What is
Medical Assistance?
Medical Assistance is Minnesota’s Medicaid program.
Medical Assistance is a public benefit available to elderly and disabled
Minnesotans who meet certain asset and income limits.
Applying for Medical Assistance is often a difficult and
confusing experience. Medical Assistance rules are complex, and most people
going through the process are doing so on behalf of a loved one who is ill or
injured. The personal stress combined with the intricacies of the system can
present quite a challenge.
The Medical Assistance application process can be
initially focused by asking a few questions.
Does the
applicant live at home, in an assisted living, or in a nursing home?
Medical Assistance covers long term care for recipients
who live in a nursing home. There are also Medical Assistance benefits
available to people who are able to stay in their homes with assistance, or
individuals who live in an assisted living facility. Those benefits are available through community-based
programs. Elderly Waiver is the community based Medical Assistance program most
utilized by elderly individuals. There are, however, programs available to
recipients with disabilities who are under the age of 65.
The application process is largely the same for long term
care and community based services. One important difference is that community
based services like Elderly Waiver require that the applicant be screened in a
Long Term Care Consultation, and determined capable of remaining in the community.
This consultation is important not only as central to approval of their
application. If the applicant is married, the asset assessment date is set on
the date the consultation takes place.
Asset assessment will be discussed below.
Is the
applicant married or single?
A single person applying for Medical Assistance will need
to demonstrate eligibility with respect to both income and assets. This means
that the applicant demonstrates a medical need, substantiated by outstanding
medical costs. Their income must be such that after the permissible deductions,
they are unable to pay for the cost of their care.
The asset limit for a single person is a set $3000. This includes savings accounts, checking
accounts, stocks and bonds, certificates of deposit, contracts for deed, IRAs,
and the cash surrender values of life insurance policies, among other things.
There are also assets that are excluded. A person may have a home, a car, a
protected amount of both life insurance and prepaid funeral expenses. There are
a few other excluded assets, and the home and car both require active use by
the recipient to maintain exclusion. Some assets are unavailable. An asset is
unavailable when the recipient has failed after a reasonable effort to access property
made unavailable either by joint ownership, pending legal action, continued
unsuccessful effort to sell, or certain trusts. A Medical Assistance recipient
who has more than $3000 in assets at the end of a month is no longer asset
eligible for Medical Assistance, and will be assessed a period of
ineligibility.
In a married couple, the income of the recipient is
treated as if they were single. Assets, however, are evaluated much differently
to allow the community spouse to maintain. The community spouse, or well spouse, is allowed to keep
assets up to a set limit. There is a minimum and a maximum asset limit for the
community spouse, set each year to reflect changes in cost of living. The asset
limit in each individual’s case is
determined by the difference between assets held at the asset assessment date
and assets held at the time of application. The asset assessment date in a long
term care Medical Assistance case is set by the date marking the first period
of institutionalization for the applicant. Institutionalization may mean a
hospital or nursing home stay. If the couple is applying for Elderly Waiver or
another community based program, the asset assessment date is set by the Long
Term Care Consultation as discussed in the previous section.
Is the
applicant a veteran?
Medical Assistance rules require that veterans applying
for benefits must also apply for Veterans’ Aid and Attendance. Veterans’ Aid
and Attendance is a pension available to veterans unable to care for themselves
in their home. If approved, the veteran receives income that in turn reduces
the burden on the state each month for the cost of care- at home or in a
nursing facility.
Has the
applicant transferred any assets during the lookback period?
Medical Assistance transfer rules are very complicated in
an effort to prevent people transferring their assets in order to become
eligible. In order to properly
prepare for a Medical Assistance application, we must discuss any transfer of
assets made since February 8, 2006. A transfer is any uncompensated or
undercompensated exchange made to obtain or maintain Medical Assistance. This
may mean granting a life estate in one’s home, annuitizing an annuity, or
simply making gifts. Each individual applicant must very carefully examine any
qualifying exchange to properly apply. After a transfer amount has been
determined, it is divided by a divisor representing the average cost of care
for nursing level care in Minnesota. The resulting figure is the number of
months, after application, the person must privately pay for the total cost of
their monthly care until Medical Assistance will begin to contribute.
These topics cover only the most basic concepts of
Medical Assistance application. Each case is different and subject to detailed,
specific rules.