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, and people of any age living with permanent kidney failure. 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 and does not cover custodial care (personal care that helps you with things like bathing, dressing, etc.).

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 1-800-397-4422 or visit their website at www.insurance.wa.gov/shibahelpline.htm. 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 1-800-562-2308.

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. Medicaid can pay for medical services in your own home or in a residential care facility including an adult family home, a boarding home contracted with DSHS, or a nursing facility.

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://www1.dshs.wa.gov/dshsforms/forms/14_001PDF.

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

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, written materials translated or on computer disk, large print materials, use of assisted listening devices, TTYs, or a qualified/certified interpreter or reader.

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. Their phone number is in the telephone directory Yellow Pages under “Senior Citizens” or “Disabled Persons” or visit www.adsa.dshs.wa.gov/resources/clickmap.htm.

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.

If you can't provide all of the necessary information during your in-person, mail, or telephone interview, you will receive a letter telling you what you need to provide and when. Get the information to the financial services specialist by the requested date. If you need more time or help getting the information, let your financial services specialist know.

Assessing your care needs

During your application process, a social worker or nurse will visit you at your residence. The social worker will work with you to determine what help you need with your personal care and what services you are eligible to receive. This is called an assessment. This assessment is used to determine your functional eligibility for services.

Income and resources eligibility limits

To receive Medicaid for long-term care services in your own home or in a residential care facility, you must meet various income and resource eligibility requirements.

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.

If you receive Medicaid to pay for your care, you may have to contribute some of your income towards the cost of your care. This is called your participation. Your participation amount depends on the services you receive, your marital status, and your income.

Part of your available income may go towards a spousal allowance. A spousal allowance is used to bring your spouse's income up to established federal government standards. Part of your available income may also go to support dependent relatives. Receiving a spousal allowance depends on the program, your needed services, and your living situation.

If you live at home, part of your available income can be kept for home maintenance (such as rent, utilities, and taxes) and personal needs. If you are in a residential care facility, you keep some of your income for your personal needs.

If you will be staying in a nursing facility a short time, you may be able to keep additional income to help maintain your home for your return. Ask about the “Housing Maintenance Exemption” when you apply.

Resources

Resources include money, assets, or property that are available to pay for your care. You must declare all resources. All resources of both spouses will be considered together to determine eligibility for Medicaid. Examples include, cash, bank accounts, stocks and bonds, retirement plans, trusts, life insurance policies, sales contracts, vehicles and land.

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 state must review transfers of resources that take place before the date you apply for Medicaid.

The state looks back 60 months for transfers into trusts and 36 months for all other transfers. If you did not receive fair market value for the resource, you may not be eligible to receive Medicaid for a period of time after making the transfer.

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. You may get two letters, one from your financial services specialist and one from your social worker.

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 on the first of each month. It pays for medical services covered under Medicaid such as prescription medications and doctor visits. It also covers medical services not provided by a nursing facility or residential care facility.

DSHS will review your financial eligibility to receive benefits at least once a year. Recovery of funds from 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;
• 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.
Collection 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 the death of the person who received Medicaid or state-only funded services, during the life of a surviving spouse, 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.

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

Abuse of vulnerable adults (people who need help to care for themselves) can happen anytime, anywhere. DSHS investigates alleged abuse, neglect, exploitation, or abandonment of vulnerable adults.

Call 1-866-EndHarm (1-866-363-4276) for help if you or someone you know is:

• not being cared for properly
• being hurt physically or mentally
• being financially exploited in any way

Home and Community Services Regional Phone Numbers - Call the number listed for your region and ask for the local HCS office nearest you.

Region 1
1-800-459-0421
TTY 509-456-2827
Spokane, Grant, Okanogan, Adams, Chelan, Douglas, Lincoln, Ferry, Stevens, Whitman, and Pend Oreille Counties

Region 2
1-800-822-2097
TTY 509-225-4444
Yakima, Kittitas, Benton, Franklin, Walla Walla, Columbia, Garfield, and Asotin Counties

Region 3
1-866-608-0836
TTY 360-416-7404
Snohomish, Skagit, Island, San Juan, and Whatcom Counties

Region 4
1-800-346-9257
TTY 1-800-833-6384
King County

Region 5
Pierce County
1-800-442-5129
TTY 253-593-5471
Kitsap County
1-800-422-7114
TTY 360-478-4928

Region 6
1-800-462-4957
TTY 1-800-672-7091
Thurston, Mason, Lewis, Clallam, Jefferson, Grays Harbor, Pacific, Wahkiakum, Cowlitz, Skamania, Klickitat, and Clark

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

Video Available

A free video is available that offers a visual tour through different residential care facility options. The video allows you to get a clearer picture of care setting options. To see the 15-minute video, Options: You Have a Choice, call your local HCS office, ask your HCS case manager, or call 1-800-422-3263 and a video can be mailed to you.

Visit the Aging and Disability Services Administration's website at www.adsa.dshs.wa.gov  The Family Caregiver Support Program

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