County Assistance for Medical Emergencies
If you cannot afford hospital care and medicine, the county may temporarily help you pay for necessary medical services if you really have no other way of paying (as a “last resort”). Ask for an application at your County Courthouse as soon as you think you might need help. The county may ask you to repay the money in small payments over time or may attach a lien to your house. If you are denied, you must ask for an appeal hearing within 28 days. Contact Idaho Legal Aid Services for a more detailed brochure about County Assistance eligibility and applications.
Medicare is not Medicaid!
Medicare is a type of federal health insurance for people 65 and over, people who have received Social Security Disability payments for over 2 years, and people with certain kidney diseases.
Medicare is available regardless of your income while Medicaid is only for low income people.
Medicare is like other health insurance: it has premiums, co-payments, and deductibles.
Medicare covers some kinds of health expenses: short stays in hospitals or nursing facilities, some home health care needs, and some doctor visits, ambulances, medical aids, and prosthetics. More information is available at 1-800-MEDICARE or www.medicare.gov.
If you are in a hospital or nursing facility, and a doctor or a hospital worker says that Medicare will no longer pay for you to stay there, you have a right to appeal. When you are denied coverage, you should be given a written “notice of non-coverage” from the doctor or hospital. The notice should explain how to appeal. If you are denied coverage, you can call Qualis Health’s Appeals Helpline at 1-877-290-4346 and ask for an immediate review of the denial.
Are you eligible for Medicaid?
Medicaid helps many low-income people pay for medical necessities, including long-term care in a nursing home or assisted-living facility. You can apply for Medicaid at any office of the Idaho Department of Health and Welfare. You may be eligible if:
- your income is less than Medicaid’s income limit AND
- your total resources (money and property) are fewer than Medicaid’s asset limit AND
- you are 65 or older, blind, disabled, raising a child, pregnant, or within a few other special categories.
Long-Term Care: Medicaid and Other Basics
Medicaid has an income limit and a resource limit.
Medicaid may help you pay for a long-term care facility, if you have a low monthly income and you have few resources (assets and property).
When you apply for Medicaid, the Idaho Department of Health & Welfare (DHW) looks at all of your (and your spouse’s) income and resources to determine if you are eligible. DHW doesn’t count all of your resources when deciding if you qualify. Some resources are “exempt” and don’t count towards the limit. Generally, some common exemptions include:
- your house
- a car
- certain burial plots
- certain life insurance plans
If you have too many “non-exempt” assets to qualify, (like money in a savings account or more than one car) you may have to consider “spending down” some of the assets before you will qualify for Medicaid. Many people pay for long-term care “out of pocket” for a while and apply for Medicaid only when they have few enough resources to qualify. If you have many resources, consider talking to a private attorney about planning for long-term care, because spending assets can involve taxes and other complicated issues. You may get a referral to an attorney from the Idaho State Bar Lawyer Referral Service at (208) 334-4500 or http://isb.idaho.gov.
If you have a little too much income, a “Miller Trust” may help you qualify.
Many low income people don’t have anywhere near the amount of income or savings to pay for long-term care (like a nursing home), but they have just a little too much income to qualify for Medicaid. These people may be able to set up a special kind of trust account, often called a “Miller Trust,” to qualify for Medicaid. Contact a private attorney or Idaho Legal Aid Services if you need help qualifying for Medicaid to pay for long-term care.
Your “Share Of Cost”: You may still have to pay part of your long-term bill.
Even if Medicaid helps pay for part of your facility’s cost, you may have to pay a share, called your “patient liability” or “share of cost.” The Idaho Department of Health and Welfare calculates how much of your income you can keep each month. Usually, it’s a small amount-- just enough to pay for toiletries and other small items. This is called your personal needs allowance. Your other income goes to the facility. Medicaid then pays the rest of the facility’s bill directly.
“Transfer Penalty”: Medicaid “looks back” to see if you gave assets away.
Many people think they can just give away assets to meet Medicaid’s resource limit. However, this may cause a penalty, because Medicaid does not want you to give away assets just to qualify. Medicaid looks back five years from the time that you apply, to see if you transferred (gave away) any assets for less than “fair market value.” For example, if you deed a house to a son or daughter, Medicaid looks at the value of the house and calculates how many months of long-term care you could have paid for if you had sold it for “fair market value.” Then you will be disqualified from Medicaid for that many months. It’s important to start planning now and not give away assets if you might need Medicaid’s help to pay for care in the next few years.
“Estate Recovery”: Medicaid can get paid back after you (and your spouse) die.
You may have heard that Medicaid will put a lien on your house to pay itself back. This is partially true: Medicaid has a right to recover from your estate (property you leave when you die) the amount of money it paid for your care. However, if you are married, and your spouse is still living in the house, Medicaid will not simply take the house. It will not try to get repaid until after your spouse dies, too. Other kinds of property is protected from estate recovery as well.
Private Long Term Care Insurance isnʼt for everyone.
Private insurance may help pay for long-term care if you buy it years in advance but it may not be a good idea if you have very few assets or low income. Contact the Senior Health Insurance Benefits Advisors (SHIBA), at 1-800-247-4422 for more information about health insurance.
Sometimes a facility abuses or neglects a senior.
“When I went to visit mom at the nursing home, she had bruises and looked like she hadn’t eaten in days. I don’t think they’re taking care of her.” Sadly, seniors may experience abuse while in the care of nursing homes and other institutions. Friends and family may rightfully worry if they notice a loved one:
- talks about verbal or physical abuse from staff
- hasn’t eaten enough
- has bedsores, bruises or other injuries
- is missing personal items
- isn’t taking medicine properly
Contact Adult Protection Services (APS) and the local Ombudsman if you suspect elder abuse. Ombudsmen investigate complaints and respond to requests for assistance from seniors living in long term care facilities, assisted-living facilities, and in residential care in the community.
