Income Limit for Medical Assistance in Pa for Family of Four
Disclaimer: This article has been posted for full general information purposes only, and applies only to Pennsylvania residents. Y'all should not act upon the information in this article without outset retaining legal counsel.
Past Robert C. Gerhard, III, Esquire
We are usually asked almost the Medical Assistance (Medicaid) long-term care resource limits. In order to authorize for benefits the bidder must be "resources eligible." This ordinarily involves a spend-down of excess resources to below the applicable limit. The trouble is that at that place is a keen deal of misinformation out there about how far i must spend-downwards earlier becoming eligible for benefits to cover nursing home costs.
This article will attempt to clear things up a bit as yous begin your research. This article is not a substitute for legal advice, if legal advice is needed please reach out, but should assistance yous better understand the topic. You lot will generally do better navigating the Medicaid awarding procedure if you lot have an experienced elderberry law attorney aid you lot along the way.
Unmarried, Widowed, and Divorced Medicaid Applicants
The answer to the resource limit question is a chip more straightforward for a single bidder than for a married applicant. For a single, non-married applicant, the resources limit depends on the person'southward "gross" monthly income.
If a not-married person applying for benefits has more than $2,382 of gross monthly income, then the resource limit for countable (non-exempt) resources is $2,400. If the applicant has gross income which is $2,382 or less, then the person's resources limit is $8,000. Examples of "countable assets" include checking and savings accounts, stocks, bonds, brokerage accounts, and non-resident real manor.
This income limit, now $2,382 /calendar month, usually changes on January 1st of each yr. This monthly figure represents 300% of the federal SSI benefit corporeality and is usually revised upward each year due to inflation. $two,382 is the income threshold amount for 2021. This number is expected to be revised upwardly by a few dollars on Jan ane, 2022.
Gross vs Net Income
We advise our clients non to rely on the depository financial institution statements to bear witness the gross monthly income. The deposit amounts reflected on the bank statements normally verify cyberspace monthly income, not the gross income. The deductions are often subtracted from the gross amount of income for taxes and health insurance before the net corporeality is deposited.
For example, the amount of Social Security income that hits the banking concern account each month is commonly net of the Medicare B premium. Similarly, pension payments often accept federal income tax or supplemental health insurance premiums withheld. The caseworker reviewing the Medicaid application at the County Assistance Office volition definitely determine the applicable resource limit based on gross income. The caseworker will demand written proof of the monthly gross income amounts, typically Social Security and pension income.
Non-countable assets
Information technology is important to note that non all assets are "countable." Ane motor vehicle, household appurtenances and personal effects, burial spaces for firsthand family, a properly funded irrevocable burial reserve, and certain business holding are examples of property that can be considered non-countable. Non-countable assets can be retained in addition to the resource allowance of either $ii,400 or $8,000.
The residence of a unmarried bidder is protected in 2021 to the extent its off-white market value is nether $603,000. Married applicants can keep their residence regardless of value.
Pennsylvania Aging Waiver Plan
At the fourth dimension of this writing, the $2,382 figure is also the income-cap, generally speaking, for access to the Pennsylvania Crumbling Waiver Program. The Aging Waiver program provides home and customs-based services for those who might otherwise require nursing facility care merely who can be safely cared for at home. The resources limit for Aging Waiver Programme is $viii,000, but as a general dominion the applicant'south gross income needs to exist at or under $2,382/month. At that place is a manner to spend-downwards income to become eligible for Crumbling Waiver services, only it is not applied for many people, so although information technology is possible, it is not oft pursued without the assistance of a lawyer. Nigh Pennsylvania seniors with gross income over $2,382/calendar month are non able to admission the Crumbling Waiver Program, and can more easily qualify for Medicaid benefits to pay for nursing habitation care. This is unfortunate since information technology is oftentimes preferable to care for loved ones at habitation and out of nursing facilities.
Married Nursing Abode Residents
Computing the resource limits in a spousal case is more complicated. Generally speaking, the spouse at home is permitted to protect half of the countable resources up to a statutory maximum, and discipline to a statutory minimum. The 2021 maximum is $130,380, and the 2021 minimum is $26,076.
The protected spousal share is determined by the caseworker at the County Assistance Office following his or her review of the Resource Assessment, Form PA-1572. This form is provided to every nursing home resident upon admission in the Nursing Home Admissions Packet. The Resource Assessment captures the resource values as of the date of admission to the nursing home.
Nursing abode admission
The first nursing home access that lasts 30 days is, generally speaking, the relevant date of admission. Although the Resource Cess form technically does non need to be filed until y'all utilize for Medicaid long-term intendance benefits, our part usually opts to file the Resources Cess presently afterwards access to the nursing dwelling – in one case nosotros are sure the nursing home stay will exceed xxx days. At a minimum you volition want to ascertain and document the precise values of the countable avails as of the engagement of access to the nursing dwelling. If y'all delay filing this class it can become more difficult to place the historical account values as of the engagement of nursing home admission. It can be done, but it is more hard to practise and then.
In cases of undue hardship the resources limit of the community spouse can be increased by filing an appeal, and and then pleading the case before an administrative law judge with the Pennsylvania Section of Homo Services Bureau of Hearings and Appeals (BHA). Sometimes the entreatment tin can be settled and resolved with a "Stipulated Agreement" with the Department that is reviewed and canonical past BHA.
Filing Appeals
An appeal can too be filed to protect boosted assets for the community spouse where that spouse'southward income, when combined with the income available from the institutionalized spouse, is bereft to run into monthly needs. In that location are rules designed to foreclose spousal impoverishment. The monthly maintenance needs allowance is determined later the caseworker's review of shelter costs (rent or mortgage), property taxes, homeowner's or renter'southward insurance, and utility costs. The minimum monthly needs allowance is $ii,155/calendar month effective since July i, 2020, and will be revised again July one, 2021. The maximum monthly maintenance needs assart is $3,259.50 effective Jan 1, 2021. It will be revised up on Jan one, 2022.
In Pennsylvania, the qualified retirement accounts of the community spouse are not counted, but the retirement accounts of the institutionalized spouse (applicant) do count.
Spouse Assets
The spouse at abode tin can retain the spousal share, described above, and the institutionalized spouse (the person in the nursing abode) is also permitted to go along his or her own resource allowance of either $2,400 or $8,000, depending on gross monthly income. As mentioned above, gross income at or below $2,382/calendar month results in a resource limit of $8,000 for the institutionalized spouse, and income over $ii,382/month results in a resources limit of $two,400.
There are cases where the community spouse predeceases the institutionalized spouse, and the surviving institutionalized spouse then has increased income. For instance, this happens when the predeceasing spouse at dwelling house had high Social Security benefits, and the spouse in the nursing home had low Social Security benefits. Upon the death of the spouse at dwelling, the spouse in the nursing home will receive the college of the two amounts. When this happens, the nursing home resident's gross income may be bumped upwardly to a figure greater than $2,382/month. The change of income must exist reported to the County Assistance Office, and this will result in a reduction of the resource limit from $8,000 to $ii,400. If resources exceed the limit and then there tin can be a notice of discontinuance gear up past the County Aid Office.
Gifts Can Create Ineligibility
The Medicaid Gifting Problem. Parents sometimes help their children financially. Grandparents give coin to their grandchildren. Unfortunately, if that parent or grandparent is admitted to a nursing habitation inside 5 years of such gifting and needs to apply for Medical Assistance (Medicaid) long-term intendance benefits there could exist problems, sometimes big problems. Specifically, the application for benefits could be denied for a period of time. This is known equally the "Medicaid transfer penalty." Large gifts can create long periods of ineligibility for Medicaid long-term care benefits. Read more about the Pennsylvania Medicaid gifting rules.
About Gerhard & Gerhard
We hope you have institute this article informative. We tin can help you lot protect your assets past following the applicable rules. Please telephone call our role and nosotros would be glad to provide guidance with the Medicaid spend-downwards. To larn more well-nigh Medicaid estate recovery statute of limitations in pa we summarized the Pennsylvania Medical Assistance Manor Recovery Plan.
Robert C. Gerhard, Iii Esquire is the managing shareholder of Gerhard & Gerhard, P.C., an estate planning and elderberry police force firm located in Montgomery County, Pennsylvania. Attorney Gerhard specializes in elderberry law, with accent on Medicaid Planning, Medicaid Applications, and Medicaid Appeals. He is the author of the Pennsylvania constabulary treatise, Pennsylvania Medicaid, Long-term Intendance.
Should y'all rent an attorney for a Medicaid application?
Does the Medicaid application procedure intimidate y'all? The application can be very overwhelming if you've never completed the procedure before. Terms like "five-year lookback" and "spousal benefits" tin can brand you realize that you don't really know much about Medicaid.
That's when an elder law chaser can be a valuable guide for you and your family. Read more than to meet why hiring an attorney might be the best solution.
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Source: https://www.paelderlaw.net/resource-limits-pennsylvania-residents-applying-medicaid-long-term-care-benefits/
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