1. MO HEALTHNET F/K/A MEDICAID AND VETERANS ADMINISTRATION Martha C. Brown, CELA 220 W. Lockwood, Suite 203 St. Louis, MO 63119 T (314) 962-0186 F (314) 962-1298 American Parkinson Disease Association Symposium 2014

2.  What was called “Medicaid”  Most common program  Medicaid to pay for medical services  “Card for services”/”straight” Medicaid  Payment source for health care received MO HEALTHNET

3.  53 Different Medicaid programs  All have different eligibility rules  Every state’s rules are different  Not always logical MO HEALTHNET

4.  Must be disabled/be medically eligible  Must be financially eligible  Income/assets  Important distinction  Rules differ for couples and singles MO HEALTHNET NURSING HOME PROGRAM

5.  Single person  Assets of less than $1,000 ($999.99)  Married couple  Assets of less than $2,000 ($1,999.99)  $2,000 if both spouses are institutionalized NURSING HOME PROGRAM FINANCIALLY ELIGIBLE

6.  Some assets not counted regardless of value  Character of assets, not the value of assets  Medicaid planning is changing character of counted assets into exempt assets EXEMPT ASSETS

7.  Some assets that aren’t counted  House  Car  Personal property  Prepaid burial plan EXEMPT ASSETS

8.  First $543,000 of house equity  Figure increases each year  Household furnishings EXEMPT ASSETS (HOUSE)

9.  One car  Regardless of value EXEMPT ASSETS (CAR)

10.  Regardless of value, except:  Unusual value of change designation from exempt asset to countable resource EXEMPT ASSETS (PERSONAL PROPERTY)

11.  Must be irrevocable … or have  $1,500 cash surrender value life insurance  Cannot have both assets  Spouse cases - $1,500 exemption each  Burial plot EXEMPT ASSETS (PREPAID BURIAL PLAN)

12.  If married  Wedding rings  Can keep half of couple’s assets to $234,280.00  Division of Assets EXEMPT ASSETS (OTHER MISC.)

13.  Community spouse is allowed to keep up to 50% of $234,280 of couple’s countable assets  If assets are more than $234,280, then assets must be spend down to $234,280 before a division of assets can be made DIVISION OF ASSETS

14.  State of Missouri has the right to recover moneys paid through Medicaid at the death of the recipient  State recovers on Medicaid payments made after recipient is 55 ESTATE RECOVERY

15.  Recover moneys from only the following:  Recipient’s home  If no surviving spouse  From a Special Needs Trust that provides for Medicaid to be paid at death of trust beneficiary  The Medicaid recipient’s probate estate ESTATE RECOVERY (CONTINUED)

16.  Birth certificates  List of all assets with the applicant’s name on the title  Remember…total must be less than a $1,000.00 (single) and $2,000 (couple) WHAT TO BRING WHEN APPLYING FOR MO HEATHNET

17.  If any gifts have been made, you must report on Medicaid application  If gifts were made more than 5 years ago;  Do not count ( Called “Lookback Period”) GIVING MONEY AWAY

18.  Gifts to a disabled child  Gifts to a trust for a disabled person  Lots of rules for this exception  Give house to a child who lives with parent for 2 years or more, but would have to go to nursing home if child did not live with the parent EXCEPTION TO “LOOKBACK PERIOD”

19.  “Personal Care Contract  Pay a person under a written contract to provide services  Must follow specific rules  Recommend getting legal advice EXCEPTION TO “LOOKBACK PERIOD”

20. Non-Service Connected Aid & Attendance Benefit VETERANS ADMINISTRATION

21.  Veteran or widow(er) of Veteran who:  Served 90 consecutive days of Active Duty with one day during War Time period  War Time Periods as declared by Veterans Administration  Received a discharge other than dishonorable  Has been declared by a physician that they need assistance of another individual to perform activities of daily living BASIC ELIGIBILITY CRITERIA

22.  Veteran or widow(er) of Veteran who:  Has out-of-pocket medical expenses that exceed his/her total yearly gross income  Have less than $80,000 for a couple; $30,000 for a single person  Not declared amounts  No Lookback Period for assets given away to be eligible for the benefit BASIC ELIGIBILITY CRITERIA (CON’T)

23.  Rates: Maximum Benefits  Single Veteran: $1,732.00.00  Married Veteran: $2,054.00  Surviving Spouse: $1,113.00 *Figures change yearly AID & ATTENDANCE 2014

24.  Veteran and Veteran/Spouse  VA Form 21-526  Application for Veteran filing for Non-Service Connected Pension  Surviving Spouse  VA Form 21-534  Application for Surviving Spouse filing for Non-Service Connected Pension AID & ATTENDANCE APPLICATION

25.  Only recurrent medical expenses are considered in off-setting projected household income  Does not include any expenses for which claimant was reimbursed  Keep all receipts/documentation of medical expense for at least 3 years VA FORM 21P-8416 MEDICAL EXPENSE REPORT

26.  Examples of medical expenses  Hospital expenses  Doctor’s office fees  Dental fees  Prescription drug costs  Medical insurance premiums  Monthly Medicare deduction  Nursing home costs  Home health services  Incontinence supplies VA FORM 21P-8416 MEDICAL EXPENSE REPORT

27. Martha C. Brown, CELA 220 W. Lockwood Avenue Suite 203 Saint Louis, Missouri 63119 (314) 962-00186 QUESTIONS?