Alabama Medicaid Long Term Care Eligibility

Alabama Medicaid Long Term Care Programs

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Alabama is an income cap state, meaning that in order to be eligible for Medicaid long term care benefits there is a hard income limit. Non income cap states allow applicants to spend down money for their care, whereas income cap states require the amount to be no higher than their limit at time of application.

The Alabama Medicaid Agency has three main programs for the elderly and disabled:

  • Medicaid for institutional care is used for nursing homes, hospitals, and ICF-MR facilities.
  • Home and community based waivers are for the elderly, disabled, homebound, mentally handicap, or those who have certain diagnoses and live in the community.
  • SSI Related Medicaid programs are for people no longer receiving Supplemental Security Income (SSI) payments, but have their Medicaid benefits protected under certain laws.

Each program has specific qualifications detailed below:

  • For all programs, an applicant must be a resident of Alabama and a U.S. citizen or have proper immigration status.
  • An applicant for Nursing Home, Hospital, or ICF-MR Medicaid must also be a resident of an approved medical institution for at least 30 consecutive days to be eligible for Medicaid benefits. (The exception is an SSI recipient.)
  • Applicants need to meet medical approval by Medicaid for the nursing facility to be paid. The nursing facility must submit the medical information to Medicaid.
  • Income Limit. The income limit for Nursing Home, Hospital, or ICF-MR Medicaid is $2,199 per month for an individual (this income limit changes each January). There is a personal needs allowance of $30.00 per month that is not factored into the countable income.
  • The resource limit for Nursing Home, Hospital, and ICF-MR Medicaid is $2,000 before the first day of the month. This means that in order to be eligible for Medicaid you must not have more than $2,000 in resources on the first day of any given month.
  • The resource limit for Home and Community Based Waivers is $2,000 for an individual. Income and resources of the spouse do not apply to waivers.
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  • For married couples: If the community spouse has less than $2,003 per month (2017) he/she is eligible to retain some of the institutionalized spouse’s income to reach the minimum (This amount changes each July). If the community spouse has gross income at or above $2,003, no additional income can be allocated from the institutionalized spouse to the community spouse. Alabama is an “income first” state, meaning the state limits the right to petition for an increased community spouse resource amount (CSRA) to couples whose combined income fails to meet the community spouse’s income needs. Basically, this means a community spouse can petition for an increased CSRA where there’s an income gap only after factoring in the nursing home spouse’s income first.
  • If the community spouse’s resources are less than $27,000 he/she may retain some of the institutionalized spouse’s resources to reach the minimum. The maximum amount of resources the community spouse can retain equals one-half of the couple’s total assets up to a value of $238,440.
  • The money paid out for SSI Related Medicaid is $735 for an individual and $1,103 for a couple. (This income limit changes each January.)
  • If you have income above the maximum, a miller trust can be set up, putting the excess money in a trust devoted to paying the state back for some of the cost of care.
  • The Medicaid applicant’s home, vehicle, jewelry, clothing, and furniture can all be considered exempt assets when figuring into the maximum resource value.
  • Meeting the various financial limits is often a process involving the structuring of one’s assets so they can be considered exempt and / or placing excess assets into trusts.  The Medicaid applicant cannot give away their excess assets as Medicaid looks into financial records as far back as 60 months prior to the application date. The applicant cannot sell anything below fair market value as this will result in ineligibility as well.

Alabama long term care insurance partnership: This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used you may apply for Medicaid with $155,000 worth of assets exempted.

Further Reading:

Application: http://www.medicaid.alabama.gov/CONTENT/3.0_Apply/

Tips for a fast application: http://medicaid.alabama.gov/documents/3.0_Apply/3.2_Qualifying_Medicaid/3.2_Nursing_Home_Medicaid_App_Tips_11-5-12.pdf

Guidelines to report changes in finances and list of district offices: http://medicaid.alabama.gov/documents/3.0_Apply/3.2_Qualifying_Medicaid/3.2_NH_7_Report_Changes_8-12-14.pdf

Medicare Savings programs: http://medicaid.alabama.gov/documents/3.0_Apply/3.2_Qualifying_Medicaid/3.2_Medicare_Savings_Programs_Revised_5-23-14.pdf

Agency Contact Information

To apply for the Elderly & Disabled Waiver contact your local Area Agency on Aging at 1-800-243-5463 or your local Department of Public Health in your county of residence.

For the State of Alabama Independent Living Waiver contact your local Department of Rehabilitation Services or call 1-800-441-7607.

For the Home and Community-Based Waiver for Persons with Intellectual Disabilities contact your local Department of Mental Health or call 1-800-361-4491.

For the HIV/AIDS Waiver contact the local Department of Public Health in your county of residence or call 334-206-5341.

For the Technology Assisted Waiver contact the Department of Rehabilitation Services at 1-800-441-7607.

For the Living at Home Waiver for Persons with Intellectual Disabilities contact the Department of Mental Health at 1-800-361-4491.