Medicaid

It depends upon the long-term care program.

• Nursing Care Program. No, the nursing care program does not have an income limit. However, it may not make sense to apply for the nursing care program if your income exceeds the private rate.
• Adult, Blind or Disability Program. If single, the income limit is $1,215/month. If married, the income limit is $1,643/month (combined total).

The State of Utah permits seniors whose income would otherwise exceed Medicaid's limits to qualify if they have significant medical expenses. The "spend-down" amount functions akin to a deductible and represents the disparity between an individual's monthly income and the income limit. Individuals can fulfill their "spend-down" obligation by settling overdue medical bills, purchasing prescription drugs, maintaining private health insurance, and covering medical expenses not covered by Medicaid. Alternatively, one may directly pay his/her spend-down amount to the state of Utah. Upon meeting the "spend-down," eligibility for Medicaid benefits extends for the remainder of the month.

he Department of Workforce Services evaluates your initial eligibility status based on the first day of the month that you are applying for Medicaid. For example, if you are applying for Long-Term/Nursing Care Medicaid coverage and you submit your application on January 15^th, you will need to be under assets at the beginning of the day on January 1st.

An exception to this general rule is if you relocate to Utah and establish residency within the state during the month; in such cases, the eligibility determination date is considered to be the date you moved to Utah. For example, if you move to Utah on January 15^th, then you will need to be under assets at the beginning of the day on January 15^th.

The 5-year lookback period is a crucial aspect of the Long-Term/Nursing Care Medicaid program in Utah. This provision is designed to prevent individuals from intentionally impoverishing themselves to qualify for Medicaid benefits.

Definition: The 5-year lookback period refers to the timeframe during which Medicaid examines an applicant's financial transactions to determine if any assets were transferred or gifted.

Duration: In Utah, this period covers the five years immediately preceding the date of the Medicaid application.

Purpose: The primary purpose of the lookback period is to identify any assets that were deliberately transferred or gifted in an attempt to meet Medicaid’s financial eligibility requirements for nursing care or other long-term care services.

Penalties: If such transfers are discovered during the lookback period, penalties may be imposed. The penalty is calculated based on the value of the transferred assets and may result in a period of Medicaid ineligibility.

Calculation: The penalty period is determined by dividing the total value of the uncompensated transfers by the average monthly cost of nursing home care in Utah.

In summary, the 5-year lookback period is a mechanism employed by Medicaid to ensure that individuals do not manipulate their financial situation to qualify for nursing care benefits.

Generally, it is not recommended to gift property away to family and/or friends during the 5 year look back period as it may cause you to be ineligible for Medicaid benefits for a period of time. The period of time is based upon the value of the gift and the average cost of nursing care in Utah.

Medicare may cover skilled nursing care, including custodial care within a skilled nursing facility, for a limited duration, under specific conditions: (1) the care is required for recovery from an illness or injury, not a chronic condition; and (2) it follows a hospital stay of at least three days. If these criteria are met, Medicare may contribute to the costs of skilled nursing care as follows:

• Days 1-20: Medicare may cover 100% of the expenses.
• Days 21-100: The individual is responsible for a co-payment.
• Day 101 and beyond: Medicare does not provide payment.

There are generally three alternative approaches to covering the costs of long-term care: (1) private payment; (2) long-term care insurance; or (3) Veteran Affairs (VA) Benefits.

Private Payment: Individuals can use personal funds to cover the expenses of long-term care. In Utah, the average cost for a nursing care facility ranges $6,000 to $12,000 per month; assisted living is $2,500 to $5,000 per month; and independent living is $1,500 to $4,000 per month.

Long-Term Care Insurance: This type of insurance provides coverage for care that is typically not covered by health insurance, Medicare, or Medicaid. However, it is important to note that long-term care insurance can be relatively expensive.

VA Benefits: Veterans may qualify for benefits that can assist in covering the costs of long-term care.

While these options exist, it’s worth noting that Medicaid coverage is the most commonly utilized method for financing long-term care.

The Ellsworth Law Firm charges a flat rate of $1,000.00 to prepare, submit and supplement the application. If additional legal work is needed, please call us for a personalized quote.