Help for
Caregivers

Press Release -- January 5, 2005

Signing Up For Medicaid - A Difficult Decision

Denver, CO. More and more low and middle income seniors are facing the need to sign up for Medicaid, especially as they face the need for care in the assisted living or a nursing home.

When seniors were planning for their retirement in the 60's and 70's with an annual income of $25,000 to $30,000 per year, they were sure they would be able to finance the care they needed in their later years. No one could have predicted the increase in health care costs, salaries, and technology.

Since 1974, the average cost of a nursing home bed has risen by about 1500% from about $12 per day to $165 or $175 per day in 2005. Thirty years ago, assisted living and many of the home care services were not available. Thus, many seniors find themselves in the dilemma of having to apply for Medicaid.

Individuals can receive Medicaid if they qualify for any one of the following four programs: Supplemental Security Income, Old Age Pension, Home and Community Based Services, or Nursing Home Care. Each program has different income and resource requirements.

To qualify for Supplemental Security Income (SSI), an individual over age 65 must have less than $579 ($869 for a couple) per month from all sources and less than $2000 in resources ($3000 for a couple).

Individuals who are over age 60 can qualify for Old Age Pension if their monthly income from all sources is less than $604 ($1208 for a couple) and they have less than $2000 in resources ($3000 for a couple).

Sometimes people find themselves in need of assistance with health care and they do not qualify for Old Age Pension or Supplemental Security Income. Individuals who have a higher income and who meet the functional requirements for being at risk of placement in a nursing home, may be eligible for Home and Community Based Services.

Under the Home and Community Based Services program, Medicaid can assist individuals in the home or in an assisted living residence. Individuals who qualify under Home and Community Based Services must have less than $1737 per month and less than $2000 in resources. Similar income and resource guidelines are used for persons living in nursing homes.

A special provision exists for couples, if one spouse needs assistance and the other spouse is able to care for him/her self. Under the spousal protection provision for persons receiving Home and Community Based Services or nursing home care, the community spouse (or the well spouse) is able to keep $95,100, while the sick spouse can keep an additional $2000 in resources. This provision helps to keep the community spouse from being impoverished.

Individuals whose income is over $1737 per month can still qualify for Medicaid by using a Medicaid Qualifying Trust. The income for the individual is placed in a Medicaid Qualifying Trust. The trustee is authorized to make payments to the spouse, the home care providers, the assisted living, and/or the nursing home.

When applying for Medicaid, the house, the car, term life insurance, and an irrevocable burial policy are exempt assets and do not count toward the resources for determining eligibility for Medicaid. A lien may be placed on the house if the individual is single (a lien will not be placed on a house if the individual needing Medicaid assistance is married).

To apply for Medicaid, contact the county Department of Human Services for assistance with financial applications. For Home and Community Based Services and/or nursing home care, in addition to the financial application, the individual must contact the Options for Long Term Care agency in their county to determine if they meet the functional requirements to be eligible for Medicaid.

For more information to determine if you might be eligible for Medicaid, call 303-333-3482.