Long-Term Medical Care in
Nursing Homes,
Residential Care Homes, or in Your Home
What is long-term care?
How can I pay for long-term care?
Does medicare cover long-term care?
Does medicaid cover long-term care?
What is choices for care (CFC)?
How do I get CFC?
What are the basic financial requirements for CFC?
Can I keep any monthly income when I am in CFC?
How is the monthly patient share figured when I am in CFC?
How much monthly income can I keep for my spouse when I am in CFC?
How much monthly income can I keep for my dependents when I am in CFC?
How much resources can I keep when I am in CFC?
How much resources can my spouse keep?
If I give away property or assets, could this affect my eligibility for
CFC?
Are there any exceptions to the medicaid long-term care transfer of
asset penalties?
Can I give my home to my children after I die without having a penalty?
The department imposed a penalty on me, is there anything I can do?
How can I get more help?
What is Long-Term Care?
Long-term care is medical, nursing and personal needs services for people who have a
chronic illness or disability. Most long-term care assists people with activities of
daily living such as eating, dressing, bathing, and using the bathroom. Long-term
care is provided at home or in the community at residential care or nursing facilities.
How Can I Pay for
Long-Term Care?
Medicare, Medicaid or private payment are the three basic ways to pay for long-term care.
Instead of paying out of pocket, you can purchase long-term care insurance. Eligibility
for insurance is based on your current health. It must be purchased prior to needing
long-term care. If you need long term care, you will not be insurable. Most financial
planners recommend that LTC insurance be purchased in your late 50's or early 60's.
The premiums are based on your age, health, and the type of plan that you purchase.
Does Medicare Cover
Long-Term Care?
Yes, but only some of what you may need. Medicare pays for
some skilled nursing facility or
home health care if you meet certain conditions. Skilled care includes
care you need on a daily
basis such as therapy or nursing services.
Medicare pays for a nursing home stay if you require skilled care after
a 3 day hospital stay. This
payment is limited to 100 days for each spell of illness. Medicare pays
100% for the first 20 days.
There is a daily Medicare co-payment of $124 for days 21-100. Medicare
supplemental policies
generally pay this daily co-payment. Once Medicare stops paying for
care, most supplemental
insurance policies will stop paying too.
Medicare does not pay for help with personal care in the home.
Does Medicaid Cover
Long-Term Care?
Yes. Long-term care is covered by Medicaid for those
individuals who are financially eligible.
In Vermont, there is a separate Medicaid program for long-term
care. In Vermont, the Medicaid
long-term care program is called Choices for Care (CFC). If
you get both Medicare and Choices
for Care, CFC will cover many costs that Medicare does not cover.
What is Choices for Care
(CFC)?
CFC is a Medicaid program that pays for long-term care in your home or
a nursing facility. CFC
is run by the Department of Disabilities, Aging and Independent Living
(DAIL). This program
used to be called the "Medicaid waiver" or the "home and community
based waiver program".
How Do I Get CFC?
You must be financially eligible and have a medical need for long-term
care. You apply with
DAIL or at a Department of Children and Families office (DCF) (formerly
PATH). You need to
do two applications, a clinical application with DAIL and a financial
application with DCF. We
recommend that you complete the financial application right away, since
there can be delays in
processing your applications. Medicaid will pay for services
for up to three months before the
month you send in the financial application, if you are eligible during
those months.
What are the Basic
Financial Requirements for CFC?
Your monthly income must be used for long-term care. Income includes
your pension, Social
Security, VA benefits or earnings. The income of your spouse is not
considered. Your resources
must be within Medicaid limits (generally, $2000 for an individual and
$3000 for a couple).
Resources include such things as property, vehicles, bank accounts and
investments.
Can I Keep Any Monthly
Income When I am in CFC?
Yes. You can keep some income each month for your personal
needs in a facility (generally, the
personal needs allowance is $47). You can also keep some
income for maintenance costs at
home and for upkeep of your home for short periods that you are in a
facility. You can keep
income for your spouse or your dependents, and for medical insurance
premiums and uncovered
medical expenses. Any left-over income must be used for your care. The
part of your care you
pay for is called the patient share.
How is the Monthly
Patient Share Figured When I am in CFC?
The amount of monthly income that you can keep depends on your living
situation and medical
costs. If you live in a facility, you can keep $47 for personal needs.
If you live at home, you can
keep $925. You can also keep income for:
1. health
insurance premiums;
2.
uncovered medical items or services, including
over-the-counter items and past bills;
3. your
spouse;
4. your
dependents,
5. upkeep
of your home for up to 6 months that you are in a facility. You can keep
$506 a month for upkeep of your home if you can return within 6 months
and no
one in your home (such as your spouse or dependents) gets any of your
income.
How Much Monthly Income
Can I Keep for My Spouse When I Am in CFC?
Some or all of your income can be kept for your spouse if needed to
bring your spouse's income
up to $1,712. This amount can be increased to cover your
spouse's shelter costs. The maximum
increase for your spouse's shelter costs is $829. Shelter
costs include rent or mortgage,
maintenance fees for a condominium or cooperative, taxes and insurance.
How Much Monthly Income
Can I Keep for my Dependents When I am in CFC?
Some of your income can be kept for your dependents. The amount that
can be kept depends on
the living and financial situation of your dependents.
How Much Resources Can I
Keep When I am in CFC?
The limit for resources is $2,000. Many resources such as your home,
automobile and burial
funds are not counted. You do not have to use all your resources for
your care. You can spend
your resources above the $2,000 limit by paying debts, buying assets
that are not counted or
purchasing goods or services of value. Your spouse can have a lot more
resources.
You can keep up to $10,000 as a burial fund. You can also
keep up to another $30,000 to pay for
additional medical care to keep you living in your home, or to make
modifications to your home
to allow you to stay there. The $30,000 is called a "contract
for care" and you will have to sign a
contract with the Department to keep that money.
Figuring out what resources count and don't count is really
complicated. Some resources can be
excluded, and you have several options to spend down resources or
convert them into excluded
resources. If you have resources over the Medicaid limit, you
should talk to a lawyer who is
familiar with Medicaid law because they can help you plan what to
do. If you are over 60, you
can call the Senior Citizens Law Project for help with this Medicaid
planning at (800) 889-2047.
How Much Resources Can My
Spouse Keep?
Your spouse can keep all resources that are not counted by Medicaid
such as the home, a car,
household goods, or personal effects.
Your spouse can also keep up to $101,640 in resources. Your spouse can
keep more than $101,640
if there are:(1) "exceptional circumstances resulting in significant
financial duress" or (2) the
spouse's resources are insufficient to raise his or her monthly income
up to $1,712.
If your spouse refuses to make excess resources available for long-term
care, you may still
qualify for Medicaid if you: (1) assign support rights to Medicaid, (2)
are physically/mentally
unable to make the assignment, or (3) denial of Medicaid would work an
undue hardship.
Resources acquired by your spouse after you become eligible for
long-term care are not
considered.
If I Give Away Property
or Assets, Could This Affect My Eligibility for
CFC?
Yes. If you give away property or assets, you may be disqualified for long term care Medicaid.
The Department calls this disqualification a "penalty" period. The rules for how these penalty
periods are calculated have changed. When the penalty starts depends on when you made the transfer.
More information about these changes is on our
Deficit Reduction Act Changes page.
The Department calculates the penalty period by dividing the value of the property given away by $207.
$207 is the average daily cost for a private nursing home bed. For example, if you gave away a house worth $100,000,
you would be ineligible for long-term care coverage for 483 days ($100,000/207 = 483) or approximately 16 months.
Are There Any Exceptions
to the Medicaid Long-term Care Transfer of
Asset Penalties?
Yes. You can transfer property to your spouse without risk of
a Medicaid penalty. You can also
transfer property to a child if the child is under 21 years of age or
is blind or disabled. You can
also transfer an interest in your home to your sister or brother, if
your sister or brother already has
an equity interest in the home and has been living in the home for at
least one year before you
became eligible for long term care. You can also transfer your home to
your son or daughter if he
or she was living in your home for at least two years immediately
before you became eligible for
long term care and provided care to you which permitted you to stay at
home.
Can I give my home to my
children after I die without having a penalty?
Yes, if done right. It is possible to give your home to your
children after you die, by transferring
the home to them now but keeping a "life estate with the power to sell"
for yourself. That means
that you own the house as long as you live. During your life,
you can still sell the home if you
want. After you die, the house goes directly to your children
without going to probate court.
Under Vermont law, it may also be possible to sell or give your
children a small percentage of
your home, like a 1% interest each, and to own your home together as
"joint tenants with the
right to survivorship". The transfer of the 1% would be
penalized, but that may not be worth
very much. After you die, your children would own the home
outright as your survivors.
You should see an attorney before doing anything to give your children
your home. Make sure
that attorney understands Medicaid law.
The Department imposed a penalty on me, is there anything I can do?
Yes. You should have the right to appeal the
penalty. You can only be penalized if you made
the transfer or gift "for the purpose of qualifying for
medicaid". So if you made the gift or
transfer for another reason, that would be an example of something you
could appeal.
You can also request a hardship exception. The rules for a
hardship exemption are changing in
2007. You need to show that it will be a hardship on you if
there is a penalty and you cannot get
long-term care Medicaid. You have the right to appeal if your
request for a hardship exemption
is denied.
The Senior Citizens Law Project of Vermont Legal Aid can help seniors
in those appeals. You
can call Vermont Legal Aid at (800) 889-2047.
How can I get more help?
The Senior Citizens Law Project (SCLP) of Vermont Legal Aid will help
seniors with questions
about long term care Medicaid. The SCLP will usually refer
clients with more than $25,000 in
resources to a private attorney for help. You can call
Vermont Legal Aid at (800) 889-2047.
Note: This is a general
description of a complex program. The information is current as of
March 2007, but can change at any time. For more information on
Medicaid eligibility and
coverage, contact the SCLP.
