Medicaid Sticking Point: The "Other Insurance," aka Third Party Liability, Washtenaw Health Plan , 555 Towner St, Ypsilanti, MI, 48198, Updated** Understanding A Medicaid Deductible, or "Spenddown", Actualizado ** Entendiendo el Deducible de Medicaid, o "Spenddown", Healthcare Counts (Washtenaw Health Plan), Medicaid Redeterminations - Implications for the federal public health emergency unwinding. The Medicaid Deductible program is available to people with disabilities, the elderly, children and parents of children who are over the income limit for full Medicaid. Create a Life Care AgreementLife Care Agreements, also called Personal Care Agreements, are formal contracts between an elderly individual and, generally, a family member or close friend. This number is based on your household income. About the WIPA Program. ACTUALIZADO ** Eligiendo un Plan de Salud de Medicaid - (888)367-6557. After you sign up, HFS will send you a Pay-in Spenddown Statement each month to tell you the amount you may pay. Can using home care technology help your family save money caring for an aging loved one? Or one could simply sell their old car and purchase a new one. Help! Walk-in hours are Monday through Friday from 9am to 4pm. You will also get a medical card for any past or future months for which you met spenddown. Happy 50th Birthday to the AAATA. DHS then add your sources of income. Welcome Jeremy Lapedis to the Washtenaw Health Plan! notify us You cannot get a medical card for June. Use or replication of this content by other web sites or commercial entities without written permission is strictly prohibited. Important: The Medicaid Deductible program does not meet the mandates of the Affordable Care Act. While asset limits vary by state, all states allow asset spend-down. For example, one's home and vehicle are exempt / non-countable assets. This program allows you to deduct certain medical expenses from your income so that you can qualify for ABD Medicaid. Ultimately, the state determines what assets count and determine your eligibility for a spend-down program. What Are Cost Sharing Reductions And Why Do They Matter? Walk-in hours are Monday through Friday from 9am to 4pm. A person eligible for RCA is ineligible for ABD until their RCA eligibility ends. Pay-in Spenddown is described later in this brochure. You pay $5 for medicine on July 14 and your doctor bills you $25 when she sees you on July 18. As of 2022, the following states are 100% states: Alaska, California, Colorado, Florida, Georgia, Hawaii, Illinois, Louisiana, Maine, Mississippi, South Carolina, Vermont, and Wyoming. Last Two Weeks: Walk-In and Evening Hours! 2016-2017 School Year Started. Birth Control? Sometimes an adult son or daughter will pay a medical bill for a parent even though the son or daughter has no legal duty to pay. However, if the couples joint assets are under the 2022 minimum of $27,480, the healthy spouse is able to retain all of the assets. As a couple, they have $280,000 in joint assets. You meet your monthly spenddown by showing your DHS caseworker unpaid medical bills, or receipts for payment of medical bills, equal to your spenddown amount. Via income spend-down, excess income can be spent down on medical bills each month in order to qualify for Medicaid. The spend-down program may also be referred to as a medically needy program or Medicaid's Excess Income Program. What's Wrong With The Senate Health Care Bill? DHS will decide if your assets, or property, are below the allowable limits. If you have medical expenses that significantly reduce your usable income, you may qualify for a Medicaid spend-down. Internet usage can be tracked. The enrollment period for an AABD Community spenddown EDG is twelve calendar months. You can use any of the following to meet your spend-down: The bill for the medical services or medications purchased must be from within the past six months. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. Enrollment in the Health Benefits for Immigrant Adults (HBIA) program will be temporarily paused effective July 1, 2023. IATP provides WIPA services to 67 counties in Illinois through a cooperative agreement with the SSA. Read more in the Pay-in Spenddown section later in this brochure. Congratulations, You're Pregnant! If all eligibility requirements for Medicaid are met, with the exception of income and / or assets, one may still qualify for Medicaid. Additionally, those who qualify for the spend-down program are automatically eligible for Extra Help with their prescription drug costs. "War Is Not Healthy For Children" and the Quest for Free, Accessible Vaccines, Special Enrollment Period March 15 - April 30, 2015. A person may be eligible for AABD if they: Receive Supplemental Security Income (SSI) or are ineligible for SSI due You can think of a spend-down as a number. The individual is then responsible for the deductible and DHHS pays the remainder. Will Your Insurance Options Change? Our Courtyard Transforms! Updated** Medicaid Dental: How to Use it and Where to Go Three Steps Toward Qualifying for a Health Care Tax Exemption, Quit Smoking! This means that as soon as you have medical bills in the amount of the spend-down, you have met your spend-down, even though you may not yet be able to pay all of those bills. This means the couple has $12,600 ($280,000 $267,400 = $12,600) in excess of the Medicaid asset limit. Worried about doing this on your own? Remember to clear your browser history to hide activity. As of 2022, this amount is between $27,480 and $137,400. Worried about doing this on your own? If you got a bill dated more than six months ago, and you want to use the bill for spenddown, ask the doctor, hospital or other medical provider to give you a new bill. Or, you can file an appeal by writing to the Bureau of Administrative Hearings, 401 South Clinton Street, Chicago, IL 60607, or calling 1-800-435-0774 (TTY: 1-877-734-7429). Want to Subscribe to this Blog/News Feed? However, remember that only one vehicle is an exempt asset. Basically, an individual pays a lump sum of money. ILAO's tax identification number is 20-2917133. https://www.illinoislegalaid.org/legal-information/aabd-allowable-limits. These are exempt assets, and include the following: DHS has set the minimum prices, called allowances, for certain kinds of needs. If you qualify for this program, HFS will send you a notice and enrollment form with a return envelope. Remember to clear your browser history to hide activity. Thank you for your response. For processing information please see Desk Aid ". Or, you may choose to use your expenses to meet spenddown for a later month to get a full months coverage. These programs are funded by trusts in some states, such as a Miller Trust. If you think you should have full coverage, the Washtenaw Health Plan offers a free assessment. If you want medical benefits for July, payment will be made for part of your doctor bill over $5, and for medical care you got in July after you saw the doctor on July 18. If your income or assets are above the limits, you will need to meet what is called a spend-down in order to be eligible for Medicaid coverage. Got Out Of Prison? Your state determines the income that makes someone eligible for Medicaid. However, you may reapply for Medicaid when you have enough bills to meet the spend-down. Starting on June 1, Martha does not have Medicaid, but again would have to meet a deductible. He went the extra mile. Your local DHS Family Community Resource Center can provide you with an appeal form and will help you fill it out, if you wish. Six Things I Learned about Healthcare While Working at the WHP, 2017 Medicare Open Enrollment Runs October 15 through December 7, Mental Health Needs? Gifting ones assets can put one in violation of Medicaids 5-Year Look-Back Period, resulting in a period of Medicaid ineligibility. IndividualsThe asset limit for a single elderly individual for long-term care is $2,000 in most states. At the hearing, you may represent yourself or be represented by a lawyer, relative or friend. Have you heard? You can add your June and July premiums together to meet your July spenddown. You will owe only the $50 doctor bill and $50 of the hospital bill. You must sign the form and send it to the HFS Pay-in Spenddown Unit in Springfield to enroll. Thanks EIP! Non-countable assets do not count toward the Medicaid asset limit. If you qualify for this program, HFS will send you a notice and enrollment form with a return envelope. 2023Illinois Legal Aid Online. 1095-A, 1095-B and 1095-C: Qu son y qu debo hacer con ellos? COBRA Insurance: Time Sensitive Decisions, Open Enrollment 2020: Marketplace, Employer Medicaid, and Medicare, 2020 Medicare Open Enrollment Runs October 15 through December 7. If your income does not meet these minimum living expenses, DHS will give you an AABD grant to make up the difference. Bills or receipts for medical services or supplies can be used to meet your spenddown. Flint Water Medicaid: See If You Qualify. If the bills and receipts are less than your monthly spenddown, you can use them with other bills and receipts you get to meet your spenddown in a later month. Your feedback is the best way for us to improve our services. In order to get DHHS to pay, a deductible report has to be submitted. When you get enough bills to meet your spend-down, send copies of the bills to your caseworker at the local DHS office. Your spenddown is $25. You meet the spend-down amount by getting medical bills in the amount of your spend-down. You are currently over the limit because you have $20,000 in savings. It is suggested one contact a Medicaid expert before undertaking any of the following purchases. For example: You are enrolled in Pay-in Spenddown. How Do I Report Self-Employment Income for Medicaid or the Marketplace? 50% States In 50% states, the spouse who is not applying for Medicaid is able to keep up to 50% of the couples combined assets (generally all assets are considered joint assets) up to the 2022 maximum amount of $137,400. A Medicaid spend-down program is available to people who aren't eligible for Medicaid but who have high medical expenses in proportion to their income and assets. Certain payments do not count as income. Combine medical expenses (bills and receipts) and a payment to IHFS. When thinking about asset spend-down for Medicaid eligibility, it is extremely important to know which assets are considered countable and which ones are considered non-countable. Married Couples with Both Spouses Applying for MedicaidWhen a couple is married, all assets are considered joint assets. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. The limit is further increased by $50 for each additional dependent. Monthly Income. Financial eligibility guidelines vary by state. The couple has an adult child who is willing to care for Joann at home, so a caregiver agreement is drawn up for 15 months at $2,880 / month ($18 / hour, 8 hours a day, 5 days / week). At that time eligibility for ABD may be determined. Now what? A Medicaid spend-down program is available to people who arent eligible for Medicaid but who have high medical expenses in proportion to their income and assets. Get Your Free Flu Shot and Protect Yourself All Winter--Here's How! When someone is eligible and applies for this program, they receive ABD Medicaid (Medicaid for the aged, blind, and disabled). All rights reserved. See, Members of a married couple and legally emancipated persons under age 18 meet the minimum age requirement for ABD cash assistance under, Persons who apply in the month of their 65th birthday are considered Aged. It is up to you. Support CHIP (Children's Health Insurance Program)! You can also enroll in Pay-in Spenddown. Sometimes an individual is approved for the Deductible program but really should have full Medicaid. 2017 Open Enrollment November 1, 2016 to January 31, 2017- Don't Be Scared! For example: If you got a bill dated within the last six months, you can use the bill to meet your spenddown now. The program is for persons who are 65 years or older, blind, or disabled and. Below is a list of common ways that individuals and / or couples can spend-down in order to gain Medicaid eligibility without violating the look-back period. Medicare and other medical insurance premiums, deductibles or other insurance co-payments. If you have medical expenses that significantly reduce your usable income, you may qualify for a Medicaid spend-down. When a new blog posts, you will receive an email. When you have bills or receipts equal to your monthly spenddown, take them to your DHS caseworker. If you used an unpaid bill to meet your spenddown in one month, you cannot use a receipt for payment of that bill to meet spenddown in a later month. For instance, the income and asset limits might be different for the regular state Medicaid program versus a Home and Community Based Services (HCBS) Medicaid waiver or nursing home Medicaid. Some states require beneficiaries to be in the spend-down program for more than one period before they can qualify for inpatient hospital coverage from Medicaid. It's NowBuilt To Play! Extra food assistance through SNAP will end in February! People who are older, blind or have a disability may qualify for pay-in spend-down. You have to show your caseworker proof that you have met your spenddown. Thus, it is extremely important to know the asset limit for ones state of residence. Note that if a spouse continues to live in the home, there is no home equity value limit. Has the Affordable Care Act Changed Your Life? In addition to nursing home care and supported living facilities (assisted living services), Illinois Medicaid pays for non-medical support services to help . The Department of Healthcare and Family Services makes the rules about who can qualify and pays most of the medical bills. Did you find this content helpful? While one may think to request assistance from their local Area Agency on Aging (AAA) office, this is not a good option. The new MIBridges! This site is for information and support; it is not a substitute for professional advice. If you used part of a receipt in one month, you can use the rest of the receipt in any month, up to six months after you made the payment. You may also wish to speak to an estate planning or elder care lawyer, depending on your needs. Sometimes you may not want medical benefits for the first month your expenses add up to your spenddown. If all other eligibility requirements are met, one will have to simply spend-down their assets in order to reach the Medicaid asset limit set by their state. To spend-down their excess assets, the couple purchases irrevocable funeral trusts in each of their names. You will have 6 consecutive months to send bills to DHS. For example: You apply for medical benefits in September. You need a medical card for August, but only have a $50 medical bill to use toward your spenddown. Some people, particularly people living in nursing homes, do meet their deductible each month, but most people do not. If you meet your spenddown, your caseworker can have a temporary medical card ready in two working days. Below is a general guide to the Medicaid spend-down process. You must decide if you want the bill paid or you want to use it to meet spenddown in a later month. And married applicants, where both spouses are applying for Medicaid, are able to keep up to $3,000. To learn more about this option,click here. United Way's VITA Extension and Financial Coaching. I understand I am not obligated to provide this consent to utilize Carings service(s). ID is Key: Get Your Washtenaw County ID Now! After your case has been in enrolled spenddown status for six months, it will be reviewed each month to see if you have met your spenddown in one of the last six months. If you would rather use the entire $30 of expenses to meet spenddown for three full months after July, you must let your caseworker know. So one should not hesitate to seek professional advice well in advance of when one thinks they might be close to becoming financially eligible for Medicaid. With a monthly Medicaid deductible, for Medicaid to become fully active, bills amounting to the deductible must be reached in a given month. When you meet spenddown with medical expenses for a full month or with a Pay-in payment, HFS will pay for the medical care you get in that month as long as the care is covered. For example: Your spenddown is $10. This is because the asset limit varies by state, as well as if one is single or married, and if married, if one or both spouses are applying for Medicaid. In general, any spending is fine, so long as ones assets are not given away or sold for significantly less than they are worth. This card will be good for the rest of the month in which you have met your spenddown. When one cancels their policy or decreases the cash value of the policy, the extra cash value goes to the policyholder, and must be spent. Medicaid Appeals Part 2: The Hearing Process, Medicaid Appeals Part 1: Filing a Hearing. Make note, the pay, with consideration of the seniors life expectancy, must be fair and reasonable. It should answer many of your questions about the program and how it can help you. We can't give legal advice in the comments, so if you have a question or need legal help, please go to Get Legal Help. How can we improve this site? Sometimes, people on Medicare also need Medicaid but their incomes are over their states limit. Your countable income is whatever is left after subtracting expenses. Instead, you may want to use those expenses to get medical benefits in a later month. Help us open opportunities for justice. Learn more here. You can call Illinois Health Connect at 1-877-912-1999 for help to find a doctor. Are YOU Falling off Medicaid? For example, Emergency Services Medicaid and the MOMS program (information here) provide partial services to immigrants. You can pay with a money order, cashier's check, Visa or Master Card. They can be used as long as the bill was dated no earlier than the sixth month before the month you use it to meet your spenddown. Required fields are marked *. The spenddown program helps some people who have too much income or too many assets (like bank accounts and other resources) to qualify for other HFS Medical Programs. On the contrary, his spouse is healthy and does not need Medicaid care. be ineligible for SSI due to income and was found disabled; be anoncitizen ineligible forSSI due to expiration of the federal 7-year limit. Because premiums add up to $100, you have met your $75 July spenddown and have $25 to credit toward spenddown in a later month. If you are aged, blind or have a disability and are approved for a spenddown case, you may be eligible to enroll in the Pay-in Spenddown option. The hospital will bill HFS for the rest. Another "partial" program is called the Medicaid Deductible program (previously called Medicaid Spenddown). Strategies to Spend Down Assetsto Gain Medicaid Approval, Speak with a Senior Care Expert Today (For Free), Joshua Iversen, President, Syzygy Financial LLC, income cap/categorically need state or a spend-down/medically needy state, Amount the Community Spouse keeps in a 50% State, Amount the Community Spouse keeps in a 100% State, Property (while ones primary home is considered a non-countable asset, property that is above and beyond ones primary residence, such as a vacation home, is considered a countable asset). Copyright 2023. If you live in a state that doesnt have a spend-down program, the limits for Medicaid are likely higher for those needing nursing home care than in states that do offer the program. However, this varies depending on the state in which one resides. However, there are some exceptions. With Medicaid Expansion, Women Don't Have to Be Pregnant to Get Covered! For help submitting bills for your Medicaid deductible or if you think you should have full Medicaid,stop into the Washtenaw Health Plan. Some states, which are called income caps states, allow applicants with excess income to qualify for Medicaid by converting their extra income into a Qualified Income Trust (QIT), also called a Miller Trust. Additionally, if you have a second home, it may be a countable asset that you would be able to sell for the money needed to cover your medical expenses. This program is also known as a medically needy pathway or excess/surplus income program. Contact your local Medicaid office to learn more about eligibility. Open Enrollment Begins November 1, 2015, Mammograms Are Free! Your spend-down is $100. Finding that your income cant keep up with your medical expenses is an all too common experience. Questions? Cancel Life Insurance Policies with a Cash Value Over $1,500Since life insurance policies with a cash value of $1,500 or less are exempt, it makes sense to cancel insurance policies that have a cash value over $1,500. Learn if your state is an income cap/categorically need state or a spend-down/medically needy state. If you fit these criteria and are working at least one hour per month but your income or assets dont let you qualify for Medicaid, its worth looking into the availability of this program in your state. The answer is most certainly Yes. Normal operations will resume on Monday, July 3, 2023. Generally, the caregiver is paid a lump sum for agreeing to care for the senior for their life expectancy. For example, earned income tax credit and energy assistance payments do not count. When you first apply for medical benefits, HFS may pay for covered medical care in the three months before you applied, if you met your monthly spenddown for those months. All other customer service options are available. An individual who is over the income limit for full Medicaid and has very few assets may be approved for the Deductible program. Save my name, email, and website in this browser for the next time I comment. For disabled individuals under 65 who are working, some states make available a program called the Medicaid Buy-In program. To combine medical expenses and a pay-in payment, you may show the $50 bill to your HFS caseworker and send a $50 payment to HFS to meet spend-down for August. Unpaid bills older than 6 months should be re-issued by your doctor before you can use them. This might include: The amount one can put in an irrevocable funeral trust depends on the state in which one resides. You can ask HFS Medical Programs to pay the bills that are over your monthly spenddown amount, or you can use the amount over your monthly spenddown to meet your spenddown in a later month. Example 1 Billy is a single, elderly resident of Illinois who requires long-term Medicaid care in his home. The call is free. Award amounts for scholarships and grants are adjusted to reflect your actual enrollment at the conclusion of the drop period. Again, this figure varies by state. Grace B. Hou, Secretary, IDHS Help Line South Carolina allows the healthy spouse to keep up to 100% of $66,480, and Illinois allows up to $109,560. Again, the asset limits vary by the state in which one resides. It is very important that you keep copies of all medical bills, prescription receipts, and records of other medical expenses. Having assets over the Medicaid asset limit does not mean a single senior or married elderly couple will not be able to receive Medicaid benefits. Generally speaking, most states allow a single Medicaid applicant to retain up to $2,000 in countable assets. Your spenddown is $100. ($10,680 each = $21,360). Non-countable assets are also called exempt assets. When meeting spenddown for a partial month with medical expenses, you pay for your medical care up to your spenddown amount. Countable assets dont include your primary home, car, or personal belongings. Assets Requirement. If you are a Medicare Part D beneficiary struggling with the cost of prescription drugs, Extra Help may be the Are you enrolled in Medicare or soon-to-be Medicare eligible? If you got a bill dated January, you can use it toward your spenddown in any month from January through July of the same year. Breastfeeding - Good for Babies and Moms! DHS will not count certain assets. Every effort is made to provide accurate and up to date information. In addition, the spouse applying for Medicaid is able to retain a set amount. All rights reserved. Or, stated differently, not all states allow applicants to spend down their extra income on medical expenses. A year of postpartum care is now included with Medicaid! If you need Medicaid coverage and your income is above the Medicaid income guidelines in your state, your state may offer a Medicaid spend-down for aged, blind, and disabled (ABD) individuals who do not meet eligibility requirements. 1-800-843-6154 Example 3 Grant is married, lives in California, and needs significant assistance with his daily living activities, enough so that he requires assisted living care. Contact your local Medicaid office to learn if a spend-down program is available in your state, and the rules for applying. Martha is responsible for paying the $800 to the hospital and DHHS pays $4,200. Your feedback is the best way for us to improve our services. Receive Supplemental Security Income (SSI) or are ineligible for SSI due to income or are ineligible for SSI due to expiration of federal time limit on assistance to certain immigrants who have not yet become U.S. citizens. Now You Need Health Care! You can only use the charges for a medical service or supply once to meet spenddown. Open Enrollment Tips, Part 3: Should I Choose A Dental Plan? You will receive an email to confirm your subscription to the healthcarecounts.org blog. Coming Together for Our Communities: Welcoming Michigan and Welcoming America Celebrate Welcoming Week, Why it could be worse (or better) to be sick in some states than others, WHP Profile / Perfil Personal: Spring Quiones. ), Medicaid work requirements: A prescription for problems, For These Four Working Households, Medicaid--Without Work Requirements--Matters, Ten Reasons To Oppose Medicaid Work Requirements. The healthy spouse is also allowed to keep some assets, referred to as a spousal resource allowance. Updated** Choosing a Medicaid Health Plan - 888-367-6557, Good News: Medicaid Can Be Secondary Insurance, Six Years! Approving ABD in the Month of a Person's 65th Birthday. Individuals in this profession have practical experience in asset spend-down and can assist you and / or your loved ones in appropriately spending down assets in order to qualify for Medicaid. To qualify for Medicaid or Medicaid long term care, seniors must meet several eligibility requirements, including having a need for care and having limited income and assets. You can give your caseworker copies of the bills and receipts. Immunizations are Free and Essential, Helping Children With Special Healthcare Needs, How to Report Income: Annual vs. Preparacin de Impuestos Gratuita or Get (Free) Help With Your Taxes! You can still get Medicaid coverage later if you meet your spend-down amount during another period of the year. Washtenaw Health Plan - What are we up to? As a side note, some states consider married applicants applying for an HCBS Medicaid waiver or nursing home Medicaid as single applicants. The Marketplace and Medicaid are Open for You! Therefore, he has spent-down the excess $8,000 in assets and is eligible for Medicaid. If someone with no legal duty to pay a medical bill for you pays that bill, you can count that bill toward your spenddown if the payment was made no more than six months ago, and the person who paid the bill wants to be repaid. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. COUNCIL FOR HEALTH JUSTICE Eligibility Guidelines Am I able to get AABD Cash? You need a medical card for August, but only have a $50 medical bill to use toward your spenddown. Grant amounts vary based on income and needs, but the minimum payment is $1. Primary Home In order for the home to be exempt, the Medicaid applicant must live in their home (or have an intent to return to their home) or have a spouse who lives in it. You must sign the form and send it to HFS to enroll. The total needs allowances you qualify must be greater than your countable income. Health Insurance Has You Covered, Washtenaw Health Plan Services for Immigrants. Uncovered Medical Devices Examples include hearing aids, dentures, and eyeglasses. You are a single elderly individual with a monthly income of $2,700. This adds to the complexity of the calculation. UPDATED: Minimum Wage is Rising! It should also be mentioned that one should not spend down non-exempt assets by purchasing other non-exempt assets. You have met your spenddown on July 18. Example 2 Michael and his spouse, Joann, are both in their 80s and are in poor health.
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