Colorado Medicaid Long Term Care Eligibility

Colorado Long Term Care

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Colorado 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.

Unlike traditional Medicaid sponsored long term care, Colorado has what they call a long term care partnership. The partnership melds together private insurance and state funds. This is a beneficial system for recipients who do not wish to deplete all of their assets paying for care. It is designed to reward residents who have planned ahead for their long term care needs. Colorado allows insurance companies to sell LTC partnership policies and guarantees that for every dollar paid out by an LTC partnership plan, a dollar of the recipient’s personal assets can be protected. Protected assets are ignored when reviewing an applicant’s financial eligibility and during estate recovery after a long term care recipient’s death. LTC partnership policy holders who apply for Medicaid are able to keep assets above the $2,000 Medicaid asset maximum.

Types of Care:

Long Term Care Services can cover a nursing facility stay or community based services (HCBS). An individual receiving HCBS is not required to make a payment towards the cost of care.

Nursing facilities provide 24 hour care in a professional setting for help with basic activities and necessities. HCBS take place in places like your home or retirement communities. HCBS can include nurse assistance, home health aid, house cleaning, meal preparation, or assistance with bathing and dressing.

NOTE:

It is important to note that the purchase of a Qualified CO LTCP policy does not guarantee Medicaid eligibility or benefits. Individuals who have LTCP policies must still meet Medicaid eligibility requirements before they can qualify and receive LTC benefits under Medicaid.

An individual must still meet other eligibility criteria referenced below (non-financial, financial and medical) to qualify for Medicaid Long Term Care. Only resources are protected under an LTCP policy, not income. Social Security, pensions, and other income must be used to help pay for long term care costs. Before applying for Medicaid long term care, the applicant does not have to exhaust their qualified LTCP insurance policy benefits.

Medicaid Eligibility:

  • Eligibility is determined by an applicant’s local county department of social services.
  • Medicaid has both financial and medical related requirements.
  • Income limit – Up to 300% of the Social Security Income rate, adjusted annually. There is a personal needs allowance of $80.00 per month that is not factored into the countable income
  • Resource limit – $2,000 for individuals and $3,000 for couples both on Medicaid LTC.
  • Must be 65+, or disabled, or blind.
  • OR the applicant must be in a medical institution for 30+ consecutive days (Hospital and/or Nursing Facility), receiving nursing facility level of care in the community for HCBS, or a combination of both.

An individual receiving Medicaid LTC Services in a LTC facility is required to make a monthly payment towards the cost of care to the facility. The payment is based on gross monthly income with deductions.
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The county’s department of human services configures the payment towards the cost of care as follows:
  • Gross monthly income
  • Minus $80 of personal needs allowance (Standard)
  • Minus potential deductions:
    • Home Maintenance Deduction
    • Spousal/Dependent Maintenance Allowance
    • Additional miscellaneous allowances allowed by law
  • Resulting amount is paid monthly by the individual.

Assets/Resources: Resources are divided into two categories—countable and exempt.

Countable resources include: cash, checking accounts, savings accounts, CDs, mutual funds, IRAs, investment portfolios, bonds, life insurance policies totaling more than $1500, vehicles if more than one is owned, properties.

Exempt resources include: household goods, jewelry, one car, one home worth up to $560,000 (if spouse/dependent/disabled child resides in it or if you intend to return to it), burial plots (some limitations apply), life insurance policies if totaled less than $1,500.

Trusts can either be included or excluded depending on the county human service office’s determination.

Usually, if an annuity is revocable and an individual can take a lump sum distribution, the annuity is a countable resource. If an annuity is assignable, it may be considered a transfer without fair consideration. If income is received from an annuity it is considered income in the month it is received.

An annuity belonging to the community spouse (CS), which is irrevocable and non-assignable is not considered an available resource. An annuity belonging to the CS which is revocable is treated as an available resource, and the value of the annuity is included in the couple’s total resources when determining the Community Spouse Resource allowance (CSRA). The income a CS receives from an annuity is included in calculating the Community Spouse’s Minimum Monthly Maintenance Needs Allowance (CSMMNA). Special Medicaid rules apply to couples to ensure that the Community Spouse (CS) who does not need LTC Services does not become impoverished when the other spouse needs Medicaid to help pay for the cost of LTC services.

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.

Spousal Rules:

Amount of assets community spouse may retain: The community spouse can keep one-half of countable assets with a maximum value of $120,900. If the community spouse’s assets do not equal $120,900, the community spouse is able to retain assets from the institutionalized spouse until the maximum is reached.

Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has a monthly income of less than $2,003. The maximum amount of income that can be retained is $3,023, varying by case.

Further Reading:

The Colorado Department of Health Care Policy & Financing administers the Colorado Medicaid program. (www.chcpf.state.co.us)

Colorado Department of Human Services: 303-866-5700; county office list: http://www.colorado.gov/cs/Satellite/CDHS-Main/CBON/1251590215770

Apply online: https://coloradopeak.secure.force.com/