Even prior to the pandemic, most prefer to stay at home as long as possible if they should need long-term care. The increase in Covid variants has caused renewed and even greater interest for alternativesto care at long-term care facilities and the desire of many to stay at home due to safety concerns. However, most have no or inadequate long-term care insurance and have limited income and resources to pay the high cost of care. Many are unaware of potential public benefits that could help alleviate some of those care costs. The following is a short synopsis of three public benefit programs that help pay for care at home:
1. Community Care for the Aged and Disabled (CCAD)–this Texas Medicaid program usually pays for a caregiver to provide attendant services based on need. Although up to 40 hours per week could be provided under this program, usually 15 to 20 hours of attendant services is more common. The applicant could use Consumer Directed Services to hire their own caregivers. Eligibility requirements depend on the health and functional needs of the client. The state has a Client Needs Assessment Questionnaire to determine the need for services such as assistance with bathing, dressing, transferring, toileting, feeding, fluid intake, nutrition, medication, medical treatments, restorative nursing procedures and managing behavioral issues and if such needs are not being met.Additionally, there are several financial requirements. The applicant for CCAD cannot have gross income that exceeds $2,382 per month. Unlike some other Medicaid programs, you cannot create a Qualified Income Trust (QIT) formerly known as a Miller Trust to overcome the income cap.
Additionally, countable resources (certain resources such as a homestead with an equity limitation of $603,000 or less if the applicant is single, a car, pre-need funeral, personal property items, some IRAs, etc. are exempt) must be less than $2,000if the applicant is single and $3,000 if married. However, unlike most Medicaid programs, there is no transfer penalty if you make a gift within five years prior to the application. It should be noted that if the applicant later does apply for a different Medicaid program that does have a look-back period and a transfer was made to obtain CCAD eligibility, the transfer would be subject to the transfer penalty rules of other programs.
2. Star + Waiver–this is a far more extensive Medicaid program which permits the applicant (if married and one spouse does not need care) to have a greater amount of countable resources (depending on income) although you cannot make uncompensated transfers without creating five years of ineligibility. The state usually pays for a managed care organization (i.e, Molina and Superior) to provide personal and home care including medical care and supplies, physical and occupational therapy and respite care for 30-50 hours per week.
The medical and financial eligibility requirements for this program are different than CCAD. The applicantmust need enough care on a regular basis that usually would be given in a nursing home that requires the skills of a registered or licensed vocational nurse or under the supervision of a licensed nurse in an institutional setting.
Although there is also an income cap of $2,382 per month (this amount changes annually), a Qualified Income Trust can be used to overcome the income cap issue (although the excess over the cap would be paid to the Managed Care Organization).
Besides the additional care provided as set forth above, there are a couple of tremendous benefits if one is married and one spouse is not an applicant. There is a formula for how much countable resources could be kept without spend-down and the allowance is far greaterfor the “well” spouse under the Star + Waiver program than the long-term care (nursing home) Medicaid program. So, although the maximum protected resource amount (excluding exempt resources) for a married couple is normally $130,380 for both Star + and long-term care Medicaid, the maximum protected resource amount can often be expanded whereby hundreds of thousands of dollars are not subject to spenddown. Additionally, if receiving Star + Medicaid, you can get immediate eligibility for long-term care Medicaid even though you might not have been able to expand the protected resource amount as great as you could under Star +waiver.
However, there are two negatives about Star + Medicaid. First, if you make an uncompensated transfer for as little as a few hundred dollars within five years of applying, then there would be five years of ineligibility. Second, due to the great benefits of this program and due to increased demands as a result, there is a wait list of approximately 22,000 as of the date of this article (there is no interest list for CCAD) and it could take two years before one gets to the top of the list. There is no need for application or for being eligible at the time a name is added to the interest list.
3. VA Benefits–wartime military veterans or the surviving spouse of a wartime veteran who are considered housebound are entitled to VA benefits which pay a certain amount directly to the claimant. The maximum monthly benefits under this program is $1,419 if the veteran is single, $1,778 if married and $1,244 ifthe claim is for the surviving spouse of a wartime veteran. In order to qualify for the housebound benefit, the claimant must be substantially confined to their homes because of a permanent disability. Individuals may be able to take care of some of their needs at home, but they must be unable to transport themselves out of the home without assistance to get the housebound allowance. The veteran must have served 90 consecutive days with at least one day during an Eligible Wartime Period (i.e.,World War II’s Eligible Wartime Period was from December 7, 1941 –December 31, 1946) and not be dishonorablydischarged. The resource limit (which includes countable assets and annualized income) must be less than $130,773 in year2021. The general rule is that the surviving spouse (if that spouse seeks to apply for benefits) must have been married to the veteran at the veteran’s death(and not have been remarried subsequent to the death of the veteran). The primary residence, all vehicles necessary for family transportation and personal property items are exempt resources. There is also a transfer penalty if the claimant made an uncompensated transfer within three years of the claim for benefits (although there are a couple of exceptions). The penalty starts from the date of the transfer unlike most Medicaid programs.
With the increase of Covid variants, it is anticipated that these public benefit programs will be utilized more frequently.
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