1. NAME OF PROGRAM: Medicaid for Long Term Care

2. PURPOSE OF PROGRAM: Medicaid pays for medically necessary nursing home care for patients in skilled or intermediate care nursing homes or in intermediate care facilities for the mentally retarded.

3. APPLICATION PROCEDURES: Application for Medicaid for Long Term Care is made with the Cabarrus County Department of Social Services through the Adult Service Intake unit. Applications generally need to be made in person by the applicant or his representative. If unable to come to the agency the supervisor of the unit should be contacted to discuss options available. No specific information is required to apply for Medicaid. However, it is helpful to have the applicant’s social security number, proof of income and information about resources (such as bank account numbers and insurance policy numbers).

4. ELIGIBILITY REQUIREMENTS: The eligibility requirements include:

1. Be age 65 or older, or under 65 and unable to work due to a severe disability that is expected to last at least 12 months.
2. Nursing home care must be medically necessary as documented by a medical form (FL-2) completed by a physician and approved by EDS.
3. The income must be less than the cost of care in the facility at the Medicaid rate.
4. Resources must be no more than $2,000 for an individual. Resources include: cash, bank accounts, second car, retirement accounts, stocks and bonds, and real estate (the individual's home may be considered a resource unless a spouse or other person the applicant is legally responsible to provide for remains in the home).
5. Medicaid policy specifies that when a legally married individual needs Medicaid to help pay for nursing facility services, a portion of the couple's income and assets may be protected for the spouse at home, the community spouse. Once assets have been allocated following spousal impoverishment rules, spousal financial responsibility ends and each spouse will be treated separately for Medicaid purposes. A portion of a married institutionalized Medicaid recipient's income may also be allocated to the community spouse.
6. Medicaid law prohibits the transfer of assets for less than market value by an institutionalized Medicaid applicant/recipient or anyone acting on their behalf. A sanction is applied for a period of time based on the value of the asset. The sanction begins the month the asset is transferred. The length of the sanction is determined by dividing the value of the transferred assets by the average monthly Medicaid cost for nursing home care. During the sanction period the individual may be eligible for Medicaid but Medicaid will not pay for institutional services.

5. OTHER PROGRAM DETAILS: When a Medicaid recipient in a nursing home dies, Medicaid files a claim against the estate to recover expenses paid by Medicaid. Estate recovery is waived if there is a spouse or dependents who continue to live on the property, the total assets in the estate are less than $5,000, Medicaid charges are less than $3,000, or in cases of hardship.

6. DATE OF INFORMATION: April 23, 2001