Medicaid – Title 19

July 14, 2016 | Funding Resources

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
  2. Medicaid
  3. Title 19

Medicaid is a welfare program jointly funded by 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. An individual is normally responsible for paying 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 its own eligibility standards, determine the type, amount and duration of services, set the rate for payment of services, and administers its own program.  This article will outline the eligibility requirements for Wisconsin as of 2016.

A single adult qualifies if they meet the 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 toward resource limits. Term insurance has no cash value and is excluded from countable assets.
  4. Household goods and personal effects: Generally, no inquiry unless there’s reason to suspect unusual value.
  5. Pre-paid funeral arrangements: Money paid for burial spaces, urns, vaults and caskets can be of unlimited value. Irrevocable burial trusts are 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 a 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 an “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: The community spouse may keep $50,000
  • $100,001-$238,440: The community spouse may keep HALF plus $2,000.
  • $238,440+: The community spouse may keep $119,220 plus $2,000 for a total of $121,220.

These figures are adjusted annually for inflation.

Note:  This article provides a limited space for information regarding Medicaid Eligibility.  There are opportunities for married couples to protect more tan the above figures.  Attorney Ryzn Zenk offers free consults or call for your free booklet on “What is Spousal Impoverishment?” please call 262-670-0888 or 1 (866) 670-0888.

For more information, please visit the Wisconsin Medicaid webpage.

Source: Barbara Horstmeyer, Benefit Specialist, Senior Planning Group