Understanding Medical Assistance and Elderly Waiver

As a loved one to an older adult that needs care, or someone thinking about care for yourself down the road, you may be worried you don’t have the financial income or savings that you need for a senior living community. You may be asking yourself, “what happens if I run out of money?” You may have heard terms like, ‘EW’, ‘MA’, or ‘Medicaid’, but are not sure what they really mean.

As you and your loved one navigate how to pay for senior living, here are some answers to frequently asked questions about medical assistance and elderly waiver program.

What is the difference between Elderly Waiver and Medical Assistance?

Medical Assistance (MA) is Minnesota’s Medicaid program for people with low income. Most people who have MA, get health care through health plans. You can choose a health plan from those serving MA members in your county. Members who do not get health care through a health plan get care on a fee-for-service basis, with providers billing the state directly for services they provide.

The Elderly Waiver (EW) program is a federal Medicaid waiver program that funds home and community-based services (HCBS) for people 65 years old and older who require the level of care provided in a nursing home, but choose to live in the community. This program provides services and supports for people to live in their homes or a community setting, and may delay or prevent skilled nursing facility (SNF) care. The purpose of these programs is to promote community living and independence with services and supports designed to address each person’s individual needs and choices. For the Elderly Waiver program, the additional services go beyond what is otherwise available through Medical Assistance (MA). People enrolled in EW can receive waiver services and MA services funded through a managed care organization (MCO). This can be through Minnesota Senior Care Plus (MSC+) or Minnesota Senior Health Options (MSHO).

What are the Asset limits for receiving Medical Assistance?

A single person applying for Medical Assistance will be eligible if his or her available assets do not exceed $3,000. For a married couple, if both spouses are applying for Medical Assistance, each may have available assets that do not exceed $3,000.

For a married couple- when one spouse is applying for Medical Assistance, and the other spouse is still at home, the spouse applying for Medical Assistance may have no more than $3,000 in available assets. The spouse who is at home may keep an amount determined by the asset assessment (see below).

What are “Available” Assets?

Available assets include any personal property or real property with monetary value that is not determined to be excluded. Available assets include, among other things, savings and checking accounts, stocks, bonds, certificates of deposit, contracts for deed, mortgage deeds, IRA or 401K accounts, investments in precious metals or gems, real property that is not your primary residence, and the cash surrender value of insurance policies.

What are “Excluded” Assets?

Excluded assets are not counted in determining your eligibility for Medical Assistance. For example, your homestead is excluded if either you or your spouse resides there. In addition, your personal property or household goods are excluded, and one motor vehicle of any value is generally excluded.

If my spouse is in a nursing home, how much can I keep?

The amount that the spouse who lives at home (called community spouse) can keep depends on what the couple owns on the asset assessment date, which is generally the first day of continuous institutionalization. All non-excluded assets owned by either or both spouses must be listed, documented, and added together as of the asset assessment date. The community spouse may keep an amount equal to half of the total non-excluded assets as noted on the asset assessment, subject to a minimum of $25,728 and a maximum of $128,640.

This amount is called the community spouse asset allowance. The minimum and maximum amounts of $25,728 and $128,640 generally increase on January 1st of each year. For example, if a couple has $100,000 in non-excluded assets on the assets assessment date, the community spouse can retain $50,000, and the institutionalized spouse can retain $3,000.

If I am in a nursing home and on Medical Assistance, how much of my income can I keep?

An institutionalized person who is eligible for Medical Assistance must pay the net amount of his or her income to the nursing home after subtracting certain allowable deductions. The deductions most often used are Medicare premiums, supplemental health insurance premiums, and clothing and personal needs allowance of $104.

Will I still be eligible for Medical Assistance if i transfer assets?

When you apply for Medical Assistance, you are required to disclose any transfers of assets for less than fair market value that you or your spouse has made during the look-back period, which is the 60 months immediately preceding your application for Medical Assistance. If you have made transfers during the look-back period for which no exception applies, a transfer penalty will be imposed and Medical Assistance will not pay for your long-term care costs.

Are there any exceptions to the transfer penalty?

Yes, there are exceptions. Some transfers are not penalized, such as transfers to your spouse, or to your child who is blind or permanently and totally disabled. There is also no penalty for transfers into trusts solely for the benefit of a person with a disability.

Will the county have a claim against my estate at death?

Minnesota law provides that the county can place a claim against your estate, if you re single, or against the estate of the surviving spouse, if you are married, for any Medical Assistance you or your spouse has received after age 55. A claim can be made for Medical Assistance received by a person not yet 55 years old only if the person resided in a medical institution for six months or longer. If the claim is against the estate of the surviving spouse, it will be applied to jointly owned or marital property (or the proceeds thereof), in which the predeceased spouse had an interest at the time of the predeceased spouse’s death. The amount of the claim is limited to the total amount of Medical Assistance you and/or your spouse received. The claim can be applied to probate assets and also, in certain circumstances, to non-probate assets, including jointly held assets, life estate interests created on or after August 1st, 2003, payable-on-death bank accounts, transfer-on-death securities accounts, and trusts.

Cherrywood Pointe is here to help you and your family navigate all aspects of senior care. We can share information with you on all the services we can provide, and if it’s something we don’t do, we’ll put you in touch with the right person or provider. If you have any questions, feel free to contact us.