While there is a lot of information available online concerning federal
benefits for , distinguishing between what is factual and what is fictional can be difficult at best. This can make it especially difficult when for your loved one.
is a federal government benefit, each state in the U.S. decides how the federal funds will be disbursed and how each prospective recipient will qualify.
The following list will help to dispel some of the common myths surrounding
benefits and inform you of certain that can help you along your caregiving journey.
and are not the same, but often get confused with one another.
only pays for limited in a and typically after only three overnight stays.
The care must be “skilled care” that licensed nurses and physicians can only provide.
will only pay the full for the first 20 days.
Days 21 through 100 of skilled care is an 80/20 split between and supplemental (if the patient has it).
In many cases,
pays nothing because only custodial care that can be provided by non-skilled caregivers at home or in a facility is required. This is where Coverage may be required.
When a couple separates because one must enter a
to prevent the impoverishment of the , (otherwise known as the spouse not entering the the may keep a share of the parties’ assets.
The protected resource allowance (PRA), is ½ of the total countable resources that the couple (and each member of the couple) owns as of the first day of the month in which the ill spouse is institutionalized.
This is referred to as the “snapshot date” which is the number of assets that the and spouse, if applicable, have on the first day of the month that the individual medically requires assistance.
The PRA is subject to a minimum and a maximum that can change annually; however the currently protected resource allowance is currently set at a minimum of $26,076 for all states in the U.S. except Alaska and Hawaii and the maximum is $130,380 for all states in the U.S, except Alaska and Hawaii, for 2022.
The home (within equity limits), most expensive automobile, most tangible personal property, and many burial arrangements are excluded from countable resources.
In 1996 Congress made it a crime to purposely transfer assets to meet
requirements for the (Granny Goes to Jail Statute). In 1997, after following significant criticism, Congress changed the law to eliminate any criminal penalty for these financial transfers.
Under the changed version, only persons who offer a fee counsel or assist in transferring assets when they transfer results in a period of ineligibility may be prosecuted.
However, the Granny Goes To Jail Statute was ruled unconstitutional and unenforceable in a federal case in New York.
Transferring or gifting assets will result in a period of ineligibility for if done within 5 years of the application according to the Deficit Act 2005 (DRA).
There are several ways that a person entering a
can lawfully transfer assets without .
When a person needs
but wishes to remain at home there is a type of care that can be delivered to the person in both a cost-effective and safe manner. Your loved one may qualify for the Virginia Community-Based Care Program which permits the resident to remain in the home with assistance provided by community-based nurses
More often than not, people tend to apply for the wrong type of
because they do not know the difference between Community-Based Care and in a nursing facility.
It is true that many states have an aggressive estate recovery policy permitted under federal law. However, estate recovery is permitted against the estate of the beneficiary, not the spouse of the beneficiary.
As long as assets are titled in the name of the , the state cannot take the asset to satisfy the institutionalized spouse’s claim.
This myth actually refers to the current
exemption amount to not qualify for and would result in a penalty. If the gifts were made within the last five years, the applicant submits an application to (DRA 2005).
requires that all transfers of assets made within the last five years before submitting the be reported.
Regardless of whether the transfer is made to a person or a trust, an ineligibility period for will be imposed.
The ineligibility period will not begin to run until the time of the or when the person would otherwise have been eligible for , whichever is later.
Occasionally an application will be submitted intentionally to have it denied in order to trigger the enrollee’s
cover penalty period.
Many states use the tax-assessed value of the real estate to determine its value for
Services and Support purposes. Selling the home for less than the city assessed value would result in an uncompensated value transfer and a period of ineligibility for Services
For example, if a home in Virginia was sold for $1.00, however, the tax assessed value was $250,000, the uncompensated value transfer would be $249,000 and would result in a penalty period of 38.77 months in Southern Virginia, and a penalty period of 27.56 months in Northern Virginia.
The above penalty periods can vary from state to state based on the Divestment Penalty Divisors Established by the specific state
Due to DRA 2005, the period on transfers is 5 years whether assets are transferred to an individual or to an Irrevocable Trust.
The Irrevocable Trust cannot have any language stating the grantor or creator of the trust can receive any income or principal from the trust.
Language for an Irrevocable Trust used for Purposes and Legally Compliant for is very specific
The Irrevocable Trust must be funded, meaning that assets must be retitled from the individual's name into the name of the trust.
can actually provide both coverage and medical services, dental care, home health, and to young adults, families, pregnant women, and children who have and are also medically needy.
Each state has a specific outlined health plan under Services with a list of participating providers that may cover both inpatient, outpatient, behavioral health prescription drugs, and services.
There are specific children’s
programs funded by the State . In addition, there are also community-based services for both young adults with disabilities children with disabilities, families, and pregnant women
Unfortunately, many care facilities are not dually certified to accept
and are strictly private pay. This means that the resident would need to utilize their monthly income from supplemental security income (SSI) and any other monthly income from pensions and assets to cover the cost of services and custodial services.
Your local Department of Health and Human Services (HHS) can provide you with a list of facilities that do accept Managed Care
There are many
and misinformation surrounding . Adding to that confusion is the fact that criteria can vary as there are both federal and individual state laws in place.
Even with the expansion of the Act, there are many individuals and families that still cannot afford nor apply for federally-funded Services. Many
do not realize that the Department of Human Services cannot provide guidance as to how to specifically become eligible for .
can be an extremely effective source to cover and it is imperative that the applicant or representative obtain credible and reliable advice and assistance for their before they attempt to file. Qualified assistance can be obtained by an
or geriatric case management firm that specializes in and assistance.
You can obtain qualified assistance by contacting www.careconnecthr.com, this geriatric case management firm assists nationally with all aspects of including , or via NAELA, www.naela.org which is the National Academy of .
Obtaining qualified assistance will ensure that applications are not submitted in vain, and will help to avoid frustration, wasted time, and money for all involved parties.
A Certified Senior Advisor with 20+ years of experience in Geriatric Care Management. She focuses on the senior housing industry, especially assisted living, nursing, and specialty memory care. She is also an Accredited Agent with the U.S. Veterans Administration, licensed to represent claims before the Office of General Counsel, and a licensed insurance agent in life, health, and annuity products for the state of Virginia.
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