If you are a single Medicaid applicant, what happens to your income? Almost every dollar is accounted for in the Medicaid rules. Elder Law Attorney Jim Koewler joins Suzanne to talk about where can you expect that money to go.
Talking in generalities, regarding income for a single person, a person’s income is used first, before Medicaid dollars. There are three places where money is usually going to go: 1) your personal needs allowance (spending money); 2) rent if you’re in an assisted living community; and 3) health insurance premiums. Whatever’s left goes to pay the costs of care so Medicaid doesn’t have to.
Learn more at http://www.protectingseniors.com or email Jim at [email protected].
View Episode Transcript
*The following is the output of transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors.
The following podcast is by Mr Jim Taylor, elder law and special needs attorney, helping and protecting those who need long term care. And Welcome back everyone to answers for elders radio network with Jim Koewler, attorney at law. And before we get started, Jim, I want to make sure that our listeners know how to reach you. Um, why don’t we? Uh, I know it’s protecting seniors dot com. Correct, is your is your website and seniors dot com is my website. If you want to read my blogs, and I haven’t blogged in several years, but they are at protecting seniors news dot com. Okay, and the website name comes from my tagline, which is protecting seniors and people with special needs. Yes, and of course, on answers for elders, Jim has his own specialist page on our website. So for those of you that are interested in reaching out to him. Um, we just heard a story of someone from North Arolina called you about somebody that’s in Akron, Ohio, so that was perfect. So you’re based in Ohio and certainly have connections to Um other attorneys across the country. So we definitely love having you on this program and certainly you’re helping us deal with this very, very complicated world of elder law, which you know, there’s no way in the world I could even begin, and I sometimes will have people ask me questions and I will go you need an elder doctor, you absolutely do. So any nerds among nerds? Yes, you are. You’re amazing. And in addition to my website, I have an answers for elders specific email address if you want to email me directly. Goes into my main box, but I give very specific email addresses so I can figure out how people found me. Yes, jkoewler, my first initial J and my name, [email protected] [email protected] com. Perfect, perfect, and I know we have that email address on your specialist page as well. So for those of you that are interested in reaching out to Jim, I know he’s more than happy to talk to you and point you in the right direction. So, Um, when we need you desperately to discover so anyway, we’re just you framed up this real complicated situation between resources and assets and income and what all that means. Now we’re moving on to, obviously the next step, which has to do with income. Okay, so the baseline. That the place to start discussing income. When we are not talking a specific person, okay, if I’m talking to a client, I know they’re married and they’re not married, okay. But when we’re talking in generalities like we are on this podcast, let’s start with income for a single person, because income for a spouse builds out of understanding income for a single person. So remember, the main tenant of Medicaid, as written in the law, is we are here to help people pay for care when they can’t afford to pay for it themselves. The the unspoken tenant is we don’t want to pay a penny more than absolutely necessary and all too often we won’t avoid paying even the people we should be paying. But, but, once someone is on Medicaid, their income is spoken for in most states, because most states consider themselves income first states. The person, the Medicaid recipients income is used first, before Medicaid dollars. So there are for a single person, there are three places where income is gonna go. Um, usually we’ll talk about people who have this imagine this concept in the real world. People have too much income. Um, putting air quotes around that. For those of you who are not watching me visually, UM, they’re UN the Medicaid rules. There is such a thing as too much income. Well, that’s at least an installment by itself. Okay, we’ll get to that later. So for people who uh now, even if you have two inch income, it all ends up the same place, with maybe one little tweak to pay for a special bank account. Okay, that’s the only difference on where the income goes. So if you have too much and if you have if you’re a single person, your income is gonna go first to your personal needs allowance. We talked about that in last installmenter. And in Ohio fifty bucks and watching it, sixty bucks. And in California, I think this hundred, thirty, hundred or some some big numbers everywhere else, but of course their cost of living is big compared everywhere else. Is Uh Iowa’s thirty last I heard. Um, and now don’t quote me on these numbers because they could change any time, but this is just elder law turney gossip. The Ohio numbers, I know. Okay, Um, so that’s you’re spending money. That’s candy bars at the at the snack bar or UH, your your cable TV fee or whatever. Okay, this is assuming you’re in a nursing home. We’re as just a living discovered by Medicaid. If you’re staying at home and getting benefits for home care through what’s called passport, uh, it’s got to be a much bigger number because you still gotta pay electricity that stuff, but you still your allowances first. It just it’s a much bigger number if you’re staying home. Okay. And some states assisted living requires that you pay a certain rent amount and that rent is based on social security. So the maximum SOC security benefit for supplemental security income. They the S S I, this SOC security disability for people who don’t have a significant work history or a recent enough work history. Okay, the maximum paid in two thousand forty one per month. So in states that kind of use that S S I number model for their rent. Again making air quotes at assisted livings. The assistant living is that number minus the personal needs allowance. So in Ohio, Fifty Bucks is your personal needs allowance. That you know that that Candy Bar Haircut thing. Um. And then so the rent at an assistant living is set one minus fifty bucks. Okay, some states, so in Iowa would be a twenty one. I’m sorry, eight, eight, eleven, eighty one minus thirty bucks, that sort of thing. Okay. Now, not all states do that. Um, so that comes out second. If you’re an assistant living and if you’re nursing home, you don’t worry about the rent thing. Okay, by the way, the numbers all work out the same as just how they are accounted. Again, bureacrat speak. Okay. So after those happen, then the Medicaid recipient can pay the premium for his or her health insurance correct okay, whether it’s an advantage plan, a supplement, a cost share on the premium side with an employer plan, whatever. Okay, they get to pay the health insurance premium for their health insurance. Because of health insurance pays, then Medicare and Medicaid get to pay less. And since the person is already needing long term care, chances are they going to be using a lot of health um services. So we want the insurance to stay in place. So personal needs allowance rent if you’re an assistant living and one of the states that uses that rent model. Then your health insurance premium, then whatever is left goes to pay the cost of care so that Medicaid doesn’t have to yes, if you’re an assistant that you could think of the rent is paying costs as being part of the cost of care. Yes, that would make perfect sense. So that’s why bureaucrats don’t do it. Okay. So the rent is a separate animal. I don’t know why, but it is. Okay. Um. So, so you notice I haven’t talked about the amount of your income. That’s simply the way it works. Personal needs allowance rent, if you have to, uh your health insurance premium and the rest goes to cost of care and then Medicaid makes up the difference between what you’ve paid towards the cost of care and the Medicaid reimbursement rate. That was making air quotes negotiated with the care provider. Okay, and at least in Ohio, care providers could be across the street from each other and you’re being paid a separate a different rate. It might be off by a buck a month, it might be off by twenty bucks a month, it might be off hundreds of dollars a month, but they aren’t in lockstep. Okay. But whatever that reimbursement rate is from Medicaid, that’s all that Medicaid is gonna pay. On the long term care piece, on the custodial taking care of people every day bathing dressing piece. Okay. They may pay more money for the CO pay to go with your health insurance, but that’s not the same every month. Okay. So that’s not built into the standard rate. They just say, Oh, there’s a bill for medical medicare paid this much, the health insurance pay that much and there’s eighty bucks left. The Medicaid paid bucks. Okay, and they will keep track of it for Medicaid State Recovery, which you’ve discussed in the past, but it’s not built into that month. The use of your income. Okay, in Long Term Care, the monthly use of income is geared toward a little bit to pay for your personal needs and the rest geared at your costs of care and your cost of being in a place to get care. Okay, but your your routine room and board care, not your medical care. I’m going to ask some really profound questions, but I know the answer. But I really want to. I want to cook some of you anyway. Of course. What happens if you need new clothes? What happens if you need new glasses? That’s what that bucks is for. Huh, that’s bucks or hundred bucks or whatever is for. I mean that’s it’s not enough if you need glasses. Okay. So if we go resource discussions, if you had help from an elder law attorney to shelter some of your resources that you’ve now given to your children, or you’ve fit into a special needs trust, a pool especial needs trust, we will talk about those at a later time. Yeah, we will. But if you set money aside somehow, almost always with the help of no law attorney, okay, is how money gets set aside. That, as far as I’m concerned, that’s my client’s comfort fund. If they if there’s money left in the Comfort Fund after the client dies, then it was improbably transferred. If it was, I. Properly transferred, then the family gets to keep it correct and if that’s what my client wanted, that’s great, okay, and that’s that. When you talked about in your last Um, you know, four segments about planning for Medicaid. This is really what this is about, about preparing for other things, because once you go on to Medicaid, Um, you’re not gonna have extra money to be able to do things like, you know, take care of yourself and, you know, buy pair of shoes, which is a good pair of shoes, Um, and that’s frequently a source of resentment for Medicaid recipients. Hey, I work to earn that money. Well, Medicaid’s response is, yeah, but now you need long term care and we’re not free. We simply make up the difference seen what you can pay and what has to be paid. We’re not paying everything. Yeah, okay. So what are we talking about next? So next, now that we’ve got the basics of what happens with a single person, we’re gonna expand that into what happens with a married come. Fabulous and still focusing on still perfect. Jim and I will be back in the next segment. State of Ohio, residents, you have a friend to help you navigate long term care while protecting your assets. You can reach Jim at protectingseniors.com, or just email him at [email protected] [email protected]
Listen to More Answers for Elders with Suzanne Newman
Keep an eye out for future Answers for Elders podcasts on the Senior Resource Podcast Network! Thanks for listening, and be sure to keep scrolling for more articles by Suzanne. For more AFE podcasts, visit AnswersforElders.com and subscribe on your favorite platform!
Founder and CEO of Answers for Elders, Inc., Suzanne Newman proclaims often, “Caring for my mom was the hardest thing I ever have done, but it was also my greatest privilege.” Following a career of over 25 years in sales, media, and marketing management, Suzanne Newman found herself on a 6-year journey caring for her mother. Her trials and tribulations as a family caregiver inspired an impassioned life mission outside of the corporate world to revolutionize the journey that so many other American families also find themselves on. In 2009, she became the founder and CEO of Answers for Elders, Inc., subsequently hosting hundreds of radio segments and podcasts, as well as authoring her first book. Suzanne and Answers for Elders, Inc. have spent 14 years, and counting, committed to helping families and seniors along their caregiving journeys by providing education, resources, and support. Each week on the Answers for Elders podcast, Suzanne is joined by vetted professional experts in over 65 categories including Health & Wellness, Life Changes, Living Options, Money, Law, and more. Suzanne lives in Edmonds, Washington with her husband, Keith, and their two doodle dogs, Whidbey and Skagit.
Connect with Suzanne
Visit AFE on the web: https://answersforelders.com/