Wallace & Kling, P.C.
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Celeste Kling


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FREQUENTLY ASKED QUESTIONS (FAQ)

Q: Can my disabled spouse receive Medicaid at home?

A: Yes, the resource rules for couples are the same for the Home and Community Based Services (HCBS) program covering in home care and assisted living as the nursing home program. The program for inhome care is also available for single people.

Q: What is the community spouse resource allowance for 2017?

A: $120,900.00 (last year $119,200). The resource allowance for the institutionalized spouse stays at $2,030.00 (effective July 1, 2017) and maximum $3,022.50.

Q: What is the average monthly nursing home cost in the state of Colorado for 2016?

A: $7,854 (last year $7,563). Note: In Colorado's Region II it is $7,776 (last year $7,781).

Q: If my spouse is on Medicaid, what is the minimum monthly maintenance needs allowance for me?

A: $2,003. The Monthly Maintenance Needs Allowance is the amount the community spouse is entitled to each month as determined by the Department of Human Services. It includes the spouse’s own income and an allocation from the income of the Medicaid recipient spouse. Remember that the community spouse is entitled to all of his/her own income.

 Q: If my spouse is on Medicaid, what is the maximum monthly maintenance needs allowance for me?

A: $3,023. It is possible to receive a higher allowance through the administrative review process.

Q: Will I have to give my property to the state in order to be eligible for Medicaid?

A: No. The state does not take your property. However, the Medicaid program has resource rules applied equally to everyone. You will have to use/spend down your assets in order to qualify for Medicaid if you have more resources than the program allows.

Q: Will I have to sell my home?

A: If you are married, the non-Medicaid spouse always has the right to the home. The rules are complicated when married couples are involved and you should talk to an attorney before you make any decisions about the home.

If you are a single person, while you are alive you may keep your residence, providing its value is less than $552,000. However, after you die the state has the right to claim reimbursement for the amount of Medicaid paid on your behalf. There are some exceptions to this rule. Again, the rules regarding residences are complex and you will want to discuss your plans with an attorney before you apply for Medicaid.

Q: If I give money away will I be penalized (ineligible for Medicaid)?

A: The lookback period for transfers without fair consideration (gifts) is 60 months (5 years) prior to an application for Medicaid. In order to determine the months of ineligibility for Medicaid, the value of the gift is divided by the average monthly nursing home cost in the state of Colorado at the time of application. The result is the number of months of ineligibility. The ineligibility period does not begin to run until the applicant is eligible for and applies for Medicaid and would be approved but for the imposition of the penalty period (or it has been more than 60 months.) This rule does not apply to spousal transfers.

An approved application requires that the applicant meet the level of care (medical) requirements and the income and resource guidelines.  There are some planning tools for gifting but you will need the assistance of an attorney.   For additional details read the regulations at 8.100.7.G . 

Q. How does Medicaid treat personal care services provided by family members?

A.  Effective March 1, 2007, payments to family members for personal services (running errands, bill paying, etc.) will be deemed to be a gift unless there is a written agreement prior to delivery of services.  The written agreement must meet specific guidelines and payments may not be made to a family member who is also the agent under a power of attorney.

 Q.  Do the rules regarding Medicaid change frequently?

 A.  Yes, the rules change frequently, so you should seek legal advice before making decisions.

 
To view Medicaid regulations online

Go to this page at the State of Colorado website 
(Which is a PDF document under the Code of Colorado Regulations).

For general eligibility rules, scroll to page 51
(8.100.5. Aged, Blind, and Disabled, Long Term Care and Medicare Savings Plan Medical Assistance Eligibility).

For long term eligibility rules, scroll to page 79
(8.100.7 Longterm Medical Assistance Eligibility).