Maine Medicaid Long Term Care Eligibility
Maine Long Term Care
1. Residency and Citizenship – the applicant must be a resident of Maine and a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested. There is a form called the MED (Medical Eligibility Determination), which is used when people are applying for long-term care services. The form is filled out by a nurse and reviews a person’s abilities and disabilities. After completion of the MED, a nurse should be able to tell if an applicant meets the medical requirements for long-term care services and whether they are financially eligible for MaineCare. After determining eligibility, the individual seeking care will be given an application, which must be sent to the Office of Family Independence.
3. Income Limitations – the applicant’s income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be less than $2,313 per month. Income in excess of $2,313 can still qualify for Medicaid coverage if excess income is placed into a Qualifying Income Trust (QIT). The trust must be irrevocable and Maine Medicaid must be the designated recipient when the beneficiary dies. Only income in excess of $2,313 must be placed in the trust. There is a personal needs allowance of $70/month for assisted living and $40/month for nursing home care that is not factored into the total countable income.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. Maine has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away.
Exempt Assets for an applicant in Maine include:
i. $10,000 or less in cash/non-exempt assets if single. Maine allows $8,000 in liquid assets beyond the national average maximum of $2,000.
ii. Personal effects and household goods.
iii. One home (equity value limited to $858,000) is exempt if planning to return home within six months, a spouse, a child under 21, or a disabled person resides in it. The house can be transferred with no penalty to the spouse; a natural, adopted, or step child who is under 21, blind or disabled; a sibling who has equity interest in the home and lived with the institutionalized individual one year prior to institutionalization; another adult, who lived with the resident and provided care for at least two years thereby delaying institutionalization.
iv. One motor vehicle if the vehicle is used for the long term care recipient’s medical treatment, employment, modified to accommodate a disability, or the primary vehicle of the community spouse—no matter the value.
v. Burial spaces and irrevocable pre-paid burial trusts if below $12,000. If above $12,000 the excess money that is not used for burial services must be returned to the applicant’s estate so Maine can recover the funds after the death of the long-term care recipient.
vi. Actuarially sound annuities are considered exempt.
Amount of assets community spouse may retain: The community spouse can keep one-half of all non-exempt resources owned by one or both spouses with a maximum of $126,420.
Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has an income of less than $2,057.50 per month. If the spouse can document high shelter expenses (rent, utilities, phone, etc.) then the income limit may be raised to a maximum of $3,160.50.
Maine 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.
Maine Department of Health and Human Services: http://www.maine.gov/dhhs/ofi/public-assistance/long-term_needs.html
MaineCare Site: http://www.benefits.gov/benefits/benefit-details/1630