Title 19 (Medicaid)
This article focuses on the Medicaid program as it applies to elderly and disabled individuals. There are three common names for one program.
1. Medical assistance
3. Title 19
Medicaid is a welfare program jointly funded between the Federal and State government. It is designed to assist in paying for skilled nursing facility expenses and many other medical expenses for individuals who have minimal assets and inadequate income to pay for these expenses. The individual is normally responsible to pay for all of his/her own long term care expenses: generally, if the cost of this care exceeds the individual's income and the individual is asset-qualified, Medicaid supplements the individual's own payment.
Within the Federal guidelines, each state is able to establish their own eligibility standards, determine the type, amount and duration of services, set the rate for payment of services, and administer their own program. This article will outline the eligibility requirements for Wisconsin as of 2008.
A single adult qualifies if the meet they following criteria: The applicant can't retain more than $2,000 plus exempt assets
1. Home: Homestead property is exempt regardless of the value if the applicant intends to return home, or if a disabled child is living in it.
2. Car: One automobile is generally excluded if the current market value is less than $4,500.
3. Life Insurance: Life insurance is exempt if the face value of all policies is less than $1,500. If the face value exceeds $1,500, full cash value counts towards resource limit. Term insurance has no cash value and is excluded from countable assets.
4. Household goods and personal effects: generally no inquiry unless reason to suspect unusual value.
5. Pre-paid funeral arrangements: money paid for burial spaces, urns, vaults, caskets, lot can be of unlimited value. Irrevocable burial trust exempt up to $3,000. Sometimes individuals contract for an all-expense package of services and burial spaces, and the purchase of "burial insurance" that they irrevocably assign to the funeral home in full payment for the service contract.
Married couples can own exempt assets listed above plus:
1. A car of any value in addition to the car of the "institutionalized" spouse with a value of $4,500 or less.
2. IRA of the community spouse
How much money may a couple "Shelter"? The Spousal Impoverishment Act passed by the U.S. Congress in 1988 and the Omnibus Budget Reconciliation Act of 1993 (OBRA'93) provides the legal means for anyone to shelter assets and qualify for financial assistance through an entitlement program. This act protects married individuals from depleting their assets due to an extended nursing home stay.
If the couple's combined assets are:
$0 - $50,000 the "community spouse" may keep ALL
$50,001 - $100,000 "community spouse" may keep .....$50,000
$100,001 - $219,120 "community spouse" may keep .....HALF + $2000
$219,120 + "community spouse" may keep ....$109,500 plus $2,000 for a total of $111,500
These figures are adjusted annually for inflation. The above figures are based on 2009. At the time of this printing, the state has not released the 2010 figures.
Note: This article provides a limited space for information regarding Medicaid Eligibility. If you would like to receive a free booklet on "What is Spousal Impoverishment?" please call 262-670-8888 or 1 (877) 670-0888.
For more information, please visit the Wisconsin Medicaid webpage.
Article submitted by Barbara Horstmeyer, Certified Senior Advisors, Senior Planning Group