Illinois Seniors Face Tough New Reality
The Aged, Blind and Disabled program of Medicaid is designed to be the payor of last resort, to assist those who have no other options. In order to be eligible for assistance, you must meet certain financial and non-financial requirements. You must require institutional level care in order to be eligible, and your assets must be below a certain level.
A caseworker will review your assets and your financial records for the 5 year period prior to your application for assistance to determine if you meet the financial requirements. If you are single, your assets must not exceed $2,000. If you are married, your assets must not exceed $3,000. Your spouse is allowed to have up to $113,640.00.
If you have assets exceeding the allowable limits, you will not be eligible for assistance until your assets have been spent on ALLOWABLE expenses. Your income (social security, pension payments, etc) will be assigned to the nursing home. You will receive a stipend of $30 per month. If you are married, your spouse’s income is also restricted to $2,739 per month. Any income above that amount must be used to pay for the care of the institutionalized spouse.
You are not allowed to give away assets or sell your assets for less than fair market value in order to reduce your assets to the allowable level.
The caseworker will look for any “Disallowed Transfers”, which are money or assets that you gave away or sold for less than fair market value. Any gifts of assets and/or sales of assets for less than fair market value during the lookback period will be considered disallowed transfers and will incur a penalty period of ineligibility.
Medicaid takes a very broad view of the word “GIFT”. The Medicaid rules presume that any money that is used by a senior for a child, grandchild, or even a religious organization or charity is a “gift”, which is an offense punishable by the denial of assistance for nursing home care.
“Incidental” gifts to your family, such as a birthday gift, may be allowed but the determination of whether or not a gift was “incidental” is left to the State of Illinois. Weekly donations to your church and donations to charity such as the American Cancer Society are all counted towards the penalty period, unless you are able to provide proof of a documented, consistent pattern of giving.
The caseworker will add up all disallowed transfers over the 5 year period, divide that total by the applicant’s per-month cost of care (which is based on the cost of a semi-private room in the facility), and will assign a penalty period of ineligibility. In plain language, you will not receive Medicaid assistance for the period of time those gifts and assets would have paid for if you had kept them for yourself.