This is Part 2 of a 6-Part Series for families regarding ways to pay for elder care services in Indiana. This information accompanies the 23-page e-book/guide called “A Family Guide to Paying for Elder Care Services in Indiana“, available for free download HERE.

Medicaid Defined

Medicaid was established by federal law (Title XIX of the Social Security Act), and is administered by each state individually. Medicaid is a program for poor or “impoverished” people, and people with high medical costs. Congress established Medicaid to provide a “safety net” for people who had no other way to pay for their health care or long-term care.

Medicaid is the long-term care payer of last resort for the frail elderly, persons with health problems, persons with mental retardation, mental illness, and those with physical or developmental disabilities.

Most long-term care and services such as prescription drugs, eyeglasses and dental care are provided at each state’s discretion. When state money is scarce these services may be the most vulnerable, not because of ill will on the part of the state decision makers, but because there may be nowhere else to cut state budgets.

Medicaid is a highly flawed program, and is under-funded and over-burdened. States continue to make, and change, decisions about Medicaid that among other things, will affect the amount of long-term care assistance available in each state, the eligibility criteria and number of persons eligible for that assistance, and the types of services that will be reimbursed.

Indiana Nursing Facility Level of Care Waivers

http://member.indianamedicaid.com

These waivers are for children and adults whose needs are primarily medical. There are two waiver programs: the Aged and Disabled Waiver and the Traumatic Brain Injury (TBI) Waiver.

ELIGIBILITY FACTORS

• Medical Conditions/ADLs
• Income
• Assets

Medical Conditions/Activities of Daily Living

A person must have an unstable complex medical condition which requires:

• direct assistance from others for the following conditions: decubitus ulcers, comatose condition, or management of severe pain; OR
• direct assistance from others for medical equipment, such as ventilator, suctioning, tube feeding, central intravenous access (I.V.); OR
• direct assistance for special routines or prescribed treatments from others such as tracheotomy, acute rehabilitation conditions, administration of continuous oxygen; OR
• direct assistance for special routines or prescribed treatments from others such as tracheotomy, acute rehabilitation conditions, administration of continuous oxygen; OR
• other substantial medical conditions, OR
• Diagnosis of a Traumatic Brain Injury for the TBI Waiver

INCOME

• The income of the individual can be up to 300% of the maximum SSI benefit amount.  Effective January 1, 2013 the limit is $2,130.00 per month.  This amount adjusts annually according based on any changes to SSI.
• Parental income and resources disregarded for children under 18
• If your income is above 300% SSI you may still qualify with a spend down if you have a Qualified Income Trust, also known as a “Miller trust”.

ASSET TEST

Spousal impoverishment provisions apply. When a couple applies for Medicaid, an assessment of their resources is made. The couple’s resources, regardless of ownership, are combined. The couple’s home, household goods, an automobile, and burial funds are not included in the couple’s combined resources. The result is the couple’s combined countable resources. This amount is then used to determine the Spousal Share, which is one-half of the couple’s combined resources.

**HOME AND COMMUNITY BASED SERVICES WAIVERS**

Waiver services allow individuals with special medical or developmental needs to live in the least restrictive setting while receiving the medical care and supports they need.

Next Up: Part 3 Long-Term Care Insurance