Podcast
Questions and Answers
What program categories should you explore to figure out if Mr. Lee qualifies for Medicaid in Non-Expansion State (NES)?
What program categories should you explore to figure out if Mr. Lee qualifies for Medicaid in Non-Expansion State (NES)?
- Elderly and disabled
- Pregnant Women, Children, Families
- Medicaid expansion adults
- All of the above (correct)
If Mr. Lee lived in another state that had expanded Medicaid, he would definitely qualify.
If Mr. Lee lived in another state that had expanded Medicaid, he would definitely qualify.
True (A)
What is the maximum allowable asset amount of an individual in Non-Expansion State (NES)
What is the maximum allowable asset amount of an individual in Non-Expansion State (NES)
- $5,000
- $2,000 (correct)
- $4,000
- $3,000
What type of coverage would Ms. Richardson or her children be eligible for in Non-Expansion State (NES))?
What type of coverage would Ms. Richardson or her children be eligible for in Non-Expansion State (NES))?
Ms. Richardson would definitely qualify for Medicaid in a state that has expanded Medicaid.
Ms. Richardson would definitely qualify for Medicaid in a state that has expanded Medicaid.
What are the Kents' monthly mortgage and tax expenses?
What are the Kents' monthly mortgage and tax expenses?
The Kents have long-term care insurance.
The Kents have long-term care insurance.
How much does a nursing home stay cost per month?
How much does a nursing home stay cost per month?
The hospital social worker has advised Mrs. Kent that she can apply for Medicaid to pay for the costs of Mr. Kent's nursing home care.
The hospital social worker has advised Mrs. Kent that she can apply for Medicaid to pay for the costs of Mr. Kent's nursing home care.
Mrs. Kent is concerned about having enough income after Mr. Kent spends all of his money on his nursing home care.
Mrs. Kent is concerned about having enough income after Mr. Kent spends all of his money on his nursing home care.
In 2023, what is the monthly substantial gainful activity income threshold if an individual is blind?
In 2023, what is the monthly substantial gainful activity income threshold if an individual is blind?
What is the 2024 SSI maximum monthly payment for an individual?
What is the 2024 SSI maximum monthly payment for an individual?
What is the amount of the Part A hospital deductible per spell of illness?
What is the amount of the Part A hospital deductible per spell of illness?
How many days does Medicare cover 100% of inpatient hospital services for?
How many days does Medicare cover 100% of inpatient hospital services for?
What is the copayment per day, for days 61-90, of inpatient hospital services?
What is the copayment per day, for days 61-90, of inpatient hospital services?
How many lifetime reserve days are available to individuals covered by Medicare?
How many lifetime reserve days are available to individuals covered by Medicare?
What is the copayment/day for lifetime reserve days (days 91-150) of inpatient hospital services?
What is the copayment/day for lifetime reserve days (days 91-150) of inpatient hospital services?
What is the monthly premium for Part B coverage?
What is the monthly premium for Part B coverage?
What is the Part B deductible?
What is the Part B deductible?
What is the coinsurance amount for most Part B services?
What is the coinsurance amount for most Part B services?
How many days does Medicare cover 100% of skilled nursing home care?
How many days does Medicare cover 100% of skilled nursing home care?
What is the copayment for days 20-100 of skilled nursing home care?
What is the copayment for days 20-100 of skilled nursing home care?
How many days of skilled nursing home care does Medicare cover per spell of illness?
How many days of skilled nursing home care does Medicare cover per spell of illness?
Flashcards
Medicaid
Medicaid
A program that provides health insurance to low-income individuals and families.
Non-Expansion State (NES)
Non-Expansion State (NES)
A state that has not expanded its Medicaid program to cover more adults.
Modified Adjusted Gross Income (MAGI)
Modified Adjusted Gross Income (MAGI)
The amount of income a person or family earns, adjusted to reflect certain deductions for expenses like taxes and medical costs.
CHIP (Children's Health Insurance Program)
CHIP (Children's Health Insurance Program)
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Health Benefits Exchange (HBE)
Health Benefits Exchange (HBE)
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Personal Needs Allowance (PNA)
Personal Needs Allowance (PNA)
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Federal Poverty Level (FPL)
Federal Poverty Level (FPL)
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Resource Limit
Resource Limit
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Cost Sharing
Cost Sharing
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Medicare
Medicare
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Supplemental Security Income (SSI)
Supplemental Security Income (SSI)
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Disability
Disability
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Substantial Gainful Activity (SGA)
Substantial Gainful Activity (SGA)
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Community Spouse
Community Spouse
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Institutional Spouse
Institutional Spouse
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Excess Shelter Expenses
Excess Shelter Expenses
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Skilled Nursing Facility (SNF)
Skilled Nursing Facility (SNF)
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Deductible
Deductible
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Coinsurance
Coinsurance
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Copayment
Copayment
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Spell of Illness
Spell of Illness
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Alzheimer's Disease
Alzheimer's Disease
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Eligibility Determination
Eligibility Determination
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Financial Need Assessment
Financial Need Assessment
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Long-Term Care (LTC)
Long-Term Care (LTC)
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Long-Term Care Insurance
Long-Term Care Insurance
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Nursing Home
Nursing Home
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Asset Transfer
Asset Transfer
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Medicaid Asset Spend Down
Medicaid Asset Spend Down
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Study Notes
Medicaid Case Histories
- Mr. Lee: 56-year-old single carpenter injured a year ago, resulting in back pain. Unable to secure consistent work. Earning $500-$600/month. Evicted and currently homeless. Developed bronchitis, unable to afford prescription ($60). Shelter staff is trying to help, but is exploring other options before using shelter funds.
Medicaid Eligibility
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Medicaid Eligibility in a Non-Expansion State (NES): Mr. Lee may be eligible for Medicaid. Several factors determine eligibility, including income and resource limits.
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Income Limits: Income limits vary by family size and are tied to the federal poverty level (FPL).
- State resource limits also apply. They determine the amount of money a person or couple can have (or assets). Specific examples for 2024 (given on the document) are detailed on page 4.
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Resource Limits: NES has specific resource limits for Medicaid eligibility (page 4). These vary for individuals and families and include assets such as bank accounts, and personal property
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Medical Needs: Mr. Lee's medical costs and ongoing health issues need to be considered. Past medical costs may be considered assets.
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Questions to Ask: To determine eligibility, questions about income, resources, and medical expenses must be asked. Explore eligibility under medically needy program or CHIP (Child Health Insurance Program).
Additional Cases
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Ms. Richardson: Lives with children in public housing. Lost health insurance and now works 30 hours/week for a small business. Trying to find better-paying, higher-paying health insurance jobs but has been unsuccessful. Earning $2,900 per month in modified adjusted gross income (MAGI). Has limited savings (around $1000). Needs health insurance for herself and her children (including medications and medical needs of her children).
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The Kent Family: Elderly couple with health problems. Husband (Clark, 73) has Alzheimer's disease, and needs nursing home care. Wife (Lois, 69) is also ill health and will likely be unable to care for him at home. Their home is paid up, but the pair are also concerned about the costs of nursing-home care. They have assets (including $250,000 in savings) and sources of income.
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General Considerations: Questions about expanded Medicaid eligibility for Mr. Lee, Ms. Richardson, and the Kent family need to be addressed given their location in a non-expansion state (NES) and various income/resource limits.
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Description
This quiz explores the case of Mr. Lee, a homeless carpenter navigating Medicaid eligibility in a non-expansion state. Participants will learn about income and resource limits that impact eligibility for Medicaid assistance. Test your understanding of Medicaid criteria and challenges faced by individuals like Mr. Lee.
