Medicaid Definitions

 Posted by on November 7, 2016
Nov 072016
 

Community Spouse Resource Allowance: the amount of assets the spouse of a nursing home applicant may maintain without having to do a spousal refusal. May also be used in certain instances in homecare applications.

Excess Resources/Excess income: countable assets/income above the permissible Medicaid level.

Lookback period: The period of time Medicaid will “lookback” from the date the applicant wants Medicaid to begin paying. The lookback period is different for nursing home care than for homecare. For nursing home care, the lookback period is 5 years from when the individual is in the nursing home and otherwise eligible for Medicaid, meaning the individual’s assets are at or below the Medicaid limit. For homecare, there is no lookback, however, some Medicaid caseworkers will request 3 months of financial records.

Managed Long Term Care Plan (“MLTC”): The entity that actually determines the amount of care an individual applying for Medicaid will receive. The home care agencies contract with the MLTC and provide the approved number of hours.

Minimum Maintenance Needs Allowance (“MMNA”): amount of income the spouse of a nursing home applicant may maintain absent extenuating circumstances increasing the amount.

Net Available Monthly Income (“NAMI”): the amount of income the Medicaid recipient is deemed to have available to offset the cost of care.

Personal Needs Account: An account set up for a nursing home resident with the facility.

Personal Needs Allowance (“PNA”): The amount of income a Medicaid applicant is allowed to maintain and still be eligible for Medicaid. Currently, a nursing home resident is allowed to maintain $50 of income.

Pooled Income Trust: A trust administered by a not for profit which hold either the assets or income of a disabled individual. Pooled trusts are frequently used to shelter the “excess income” or “spenddown”, which is the income of the applicant above the Medicaid limit, which would otherwise have to be used to pay for the individual’s care. By using a pooled trust for income, the money can be used for the disabled individual’s expenses.

Promissory Notes: Promissory notes are used as part of a Medicaid planning technique when a gift of assets is made. It allows for a portion of an applicant’s assets to be considered a gift, which will cause a penalty period. The promissory note creates a loan of assets that will cover the resulting penalty period.

Spousal refusal: a letter by which the nonapplying spouse refuses to make his/her income or assets available to pay for the cost of care of the Medicaid applicant spouse.