1. Community Spouse: means a person who is the spouse of an institutionalized person and resides in the community.
2. Community Spouse Monthly Income Allowance: means the amount of income the community spouse is allowed as defined by Medicaid rules. Also known as Minimum Monthly Maintenance Needs Allowance (MMMNA). In 2020 the community spouse’s minimum monthly maintenance needs allowance (income) is $3,216.00.
3. Spousal Refusal: means the Community Spouse declines to contribute any part of his/her assets towards the care of their sick spouse.
4. Family Member: means a minor child, dependent child, dependent parent or dependent sibling of the institutionalized spouse or of the community spouse who resides with the community spouse. Moreover, a person is considered a dependent if over 50 percent of his/her maintenance needs are met by the community spouse and/or the institutionalized spouse.
5. Institutionalized Spouse: means a person who is in a hospital or nursing home and is likely to remain there for at least 30 days. Additionally, the institutional spouse is married to a spouse (community spouse), who is not hospitalized or in a nursing home.
6. Homestead: means the primary residence of the Medicaid applicant/recipient and/or members of his/her family. Family members may include the applicant’s spouse, minor children, certified blind or certified disabled children, and other dependent relatives. The homestead may be the home and land, cooperative apartment, condominium or even a mobile home.
7. Legally Responsible Relative: means a person who is legally responsible for the support and care of one or more relatives. For Medicaid medical assistance purposes, a legally responsible relative is:
(a) the spouse; or
(b) the parent(s) of a child under the age of 21; however, a parent is not financially responsible for a certified blind or certified disabled child who lives separately from the parental home for over 30 days, even if the child visits his parental home occasionally.
8. Resources: means assets which the Medicaid applicant or their spouse may have. This may include, checking accounts, savings accounts, brokerage accounts, stocks, bonds, some annuities, properties other than their primary residence, cash surrender value of whole life insurance policies, and assets owed to applicants and their spouses. However, IRA’s that pay out at least the minimum distributions are counted as income and not resources.
9. Income: means any income such as, wages, tips, social security benefits, social security disability benefits, pensions, distribution from IRA’S, annuities, any dividends, and gifts.
10. NAMI: means Net Available Monthly Income. Nursing home recipients are entitled to $50 a month of income from their Social Security and/or pension. Unless there’s a spouse in the community who’s income is less than the spouse income level, all of the remainder is considered excess income and that amount is considered NAMI which the nursing home will be entitled to.
11. Medical Facility: means any hospital, skilled nursing facility, intermediate care facility, psychiatric facility or alcoholism facility.
12. Intent to Return Home: means that an institutionalized individual wishes to return to his/her primary residence.
13. Social Security Benefits: means benefits to individuals of old age, survivors, and disability insurance.
14. Supplemental Security Income (SSI): means eligible individuals or couples who are 65 years of age or older, or who are certified blind or certified disabled, and either have no income or receive social security, but are under the Medicaid income standards, can apply for additional income, called SSI.
15. Managed Long Term Care: Almost all Medicaid recipients (community and home-care), will need to join a Medicaid Managed Long Term Care plan also called MLTC. What does it mean to the Medicaid applicant/recipient? Basically, a Medicaid recipient will only be allowed to see doctors in their plan’s network, and will need to follow their plan’s rules regarding their care. They will be assigned a primary care provider who will make referrals and authorize any medical services.
16. Who is exempt from MLTC: Recipients enrolled in a Medicare Advantage program, waiver programs, such as, Traumatic Brain Injury waiver, Care at Home Waiver program, or Nursing Home Transition & Diversion Waivers, and recipients receiving Hospice services.
17. Look Back Period: Means the period of time, which Medicaid requires financial documentation for. Since 2013 Medicaid imposed a five (5) year look back period for all nursing home applicants; however, this does not mean that Medicaid applicants will automatically be penalized from nursing home medical assistance for any period of time.
18. Pooled Income Trust: There are several Medicaid approved pooled-income-trusts, that allow Community Medicaid recipients or Medicaid Home Care recipients to deposit their excess or surplus income into the trust and have the trust use the assets to pay the recipients bills, such as, rent, telephone, electric, food, credit cards, etc.
19. Promissory Note: A promissory note allows nursing home applicants to protect some of their life savings. Depending on the cost of the nursing home and the applicant’s monthly income, applicants can sometimes protect 50% and even more of their assets.
20. Caregiver Agreement: Caregiver agreement, also known as Personal Service Contract, allows nursing home applicants the ability to protect some of the transferred assets by hiring private care and services, which Medicaid does not provide, such as, companions; assistance in financial matters, paying bills, purchasing clothing, and other incidentals as needed; assistance in arranging legal and financial services; and continued contact with out of town family and friend, are just a few.
21. Consumer Direct Personal Assistance Program (CDPAP): Here is a program allowing family members to get paid by Medicaid to take care of their loved ones at home instead of an agency sending home attendants. The programs allows you to hire and fire anyone as long as they are legal and have a social security number. There is no license or certification requirements.
22. Discharge Alert: Applicants in nursing homes applying for Medicaid nursing home coverage are allowed only $50 per month for personal expenses; however, filing a discharge alert allows the applicant to retain in 2019 $875 per month for the first six month in the facility.