Medicaid

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Medicaid provides health care services for low-income people. In Oregon, Medicaid pays for some long-term services and supports in home and community-based settings and nursing facilities. However, you must qualify based on your long-term services and supports needs and your finances.

Qualifying for Medicaid can be hard

You must meet the following requirements to qualify for long-term services and supports through Medicaid:

• You must meet Medicaid income eligibility based on “countable income” limits. For 2013 your income cannot exceed $2,130. In certain situations you can have a higher income and still qualify. What’s considered countable income varies depending on your personal circumstances.
• You must have no more than $2,000 in “countable resources.”
• Home equity cannot exceed $536,000 unless certain conditions are met.
• Neither you nor your spouse can transfer income or assets to qualify for Medicaid without being penalized. You also cannot have transferred any resources in the 60-month period before you apply.
• The block of time these transfers are not allowed is called the “look-back period.”
• You must meet the service priority level (SPL). This is determined by how much help you need with activities of daily living. Those who qualify usually do not have to wait for services.

You may have to spend down your resources

You will likely have to spend down your countable resources if you hope to qualify for Medicaid long-term services and supports. This includes your savings and other resources that can be converted to cash. Medicaid may require that you pay for part of the long-term services and supports if you qualify but still have income.

Medicare may recover from your estate any additional expenses for your care. Getting long-term services and supports through Medicaid can be challenging and expensive for a person who has worked and saved for the future.

Medicaid is a payer of last resort

Medicaid is a payer of last resort. If you qualify for Medicaid but have other sources of support, you will have to pay for your care first before Medicaid pays for it. These sources include health care coverage, long-term care insurance or another party liable for your medical expenses.

Medicaid disability trusts

A person with a disability who qualifies for public benefits can set up a Medicaid disability trust. Medicaid disability trusts are limited to people with disabilities under age 65. They are funded with the person with the disability’s assets. A court, a parent, grandparent, legal guardian or conservator may create the trust for the person with a disability. The person with the disability can also establish certain trusts managed by nonprofit associations. This is the only kind of trust exempt from rules regarding trusts and Medicaid eligibility.

Important considerations

• When an individual dies, the state can recover any Medicaid benefits it has paid on the person’s behalf.
• Tax implications are complex. Consult your tax professional when considering a Medicaid disability trust.