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Medicaid Update – It’s Not Your Grandmother’s Medicaid

By Gail Glockhoff-Long
GolderCare Solutions
Benefits Advocate

Medicaid has changed over the years – some good changes and some not as good. Before 1988 a couple had to spend down to $3,000 for one of them to qualify for nursing home Medicaid.  $3,000 is not much left for the community spouse to live on. The county and state workers actually helped you complete the paperwork and were available to answer questions. That was then.

For the last several years, the Illinois rule was the nursing home person could have no more than $2000 in their name. All income minus medical insurance costs and $30 per month for personal needs went to the nursing home to pay for care. The state made up the rest. The community spouse was allowed to keep $120,780 in their name. If you were the community spouse and your income was below $3,715.50, you were able to divert income from your spouse to you to bring you up to the minimum monthly maintenance needs allowance (MMMNA).  Those numbers did not change much for years.

The Medicaid processes and allowances were reviewed as the state came out of the COVID emergency status. The upside of post-COVID is the increase in allowance that are more reasonable for this day and age. The $2,000 asset limit was raised in Illinois to $17,500. The personal needs allowance is currently $30 but there is proposed legislation to raise it to $60. The community spouse asset allowance went to $129,084 and the MMMNA increase to $3,853.50.  Every increase helps increase the quality-of-life options for both the nursing home resident and the community spouse.

Iowa made some increases also but not as dramatic as Illinois, as Iowa had been making gradual annual increases.  The nursing home resident asset limit stayed at $2,000, but the community spouse asset limit is now $154,140. The community spouse MMMNA is the same as Illinois at $3,853.50.  Iowa is an income cap state, which means if your income is more than their limit, you make too much money for Medicaid.  The limit for some time was $2500 per month.  That is obviously not enough to pay for care, so Iowa created a work around of establishing a Medical Assistance Income Trust, commonly known as a Miller Trust, as an income pass through.  Income goes into the account and is written out to the nursing home. The threshold for needing a Miller Trust is now $2,829.

To every up there is a counter balancing down. During the COVID emergency, Medicaid applications were not reviewed in detail. If you applied, you generally received Medicaid. The annual reviews for eligibility were suspended so everyone stayed on Medicaid. As nice as that was, the COVID emergency is now over. States are to reassess every recipient of Nursing Home Medicaid by the end of May 2024.  If you had the cursory review when you initially applied, your review this round may ask for everything from 2-5 years of bank statements with copies of checks and deposits over $1,000 to income verification and funeral information, and the list goes on.  You often have only a 10-day deadline. I recently received a request for a client approved during the COVID emergency that was 4 pages of items the state wanted verified. If you talk to someone who applied for Medicaid in the last few years and said how easy it was – that was COVID rules and the state no longer plays by COVID rules. This is true in both Iowa and Illinois.

As the states continually change the rules and make the application process more difficult, it increases your need to work with an independent advocate who knows how the
system works. GolderCare has been assisting seniors in the Iowa and Illinois since 2008. We are here to guide families through the confusion and overwhelming process of long-term care Medicaid. We advocate for you.

GolderCare Solutions is an independent advocacy group for seniors, the disabled and those that care for them. GolderCare has offices in Moline and Bettendorf. You can reach GolderCare at (309) 764-2273 or learn more at www.goldercare.com.