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Caregivers

Press Release -- 7.06.04

Medicaid Increases The Amount Spouse Can Keep For Spouse to Enter a Nursing Home

Denver, CO. Often times when individuals are required to enter the nursing home, the spouse is concerned about the cost of care. Under Colorado law, three things must be considered for an individual to be eligible for nursing home care. The same rules apply for individuals applying for care under the home and community based services care program, including assisted living.

The individual must qualify for assistance by meeting the functional requirements set forth by the state. These include needing substantial assistance with bathing, mobility, transferring, incontinence, eating, and dressing. Individuals can also qualify if they need assistance with supervision, including such things as behavior management, memory/cognition including medication assistance.

The single entry point agency is responsible for making the determination for functional eligibility.

In addition, individuals need to be financially eligible to receive Medicaid. To qualify the applying individual must make less than $1692 each month in income. If the individual is married, the spouse can keep $1561.25 in monthly income. The balance becomes part of the patient payment to the nursing home.

If the income is more than $1692, the individual may still be eligible for assistance by filing for a Medicaid Qualifying Trust, or sometimes known as a Miller Trust.

With a Miller Trust, the all of the individual's income becomes the property of the Trust and the Trust then is instructed to pay the approved expenses. Usually a significant other is approved to be the trustee. The application for a Miller Trust is made with the Medicaid application that is submitted to the county department of social services.

In addition to the income requirement, the individual must have less than $2000 in resources. If the individual is married, the spouse is allowed to keep $92,760 in resources. The house, car, term life insurance and an irrevocable burial policy are exempt. Things such as cash, savings, stocks and bonds, and retirement accounts are considered assets.

Sometimes individuals are worried about a lien being placed on their home. A lien can be placed on the home if Medicaid pays for care of a resident through home and community based services or for nursing home care.

A lien can not be placed on the home 1) if the individual is married, 2) a brother or sister own an equity portion of the home and have lived in the house for at least one year before placement and continues to live in the home after the individual goes to a nursing home; 3) if a son or daughter lived in the house for at least two years before the individual entered the nursing home, and if the son or daughter has continued to live in the home since the parent entered the nursing home; 4) or if the home is owned in joint tenancy.

If the home is owned in joint tenancy with someone other than the spouse for more than thirty-six months, the state is unable to impose lien on the home.

If the title to the home was transferred prior to thirty-six months before applying for Medicaid, a penalty period may apply. The amount of the penalty for 2004 is $4745 per month. To calculate the penalty, the amount of equity that is transferred is divided by $4745 to determine the number of months of ineligibility for Medicaid benefits.

To apply for Medicaid, the individual should contact the county department of social services for the financial application and the single entry point for the functional application.

For more information, call 303-333-3482.