Comparison of New Jersey and Pennsylvania Medicaid Eligibility Rules
New Jersey and Pennsylvania Medicaid eligibility rules differ. We break down what you need to know to plan confidently for long-term care.
What is the 5-Year Medicaid Lookback Period?
The 5-Year Medicaid Lookback Period is a specific provision that is often confusing, but it plays a vital role in determining Medicaid eligibility. Understanding the 5-Year Medicaid Lookback Period The 5-Year Medicaid Lookback Period refers to a five-year timeframe during which Medicaid reviews all financial transactions, asset transfers, and gifts made by an applicant. This period is designed to prevent people from giving away or transferring assets at less than fair market value to qualify for Medicaid benefits. If an applicant has made such transactions within the five-year window prior to applying for Medicaid, penalties may be imposed, potentially delaying [...]
What is the difference between Medicare and Medicaid?
Understanding the difference between Medicare and Medicaid is essential for anyone navigating the healthcare landscape in the United States, especially for seniors and those with low incomes. While Medicare and Medicaid are government-sponsored healthcare programs, they serve different populations and have unique eligibility requirements, coverage options, and funding sources. Both programs have distinct features, and here we’ll shed light on the difference between Medicare and Medicaid. Origins of Medicare and Medicaid Medicare and Medicaid were established in 1965 under the Social Security Act but were designed to serve different purposes. Medicare is a federal program that provides healthcare coverage [...]
Involuntary Nursing Home Discharge: “We Have No Long-Term Care Beds”
I recently met with a family regarding their ailing father and a potential involuntary nursing home discharge. Their father fell in his home and was subsequently hospitalized. He then transitioned from the hospital to a local nursing home for rehabilitation covered by Medicare. The amount Medicare pays a nursing home for a resident undergoing short-term rehabilitation is significantly higher than what the nursing home would receive via Medicaid. However, Medicare will only pay for a maximum of 100 days if the resident needs skilled care. The 100 days is by no means guaranteed. With this client, the nursing home discharge [...]
Medicaid Coverage for Assisted Living: PA Legislation Proposal
In December 2022, Pennsylvania state Senators Michelle Brooks and Judy Ward proposed legislation that would expand Medicaid coverage for assisted living facilities. The proposal is designed to provide support for older adults who require assistance with daily living but do not require the high level of care provided by nursing homes. Under the proposed legislation, eligible seniors would be able to access Medicaid coverage for assisted living services, including room and board, personal care, and medication management. This would be a game-changer for many seniors who are currently struggling to pay for these services out-of-pocket or relying on family members [...]
Millions at Risk to Lose Medicaid Coverage as of April 1, 2023
Analysts estimate that up to 18 million people (or one in five enrollees) will lose Medicaid coverage between this year and next, and among those, 3.8 million will remain without health insurance. Here is what you need to know. Medicaid enrollment ballooned by 20 million people during the Covid-19 pandemic to nearly 84 million people. That was no fluke: with a declaration of a Public Health Emergency (PHE), states were barred from removing people from the program. This is all about to change. The $1.7 trillion government spending bill passed in December reinstated states’ ability to kick people off Medicaid, [...]
What is the Community Spouse and the MMNA in Medicaid?
What is a community spouse, and how is one eligible for spousal allowance in the event their loved one is moved to a nursing facility? Before we answer, it’s important to first understand cost-sharing in Medicaid and qualifications based on income. Medicaid is a cost-sharing program, meaning that the Medicaid recipient shares in the cost of their care. Each nursing home has its own Medicaid reimbursement rate, or the daily rate that Medicaid pays them for its nursing home residents. The resident contributes a portion of their monthly income, and Medicaid makes up the difference. The resident’s income contribution is [...]
How Can I Fight a Medicaid Transfer Penalty?
If you are planning to apply for Medicaid, whether for yourself or a loved one, it can be important to be aware of and, if possible, prepare for a Medicaid transfer penalty. If a Medicaid applicant has given away assets, inclusive of cash, bank account transfers, properties and/or vehicles, without receiving fair market compensation within the last five years, the Medicaid caseworker processing the application will impose a Medicaid penalty. What is a Medicaid Transfer Penalty? A Medicaid transfer penalty is a period of time during which Medicaid will not reimburse your long-term care provider for services, including home and [...]
Extension of the 3-Day Prior Hospitalization Waiver
What does the 3-Day Prior Hospitalization waiver extension mean for seniors seeking skilled nursing facility-level care? Over the course of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services issued several waivers in response to the Public Health Emergency. These waivers were scheduled through at least January 2022. In January, it was determined that the 3-Day Prior Hospitalization waiver would remain in effect at least through April 16, 2022. This waiver allows for Medicare coverage of skilled nursing facility level of care without a qualifying hospitalization. Under the traditional Medicare guidelines, a Medicare beneficiary must be admitted to a [...]
Advocacy is Essential When Applying for Medicaid
As an attorney for Rothkoff Law Group, I help support our Public Benefits staff with complicated Medicaid issues and unexpected application outcomes when applying for Medicaid. As a result, I have found the internal processes of state Medicaid agencies processing Medicaid applications do not always comply with state and federal Medicaid laws, often to the detriment of our clients. For this reason, it is essential to have an advocate when applying for Medicaid for long-term care in both New Jersey and Pennsylvania. It is worth noting I do not believe the Medicaid agency’s occasional failure to comply with Medicaid rules [...]