Tuesday, October 27, 2015

Medicaid Jargon Made Easier

Let's face it.  Learning the complexities of Medicaid is tough.  If your parent is running out of money, you'll need to know the meaning of the following words.

A little introduction.  To be eligible for Medicaid, your aging parent has to qualify two ways:  first, financially, and second, medically.  Each state has its own program.  The basic rules are similar, but dollar amounts on income and assets can vary. 

Most people these days in Washington State are applying for a Medicaid-waiver program called COPES (Community Options Program Entry System) which offers people care in their homes, in assisted living communities and in adult family homes.  Traditional Medicaid refers to care offered in a skilled nursing facility. 

Step One:  Financial Qualification--words you'll need to know:

1.  Income cap--this is the limit on monthly income your parent can have and still qualify for COPES.  In Washington State, the income cap is currently $ 6381.  If your parent seeking COPES help is married, his or her income in their own name cannot exceed this amount. 

2.  Asset cap--in Washington State, and in many states, the limit for resources (assets, property and savings) is $2000 for a single person.  In the case of a married couple in which one spouse applies for COPES, they can have $56.726. 

3.  Exempt resources--These are resources that don't count toward the $2000 limit.  They can include a home (under certain conditions including when one spouse continues to live there when the other goes on COPES), household goods and personal affects, some real estate contracts, a car, life insurance with a face value of $1,500 or less, most burial plots and prepaid burial plans.

Step Two:  Eligibility Due to a Need for Help with Activities of Daily Living--more words

1.  Comprehensive Assessment--a social worker will assess your parent's needs for help with such things as eating, bathing, transfer (e.g. moving from a bed to a chair), bed mobility (positioning), locomotion (walking and moving around), using the toilet and medication management.  A person can run out of money and still not qualify for Medicaid if he or she is still independent or needs very little help.

2.  Award letter--This letter is the official approval for COPES help.

3.  Reimbursement rate--If your parent is applying for care in an assisted living community or adult family home, DSHS will set a daily rate that the State will pay for your parent's care.

4.  Participation--This is the amount your parent will pay toward the cost of the care.  Generally, a person "contributes" his income toward the care, minus a small amount for personal expenses.

Much of the above is excerpted from a publication of Columbia Legal Services, Questions and Answers on the COPES PROGRAM.

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