Medicaid is accepted at our community

Presenting some tips and tricks for navigating the sometimes complicated world of Medicaid

medicaid

Not only does our community provide our residents with all-inclusive care and services, but those services can be funded by Medicaid. Utilizing Medicaid dollars makes all the difference for many of our residents but accessing the program can seem a bit daunting at first. 

We'd like to offer some guidance for navigating the process. 

"Finances and how am I going to be able to pay for this - that's always our residents' first concern," said Placement Specialist Sarah Ingram, of Best Life for Seniors. 

Our goal is to provide you with a framework and the tools to help you navigate the financial aspect of your journey. And for many, the answer to "How can I afford this," comes through the help of the Medicaid/SA assistance program. 

A major requirement for Medicaid/SA eligibility is demonstrated financial need. You have to make sure that your income is below a certain level and that you have less than $2,000 in the bank and no assets.

Pre-planning is vitally important because all assets must be out of the resident's name five years before they become eligible for Medicaid/SA. It's important to be prepared because medical emergencies cannot be predicted. Vehicles, homes, real estate, all of it must be divested five years before you become eligible for Medicaid.

For many the option is a spend down, but there are requirements in place for that process. Money spent on the senior's care, whether it's a burial plot, gift certificates for hair dressing, and paying for medical care are all acceptable choices when it comes to spending down one's assets.

One problematic issue is that Medicaid's monthly income limits have not been raised or adjusted for inflation for the last 20 years, while social security has had annual increases. For North Carolina the income limit for Medicaid to help fund assisted living is $1,248 per month. For memory care it's $1,581 per month. For those who are living solely on Social Security, those numbers are usually manageable, but many people have additional income from pensions and other sources which can quickly push their monthly income totals above their state's limits.

There are also eligibility requirements to consider. For example, people who move to North Carolina in order to move into senior living must live here for a minimum of six-plus months or have established a permanent residence for sixty days before they become eligible for Medicaid assistance.

When you apply for Medicaid, the state of North Carolina will initiate what's called a 60-month Medicaid Look-Back Period. What this means is that the state will examine all your asset transfers for the past five years to ensure no assets were sold or given away for less than fair market value. This includes asset transfers made by one's spouse. If the state determines that the look back rule has been violated it's assumed that it was done to meet Medicaid's asset limit, and a penalty period of Medicaid ineligibility will be calculated.

An online spend down calculator can help you determine exactly how much of your assets must be spent down to be eligible for Medicaid long term care. It's available here: medicaidplanningassistance.org/medicaid-spend-down-calculator.

North Carolina's special assistance eligibility requirements are listed online at policies.ncdhhs.gov/divisional/aging-and-adult/special-assistance/documents/sa3100-1.pdf

It can be a complicated process for many, and an attorney specializing in elder law can help you navigate the system.

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