Assistance / Benefits
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Assistance / Benefits |
Financial and Medical Assistance - State and Federal Government Benefits
Introduction
There are a variety of long-term care options available. Whether you have immediate decisions to make or are planning ahead, you will want to understand what financial resources are available for you, a friend or family member.
This section is for people:
• 18 or older thinking about applying for Medicaid to help pay for their long-term care.
PAYING FOR LONG-TERM CARE
Many people pay privately for long-term care services. There are also financial programs that pay all or part of the costs for people who qualify because of income or other reasons.
Medicare
Medicare is a federally-funded, health insurance program for people 65+, certain people under the age of 65 with disabilities, People of any age with End Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant). It pays for many health care expenses but does not cover them all.
Medicare has limits on the length of time and the circumstances under which it pays for care. Medicare covers only medically “reasonable and necessary” care. Items and services that Medicare doesn’t cover include, but aren’t limited to, long term care, routine dental care, dentures, cosmetic surgery, acupuncture, hearing aids, and exams for fitting hearing aids.
Contact a Social Security Administration office for a Medicare application and more information about the program. You can find the number in the government section of a telephone book under “United States” or at www.ssa.gov.
You can also call the Statewide Health Insurance Benefits Advisors (SHIBA) for free assistance. SHIBA volunteers are trained by Insurance Commissioner's staff to educate and counsel consumers on a wide range of health insurance options and issues. Their services are impartial and free. To locate the SHIBA volunteer nearest you, call 1-800-562-6900 or visit their website at http://www.insurance.wa.gov/index.asp You will also find a variety of helpful consumer publications.
Veteran's benefits
If you are a wartime veteran or surviving spouse (married at the time of the veteran's death), you may be eligible for a pension health insurance or long-term care through the Department of Veterans' Affairs (VA). Also, the dependent parent of a veteran killed in service or who dies of a service-connected disability may be eligible for VA Dependency and Indemnity Compensation.
If you have any relationship to a veteran, call the Department of Veterans' Affairs for more information.
The toll-free number is 1-800-827-1000.
Long-term care Insurance
Some people have purchased long-term care insurance that pays for services. Check your policy carefully to see what is covered. Call SHIBA for more information. If you receive Medicaid and have insurance to help pay for long-term care (e.g., long-term care insurance for in-home care, community residential facility care, or nursing home care), the state must be reimbursed for any benefits you receive. You will have to turn over insurance payments to the state.
Medicaid
Medicaid is a program that uses both state and federal money to help you pay for medical services. It is for people with limited income and resources, such as savings or property. If you are already eligible for Medicaid, you and your family members may be able to get help with the costs of services that help you stay in your home instead of moving to a nursing home. Examples include homemaker services, personal care, and respite care. For more information, contact your State Medical Assistance (Medicaid) office. Call 1-800-633-4227 and say “Medicaid” to get the telephone number, or visit www.medicare.gov. TTY users should call 1-877-486-2048. Medicaid programs vary from state to state.
APPLYING FOR MEDICAID
If you are 18 or older, you, or someone acting for you, can apply for Medicaid through your local Home and Community Services (HCS) office. Call to ask for the telephone number and address of your local HCS office. This information is also available at www.adsa.dshs.wa.gov.
Call or visit the HCS office. Tell them you would like an application form to apply for Medicaid to help pay for long-term care services. The application form can be:
• mailed to you;
• picked up at the HCS office;
• downloaded and printed off the Internet at: http://dshs.wa.gov/pdf/ms/forms/14_001.pdf
There are three main parts to the application process, including:
• filling out the application;
• a financial review to determine your financial eligibility;
• an assessment of your personal care needs to determine functional eligibility for services.
Fill out and return the application form. Follow the instructions and answer all the questions on the application. If you need help filling out the application, contact your local HCS office or your local Senior Information and Assistance office (I&A).
Information you will need to provide includes:
• Social Security number
• Proof of identification
• Proof of income
• Documentation of resources (such as bank statements, property tax statements, life insurance)
• Immigration or alien documents
* Proof of citizenship if you do not receive Medicare or Supplemental Security Income (SSI).
Additional support
If your primary language is not English or you have mental, physical, hearing, or sight issues that make it difficult to understand what is happening during the application process, you may ask a HCS staff person for further assistance. Accommodations may include (but are not limited to): Braille materials, translated written materials, large print materials, use of assisted listening devices, TTYs, or a qualified/certified interpreter or reader may be provided.
HCS/DSHS employees can explain the rules but are not able to give you personal, financial or legal advice. They will recommend that you consult an attorney who understands Medicaid rules if you need help with a decision.
Your local Information and Assistance Office can help you locate legal assistance. Wrong 11: Visit their website at : www.adsa.dshs.wa.gov/resources/clickmap.htm. If you are low-income and have a non-criminal legal problem, the NW Justice Project has many free resources and self help information that can help.
Financial review
You will talk to a HCS financial services specialist as part of your application process. At that time, you can explain in more detail the answers on your application form. The next several pages of this section will give you more information about the income and resource eligibility limits the financial services specialist will be reviewing with you.
Assessing your care needs
A HCS social worker comes to your home and talks to you at length. This interview allows the social worker to understand and evaluate what is currently happening in your day-to-day life and what kind of help you need. This is called an assessment.
This assessment is then used to determine if the level of care services you need makes you functionally eligible to receive Medicaid.
Income and resources eligibility limits
You must meet various income and resource requirements to be eligible for Medicaid. Income and resource limits are set by law and change each year. Income and resource limits are set by law and change each year. The HCS office will have current information.
Income
Medicaid income limits vary depending on the services you need, your living situation, and your marital status.
Resources
You must declare all resources you have when applying for Medicaid. Resources include money, assets, or property you have such as cash, bank accounts, stocks and bonds, retirement plans, trusts, annuities, life insurance policies, sales contracts, vehicles and land. If you are married, resources of both spouses will be used to determine your eligibility for Medicaid.
Certain “exempt” resources are not counted toward the resource limits. Exempt resources can include your home, household goods and personal effects, some real estate sales contracts, a car, life insurance with a face value not more than $1,500, burial plots, and most prepaid burial plans.
Resource limits vary depending on your marital status and other factors. Be sure to ask when you apply.
Transferring resources
Under state and federal law, the HCS financial services specialist must review any transfer of resources that took place 60 months before the date you apply for Medicaid.
If resources were transferred within that timeframe and you did not receive fair market value for them, you may not be eligible to receive long-term care Medicaid services for a period of time.
You can transfer your home without penalty to your:
• spouse;
• sibling who has an equity interest in the home and who has lived there at least one year immediately before the date of Medicaid eligibility;
• dependent child who is under 21 years of age;
• child who is blind or disabled; or
• adult child who has lived with you and provided care to allow you to remain at home for the past two years.
What to expect when your application is approved
If your application is approved, you will get a letter saying you are approved for Medicaid coverage.
The letter(s) will tell you how much of your income you may keep for your personal needs, spousal support, home maintenance allowance, medical insurance premiums, and necessary medical expenses not covered by Medicaid. It will also tell you how much you must pay your provider to participate in the cost of your care. You are required to pay these participation costs.
If you are eligible for Medicaid, you will receive a Medicaid Identification Card or a Provider One Services Card. It pays for:
• Medical services covered under Medicaid such as lab work or doctor visits.
• Prescription drugs if you are not receiving Medicare. Medicare Part D pays for most of your prescription drugs if you are receiving Medicare.
The social worker will help you develop an individualized care plan. He or she then coordinates setting up needed services.
You will receive a Client Rights and Responsibility form (DSHS 14-113) that outlines your rights and responsibilities when receiving Medicaid.
DSHS will review your financial functional eligibility to receive benefits at least once a year.
Recovery of Funds by Your Estate:
By law, the state may recover (be paid back) payments DSHS made for all Medicaid and long-term care services the recipient received prior to their death. Payment is taken from the recipient's estate (assets owned or had an interest in at the time of death). This is called Estate Recovery.
Washington state will recover the cost of all Medicaid funded services (federal and state funded programs) and long-term care services from age 55, including:
• Doctor;
• Hospital;
• Prescription drugs;
• Medical appliances;
• All other medical services;
• Nursing home services;
• COPES;
• Medically Needy Residential and In-Home Services; New Freedom
• Medicaid personal care services;
• Adult day health;
• Private duty nursing;
• Managed Care Premiums;
• Medicare Premiums for individuals also receiving Medicaid; and
• Medicare Savings program services for individuals also receiving Medicaid.
Washington state will also recover the cost of state-only funded long-term care services received at any age, including:
• Chore;
• Adult family home;
• DDD state-funded Long-Term Care services;
• Adult residential care; and
• Related hospital services and prescription drug costs.
Estate recovery only applies to assets the recipient owned or had an interest in at the time of death. It does not apply to property solely owned by a spouse or child. The state will not begin recovery efforts until after your death, during the life of a surviving spouse, domestic partner, or while a surviving child is under age 21, blind, or disabled. Hardship provisions to protect dependent heirs may apply.
Various exemptions have existed over the years. DSHS will apply whatever estate recovery law existed on the date that benefits were received. Certain lands belonging to American Indians or Alaska Natives may be exempt from Estate Recovery.
Liens Against Property
DSHS may file a lien or make a claim against any property that is included in the deceased recipient's estate. Before filing a lien against real property, DSHS will give notice and an opportunity for a hearing to the estate's personal representative or any other established titled owner of the property.
For more information, consult an attorney with experience in Medicaid law. You can also contact Coordinated Legal Education, Advice, and Referral toll-free at 1-888-201-1014. They have a web site in English and Spanish at www.nwjustice.org.
To learn more about caregiving and long-term care topics visit: www.adsa.dshs.wa.gov At this site, you will find:
• Free brochures and booklets on caregiving and long-term care topics.
• More information on the Family Caregiver Support Program.
• Telephone numbers and addresses of local offices working with seniors.
• A list of adult family homes boarding homes or nursing homes by county.
• Frequently asked questions and answers about long-term care.
Ordering Publications
You may order this booklet in expanded form and other DSHS publications through the Department of Printing's (DOP) General Store. Go to the DOP's website at: www.prt.wa.gov
Publication requests may also be placed:
• By e-mail at fulfillment@prt.wa.gov
• By phone at (360) 586-6360
• By fax at (360) 586-6361
We are all partners against adult abuse
Correct 27: As soon as you have reason to believe that abuse is occurring, call for help. You do not need absolute proof to report suspected abuse or to give your name. Remember, law enforcement and social service agencies cannot be everywhere. It takes all of us to help make sure that those who need protection are safe.
To report abuse or neglect of a vulnerable adult or a child in Washington State, call the DSHS toll-free EndHarm hotline anytime day or night at 1-866-363-4276. ENDHARM is TTY accessible. When you call, you will speak with a real person, who will connect you to the direct, local number to make your report. You can also call directly during business hours. Call:
Home and Community Services County Phone Listing:
Adams: 509-764-5657 or Toll Free: 1-800-671-8902, TTY: 1-800-833-6388
Asotin: (509) 751-4672 or 1-800-310-4881
Benton: (509) 374-2100 or 1-800-310-4833
Chelan: 509-764-5657 or Toll Free: 1-800-671-8902, TTY# 1-800-833-6388
Clallam: (360) 565-2160 or 1-800-280-9891
Clark: (360) 397-9500 or 1-800-280-0586 , (360) 750-4079 TTY
Columbia: (509) 524-4960 or 1-800-310-5678
Cowlitz: (360) 501-2500 or 1-800-605-7322, (360) 577-7591 TTY
Douglas: 509-886-6135 or 1-800-670-8874, TTY: 509-886-6223
Ferry: 509-775-2227 or 1-888-437-0516, TTY(509) 775-2661
Franklin: (509) 374-2100 or 1-800-310-4833
Garfield: Phone: (509) 751-4672 or 1-800-310-4881
Grant:
Moses Lake: 509-764-5657 or 1-800-671-8902, TTY# 1-800-833-6388
East Wenatchee: 509-886-6135 or 1-800-670-8874, TTY 509-886-6223
Grays Harbor: (360) 533-9218 or 1-800-487-0119, (360) 533-9730 TTY
Island: (360) 240-4737 or 1-800-326-1247
Jefferson: (360) 379-4326 or 1-800-280-9991
King: 206-341-7750 or 1-800-346-9257, TTY: 1-800-833-6384
Kitsap: 360-473-2299 or 1-800-422-7114, TTY: 360-478-4928
Kittitas: (509) 925-0433 or 1-800-310-4999
Klickitat: (509) 493-1012 or 1-800-504-1180
Lewis: (360) 767-6460 or 1-800-487-0360
Lincoln: (509) 323-9400 or Toll Free 1-800-459-0421, TTY# (509) 456-2827
Mason: 360-664-7575 or 1-800-462-4957
Okanogan: 509-846-2103 or Toll Free 1-888-437-0529, TTY# (509) 826-7389
Pacific: Long Beach (360) 642-6220 or 1-800-280-1296;
South Bend (360) 875-4222 or 1-800-458-3747
Pend Oreille: 509-447-6223 or 1-888-437-0516
Pierce: (253) 476-7200 or 1-800-442-5129, TTY: 253-593-5471
San Juan: (360) 378-6504
Skagit: (360) 416-7289 or 1-866-608-0836
Skamania: (509) 427-5611 or 1-800-505-4203
Snohomish: Everett (425) 339-4010 or 1-800-780-7094
Lynnwood 425-673-3339
Monroe (360) 794-1700 or 1-800-398-4172
Arlington (360) 651-6800 or 1-800-827-2984
Spokane: (509) 323-9400 or 1-800-459-0421, TTY# (509) 456-2827
Stevens: 509-685-5644 or Toll Free: 1-888-437-0516
Thurston: (360) 664-7575 or 1-800-462-4957 , TTY (360) 664-7800
Wahkiakum: (360) 501-2500 or 1-800-605-7322, (360) 577-7591 TTY
Walla Walla: (509) 524-4960 or 1-800-310-5678
Whatcom: (360) 756-5750 or 1-800-239-8292
Whitman: 509-397-5091 or 1-800-459-0421
Yakima: Yakima (509) 225-4400 or 1-800-822-2097
Sunnyside (509) 839-7278 or 1-800-310-5923
Wapato (509) 877-5165 or 1-888-201-5402
It is the policy of the Department of Social and Health Services that no person shall be subjected to discrimination in this agency or its contractors because of race, color, national origin, sex, age, religion, creed, marital status, disabled veteran status or Vietnam era Veteran status, or the presence of any physical, mental, or sensory disability.
Translated versions of this booklet in Cambodian, Chinese, Korean, Laotian, Russian, Spanish, and Vietnamese can be found on the Aging and Disability Services Administration website: www.adsa.dshs.wa.gov
Family Caregiver Support Program
Visit the Aging and Disability Services Administration's website at www.adsa.dshs.wa.gov. The Family Caregiver Support Program (FCSP) provides support services for family and other unpaid caregivers who care for adults with functional disabilities. FCSP offers specialized information and help getting services, caregiver training, counseling, support groups, and respite care.
Some eligibility rules apply and services vary by geographic area. Contact your local Area Agency on Aging (AAA) office for more information. Look for the telephone number of your local AAA office in the phone book under “Senior Services”, on the Internet at www.adsa.dshs.wa.gov/resources/aaa.htm or call 1-800-422-3263.
To learn more about choosing care in an adult family home or boarding home, order a Guide to Choosing Care in an Adult Family Home or Boarding Home, DSHS 22-707x. Visit the website at: www.adsa.dshs.wa.gov
If someone living in any residential care facility needs help resolving a care or service problem, call the State Long-Term Care Ombudsman toll-free at 1-800-562-6028.
MedicAID and MedicARE are NOT the same:
• There are no income or resource requirements for MedicARE.
• For MedicAID you must meet income and resource eligibility.
Here are some important tips:
• If you are applying for someone else, be sure the applicant signs a consent form giving you permission to represent them during the application process.
• Be prepared to answer questions about the applicant's personal and financial situation.
• Don't be afraid to ask questions. Write down the answers so you can remember everything later. Write down the names of people you talk with in case you need to speak with them again.
• The consent form must be updated yearly.
• Be sure the service you choose will accept payment from Medicaid. Most residential care facilities accept payment from Medicaid, but some do not. If you are considering a particular residential facility, ask them if they accept Medicaid payments.
• Contributing some of your income towards the cost of your care is called your participation. Do you really need nursing home care?
With the proper support, you may not need to go to a nursing home. Before you enter a nursing home, meet with a HCS social worker or nurse. They will talk with you, assess your care needs, and help you decide what is best for you.
Source: Aging and Disability Services Administration, Washington State Department of Social and Health Services, www.adsa.dshs.wa.gov
For more information on traumatic brain injury, please contact your doctor or refer to the TBI Toolkit, produced by the Washington State Department of Social and Health Services, http://www.aasa.dshs.wa.gov/Library/tbitoolkit.pdf
updated 04/29/2010