health care is less expensive than residential 24/7 care, the cost is still high for many people. If you or a loved one need home health care, it’s important to answer the question, “Does Medicaid pay for home health care?”
Medicaid: The Basics
You very likely have heard of Medicaid. Although many people confuse Medicaid and Medicare, they are completely different programs.
Medicaid is funded by the federal government. However, each state manages their own Medicaid program. In fact, states may vary in the type of coverage they offer.
Medicaid Home Health Care Programs
Alabama Medicaid offers a wide range of services to people who qualify for Medicaid. Several programs provide coverage for care given at home:
- Elderly and Disabled (E&D) Waiver Program. As you can tell from the name, this program provides services for Medicaid recipients who are elderly and/or disabled. In fact, a person who needs a level of care typically given in nursing homes may qualify for this program. Services includes homemaker services, personal care, skilled and unskilled respite care, home delivered meals, and adult companion services.
- State of Alabama Independent Living Waiver (SAIL) Program. An adult who wants to stay at despite qualifying for nursing home care may be accepted into this program. However, this program is for people with certain specific medical conditions. While not a complete list, the following diagnoses are covered: traumatic brain injury, multiple sclerosis, muscular dystrophy, substantial neurological impairments, debilitating diseases, and rare genetic disorders. Recipients may receive personal care services, environmental accessibility adaptations, and medical supplies, assistive technology, to name a few.
- Alabama Community Transition (ACT) Waiver. This program helps Medicaid recipients currently in residential care transition to a home or community setting. Services include transitional assistance, personal care, homemaker, home delivered meals, skilled nursing, and medical equipment.
Home Health Care for Other Disabilities
In addition, programs for intellectual disabled individuals offer assistance in living at home or in a community setting:
- Home and Community-Based Waiver for Persons with Intellectual Disabilities (ID). This program assists people who are at least age 3 who have been diagnosed as mentally retarded. In addition to Medicaid income and resource qualifications, individuals must need intermediate care facility care and have an IQ of 70 or lower. This program provides a number of services, including group home facilities, supported employment, physical therapy, companion services, personal care, skilled nursing, and specialized medical equipment.
- Living at Home (LAH) Waiver for Persons with Intellectual Disabilities. Again, individuals in this program mentally retarded and at least 3 years old. Services include personal care, prevocational services, occupational therapy, skilled nursing, specialized medical equipment and supplies.
Of course, knowing about these home health care programs is not enough. You have to be a Medicaid recipient first.
Applying for Medicaid Can Be Frustrating. We Can Help.
The application process for Medicaid is a difficult path for most people to navigate. However, the attorneys at Miller Estate and Elder Law help many of their clients every step of the way.
For a free consultation with an experienced Alabama attorney, contact us at 256-251-2137 or use our convenient Contact Form. We have offices in Anniston and serve clients in Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
by Bill Miller | Oct 15, 2018 | Medicaid, Medicaid Planning
Have you ever looked for something, thinking it was far away only to learn it was right there in plain sight? If you or a loved one needs help with Medicaid, it’s important to understand why hiring an Anniston Medicaid lawyer may be best.
As an example, let’s look at Brad and Angie’s situation. They live in Oxford, but Brad’s elderly parents still live in Anniston. His parents need to apply for Medicaid. Brad and Angie are confused by the paperwork and think of hiring a Birmingham Medicaid attorney. Then they start looking into reasons to hire an Anniston Medicaid lawyer.
Location, Location, Location
Sure, you could hire an attorney that’s an hour away, but why? Think of all the time you would waste driving back and forth when assistance may be right in your own backyard. Brad and Angie may have more time for their family, his parents, and themselves by hiring an attorney in Anniston.
Knows the Community
An Anniston-based lawyer knows more than where to find the best BBQ in town. A local attorney knows and understands local people, cultures, and laws.
Why is this helpful when Medicaid is administered by a state agency?
Because you or your loved one may need Anniston-based nurses and at-home care workers. If you are checking out nursing homes in the Anniston area, your Anniston Alabama lawyer may be able to point you toward a facility that meets your needs.
For example, Brad and Angie needed to find someone to help with in-home care. Their Anniston Medicaid lawyer networked regularly with healthcare providers at all levels and provided some input.
Well-Known in the Community
Medicaid planning and application is not easy, so you need someone you can trust. When you choose an attorney who’s close to home, it’s that much easier to check out his or her reputation.
An Anniston Medicaid lawyer may even attend local churches, participate in local charities, or serve with the Calhoun County Bar Association.
Brad and Angie looked online for an Anniston lawyer, but also talked to family and friends in the area. They hired an attorney with an excellent reputation in the community.
Talk to an Anniston Medicaid Lawyer
If you or a loved one need Medicaid, look no further than Adams & Miller, P.C. We offer our clients the individual attention they need. The attorneys at Adams & Miller, P.C. assist clients probate whether the estate is large or small. For a free consultation, contact us at 256-251-2137 or use our convenient Contact Form. Although we’re located in Anniston, we also help clients in the Birmingham, Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
