Are the income limits given to qualify for Medicaid referring to gross (pre-tax) income or is it take-home (after-tax)?
I don't find this addressed in any of the articles or books I've seen so far. Can someone please clarify? It makes a difference in how much spend down one has to do to qualify.
Alice, if this is abt having your hubs go onto LTC Medicaid so that it’s he’s moving into a facility, please please do not try to DIY this.
The rules for couples when 1 stays at home (aka the community spouse) & the other becomes a LTC resident in a NH are not simple and straightforward. You as a CS are allowed to have your own assets & Your own income which do not effect his eligibility for LTC Medicaid which requires that he is basically impoverished. But how to differentiate his versus yours is not a DIY. You can file a waiver for Community Spouse Resource Allowance (Called CSRA or MMNA) if need be.... but how to document your need for CSRA is not a DIY.
Really for couples you need a atty who understands the nuances of Medicaid and how it runs for your state. I’d suggest that you call around to CELA level of elder law attorneys and make an appointment with one. & ASAP. If $ or assets need to get shifted it has to be done before a Medicaid application is ever filed. Why? cause Medicaid usually affixes all joint & individual income & assets to the date of the application.
Really couples Medicaid planning & eligibility not a DIY.
Financial Eligibility The Affordable Care Act established a new methodology for determining income eligibility for Medicaid, which is based on Modified Adjusted Gross Income (MAGI). MAGI is used to determine financial eligibility for Medicaid, CHIP, and premium tax credits and cost sharing reductions available through the health insurance marketplace. By using one set of income counting rules and a single application across programs, the Affordable Care Act made it easier for people to apply and enroll in the appropriate program. MAGI is the basis for determining Medicaid income eligibility for most children, pregnant women, parents, and adults. The MAGI-based methodology considers taxable income and tax filing relationships to determine financial eligibility for Medicaid. MAGI replaced the former process for calculating Medicaid eligibility, which was based on the methodologies of the Aid to Families with Dependent Children program that ended in 1996. The MAGI-based methodology does not allow for income disregards that vary by state or by eligibility group and does not allow for an asset or resource test. Some individuals are exempt from the MAGI-based income counting rules, including those whose eligibility is based on blindness, disability, or age (65 and older). Medicaid eligibility for individuals 65 and older or who have blindness or a disability is generally determined using the income methodologies of the SSI program administered by the Social Security Administration (some states, known as 209(b) states, use certain more restrictive eligibility criteria than SSI, but still largely apply SSI methodologies). Eligibility for the Medicare Savings Programs, through which Medicaid pays Medicare premiums, deductibles, and/or coinsurance costs for beneficiaries eligible for both programs (often referred to as dual eligibles) is determined using SSI methodologies.. Certain Medicaid eligibility groups do not require a determination of income by the Medicaid agency. This coverage may be based on enrollment in another program, such as SSI or the breast and cervical cancer treatment and prevention program. Children for whom an adoption assistance agreement is in effect under title IV-E of the Social Security Act are automatically eligible. Young adults who meet the requirements for eligibility as a former foster care recipient are also eligible at any income level. Non-Financial Eligibility To be eligible for Medicaid, individuals must also meet certain non-financial eligibility criteria. Medicaid beneficiaries generally must be residents of the state in which they are receiving Medicaid. They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. In addition, some eligibility groups are limited by age, or by pregnancy or parenting status.
I think, if I am honest, most who can qualify for medicaid are no longer paying taxes at all for some years? This is a good question for 1-800-medicare, which can answer or refer you for medicaid questions as well. Things vary state to state and you really don't want to get any of this wrong.
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The rules for couples when 1 stays at home (aka the community spouse) & the other becomes a LTC resident in a NH are not simple and straightforward. You as a CS are allowed to have your own assets & Your own income which do not effect his eligibility for LTC Medicaid which requires that he is basically impoverished. But how to differentiate his versus yours is not a DIY. You can file a waiver for Community Spouse Resource Allowance (Called CSRA or MMNA) if need be.... but how to document your need for CSRA is not a DIY.
Really for couples you need a atty who understands the nuances of Medicaid and how it runs for your state. I’d suggest that you call around to CELA level of elder law attorneys and make an appointment with one. & ASAP. If $ or assets need to get shifted it has to be done before a Medicaid application is ever filed. Why? cause Medicaid usually affixes all joint & individual income & assets to the date of the application.
Really couples Medicaid planning & eligibility not a DIY.
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Financial Eligibility
The Affordable Care Act established a new methodology for determining income eligibility for Medicaid, which is based on Modified Adjusted Gross Income (MAGI). MAGI is used to determine financial eligibility for Medicaid, CHIP, and premium tax credits and cost sharing reductions available through the health insurance marketplace. By using one set of income counting rules and a single application across programs, the Affordable Care Act made it easier for people to apply and enroll in the appropriate program.
MAGI is the basis for determining Medicaid income eligibility for most children, pregnant women, parents, and adults. The MAGI-based methodology considers taxable income and tax filing relationships to determine financial eligibility for Medicaid. MAGI replaced the former process for calculating Medicaid eligibility, which was based on the methodologies of the Aid to Families with Dependent Children program that ended in 1996. The MAGI-based methodology does not allow for income disregards that vary by state or by eligibility group and does not allow for an asset or resource test.
Some individuals are exempt from the MAGI-based income counting rules, including those whose eligibility is based on blindness, disability, or age (65 and older). Medicaid eligibility for individuals 65 and older or who have blindness or a disability is generally determined using the income methodologies of the SSI program administered by the Social Security Administration (some states, known as 209(b) states, use certain more restrictive eligibility criteria than SSI, but still largely apply SSI methodologies). Eligibility for the Medicare Savings Programs, through which Medicaid pays Medicare premiums, deductibles, and/or coinsurance costs for beneficiaries eligible for both programs (often referred to as dual eligibles) is determined using SSI methodologies..
Certain Medicaid eligibility groups do not require a determination of income by the Medicaid agency. This coverage may be based on enrollment in another program, such as SSI or the breast and cervical cancer treatment and prevention program. Children for whom an adoption assistance agreement is in effect under title IV-E of the Social Security Act are automatically eligible. Young adults who meet the requirements for eligibility as a former foster care recipient are also eligible at any income level.
Non-Financial Eligibility
To be eligible for Medicaid, individuals must also meet certain non-financial eligibility criteria. Medicaid beneficiaries generally must be residents of the state in which they are receiving Medicaid. They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. In addition, some eligibility groups are limited by age, or by pregnancy or parenting status.