Medicaid Policy Updates Impacting In-Home Care

Families that help a loved one apply for Medicaid benefits aren’t usually aware of the existence of a manual containing Medicaid eligibility rules. The Bridge’s Eligibility Manual contains pages and pages of policy that impact a person filing for Medicaid. When talking about Medicaid benefits for older persons, an October 1, 2015 update impacts persons who haven’t even considered filing for Medicaid benefits. But, if a person does apply for such benefits within five years of paying for in-home care they need to be concerned about this policy change.

When it comes to assisted living and nursing home Medicaid eligibility, the Medicaid program rightfully will deny benefits or penalize someone who gave away their assets just to attain eligibility. But most of us don’t conduct ourselves in fear of what the Medicaid manual will say when we may never need benefits. But, the October 1, 2015 change should cause concern for anyone that may need financial assistance for assisted living or skilled nursing care within five years of paying for in home-care.

The policy change infers that anyone providing in-home care to a person, even a professional care-giving company, needs a contract that complies with Medicaid policy to avoid the payments being classified as divestment. This will never matter for someone who doesn’t apply for government benefits. But for those who do, a penalty for divestment within five years of applying for benefits will be assessed. This will delay benefit eligibility, cost applicants money they likely don’t have, and impose a great amount of stress on families.

If a family member is getting paid to care for a loved one or a third-party is hired to provide care then they should make sure to have a Medicaid-complaint contract before any money is exchanged. The policy contained in BEM 405 details the requirements of personal care contracts and home care contracts. Tax reporting and withholding implications as to family caregivers receiving income for care must also be considered and handled appropriately. The policy also requires that someone needing care get a “prescription” from their physician detailing the type of care needed and that such care would keep them out of assisted or nursing home facilities.

I have seen families go above and beyond for loved ones to keep them out of skilled care as long as possible. So, I’m always dismayed to hear when this caring family is then faced with penalties they cannot pay or denial of benefits. Becoming educated on Medicaid policy now can save your family financial and emotional stress later.

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