THE HECK IS A
YOUR ELDERLY OR DISABLED FAMILY MEMBER WITH INCOME THAT IS "TOO HIGH"
CAN STILL QUALIFY FOR MEDICAID HOME CARE
In CONNECTICUT, a person can get Medicaid to pay for regular old doctor visits, drugs, and hospital stays, in various different ways, but usually having "too much income" won't prevent Medicaid from paying and will only affect the type of program, the deductible or "spenddown."
BUT IF AN ELDERLY OR DISABLED PERSON NEEDS MEDICAID TO PAY FOR SO-CALLED "WAIVER SERVICES" -- such as paying for home care that Medicare doesn't cover, such as supervision, or help with activities of daily living, INCOME MATTERS. Too much income and you don't qualify. These programs include:
1. CT Home Care Program for Elders (Medicaid Waiver) -- home care for those 65+.
2. Acquired Brain Injury Waiver -- services and supports for those with a brain injury, any age.
3. Personal Care Assistance Waiver - services and supports for those able to supervise an attendant. (These services may also be available under "basic" Medicaid but with a big copay if income is over about $900/month.)
For these programs, if the applicant's income is more than 300% of the SSI benefit (for 2016, this means $2,199), the person's income is TOO HIGH -- NOT ELIGIBLE.
But this is crazy -- the person could have $3,000 of income and Medicaid would pay for a nursing home (after requiring all income to be paid towards the cost) but not if the same person wants to stay home????
Don't ask why. It's complicated. The
point is that
A "pooled trust" is a type of common fund where people have "accounts" representing their contributions to the fund. This set-up was originally intended to help disabled people with excess assets where a Special Needs Trust seemed too expensive, or slow, or complicated. Unlike a Special Needs Trust, a pooled trust account can be created for a disabled person of any age. A person of any age can set up the account and put assets in the account .... or income..
What if your family member was never disabled before? He or she may need help due to the disabilities of old age only, but that counts!
How does it work? Suppose Mom's income is $2,500 and she needs 40 hours a week of home care -- someone to watch her, change her, and help her shower. All she owns is her home and about $1,000. To get Medicaid waiver home care, she needs a pooled trust.
PLAN will require:
· A lawyer on the PLAN registry to oversee the setup. Fees SHOULD be low, but be careful here.
· A one-page application.
· A "spending plan" for income or assets going into the trust.
· Someone with a POA, or a designated contact "agent."
· $1,050* to set up (can be spread out over time if there isn't enough money up front).
· The form has to be signed by the applicant, or a POA (only if the POA authorizes trusts) or by conservator after getting court approval. No notary required.
DSS will require (in addition to any other application forms):
· Doctor's form attesting to disability (PLAN needs it too)
· A copy of the pooled trust form
· Proof that this month's "excess" income has gone into the account.
How much should go into the account? It depends. If Mom has $2,500 of income, putting in $301/month might be enough to make her eligible for home care, she'll have to pay $219 towards her care (net any medical premiums). But if she puts in $520 - that is everything over the $1980* personal needs allowance-- NO copay. This can be tricky and you may need that lawyer to help figure it out.
What happens to the income that goes in? Mom needs her $2500 to pay other expenses! Although PLAN has to withhold some amount for expenses and reserve, most of the money can, and even MUST come back out to be spent on mom's needs. PLAN cannot send Mom her whole $520, but can probably send $400/month to the private caregiver, pay the $38 cable bill.
What happens when Mom dies? Everything left in the account goes to the State, or to PLAN. NOTHING COMES BACK AFTER MOM DIES. So that last month's bill from the private caregiver may not get paid.
Hope this helps!
DISCLAIMER: NOT PROVIDED AS LEGAL ADVICE -- CONSULT AN ELDER LAW ATTORNEY!
© Lisa Davis (2016)