Long Term Care Medicaid-Eligibility Criteria

To qualify for Medicaid, you need to meet the following requirements:

  • General Requirements
  • Financial Eligibility Requirements
  • Functional Eligibility Requirements

General Requirements:

  • Colorado resident; and
  • 65 or older or permanently disabled or blind; and
  • US citizen or qualified non-citizen

Medicaid’s Financial Eligibility Requirements:

An income and resource test will be performed in order to determine an applicant’s financial eligibility.

Income

Income is any item an individual receives in cash or in-kind that can be used to meet his or her need for food or shelter. Some income is considered countable, while other income may be considered not countable when determining eligibility. The 2010 income limit for Long Term Care Medicaid is $2022 (3 times the current SSI income limit).

Applicants in a nursing facility or in need of Home and Community Based Services (HCBS) who have income over $2022 but under the regional private pay rate for which they live may establish an income trust to meet the income requirements. Without the use of an income trust, eligibility can not be established; therefore, the income trust must be set up for eligibility to begin. Additionally, it must be properly funded each month by income over $2022. If the excess income is not transferred into the trust, eligibility may be terminated.

Resources

Resources are defined as cash and any other personal or real property that the applicant has the right, authority, or power to convert to cash (if not already cash); and is not legally restricted from using for her support and maintenance.

Medicaid resource limits vary depending on your circumstances:

o        Single Individual: $2000

o        Married Couples: $3000

o        Married Couples Sharing a Room  in a Institution: $4000 ($2000 per individual)

o        Spousal Impoverishment: $109,560 (If one spouse lives in an institution and the other spouse is still living in the community and not receiving Medicaid)

Some of your assets are considered, while other assets are excluded, and not counted. Exempt assets include but are not limited to a primary residence, personal items, one vehicle, life insurance policies with a face value under $1,500, and certain burial policies. Almost all other real or personal property and funds held with a financial institution owned by you or your spouse are counted toward the resource limit.

Transfer of Assets

Transfer of assets occurs when an individual, or spouse of such individual, disposes of assets for less than fair market value within the 5-year look back period. If you transfer assets, Medicaid may not pay for your long term care services during the penalty period. The penalty period is the amount of time during which the individual will be ineligible for Medicaid and depends on the amount of assets transferred.

Functional Eligibility Requirements:

In order to receive long term care Medicaid, the applicant must be assessed and determined in need of long term care services. This evaluation is done by the Single Entry Point agency in the area in which you live. The need for long-term care services is generally determined by the applicant’s ability to perform activities of daily living. Examples of these activities include bathing, dressing, using the toilet, transferring, and eating.

Getting Help:

Helping Hands Consulting, LLC is Colorado’s premiere Medicaid consulting group. We can assist you and your family navigate through the complexities of rules and regulations involved in obtaining Long Term Care Medicaid. We will streamline and simplify this process while working to maximize your eligibility. Call 303-717-6082 or Toll Free (888) 849-4346 for a free phone consultation or visit www.helpinghandsconsultingllc.com for more details on how we can assist you.

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Welcome to Colorado Long Term Care and Medicaid Information

Coming soon! In the meantime visit DenverMedicaid.com for relevant info

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http://www.helpinghandsconsultingllc.com

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