Frequently asked questions.
Q: Do I have to be appointed the legal guardian or
have power of attorney to apply on the patients behalf?
A: No, anyone having knowledge of the patient's assets
and income may apply. The patient may designate an
authorized representative in writing.
Q: Do I have to pay all my income to the nursing facility
in I stay an entire month?
A: No, you may receive a $40 personal allowance and
other deductions can include medical premiums, unpaid
medical bills, and a monthly income allowance if you
have a spouse and/or dependent child in community.
Veterans with no spouse or children in the community
or widows of veterans may receive $900 personal
allowance.
Q: If I am discharged to my home, must I pay my
income to the nursing home?
A: No, as long as you are discharged before the last
day of the month.
Q: After I quality for Medicaid, should I terminate my
other medical insurance?
A: Medicaid will allow you to pay the medical premium
from your monthly income as long as your coverage
is in force. There are some advantages to retaining
your policy. For instance, you may wish to choose
a doctor that does not accept Medicaid. Also, the
patient liability may be refunded if the Medigap
insurance will pay for the coinsurance days while the
patient is on Medicare skilled days.
Q: If I die while I am a resident of a nursing facility,
can my personal allowance funds held by the nursing
home go to a designated person?
A: No, if you are a single individual, the nursing home
staff must return all these funds to the Recovery Unit to
offset any Medicaid funds expended during your life time.
The nursing home staff can however, pay for any unpaid
funeral or burial expenses before sending the remainder to
the Recovery unit. If you have a spouse or dependent
child in the community, remaining funds will be directed
to them.
Q: If I chose Medicaid Hospice care, do I continue to
pay my patient liability?
A: Yes, the Hospice Program still requires that patient
liability be collected. This offsets the room and board costs.
Q: Do I have zero assets before I quality for Medicaid?
A: No, some assets are exempt. The Medicaid Program has
rules which determine exempt and countable resources.
Q: If I must spend down some of my assets to quality, can I
preplan my burial?
A: Yes, it is wise to purchase an irrevocable burial contract.
Make sure your plans are complete by including grave, grave
maker, and any other funeral expenses.
Q: Can my spouse or dependent children in the community
have my assets and income?
A: Yes, it may be possible to protect at least one-half of
marital assets for the community spouse. The community
spouse or representative should request a resource assessment
at the time of admission so assets are not over spent. If income
is below the community spouse standard, or there are high
housing expenses, the nursing home resident's income may be
transferred to the spouse and any dependent children living
in the community.
Q: If I am a community spouse, must I spend the excess
assets solely on nursing home costs?
A: No, the overage may be spent on purchases that
benefit the community spouse. For example, home
repairs, car and personal items.
Q: Does the Medicaid program recognize common-law
marriages?
A: Only if the common-law relationship was established
before 10/1/91. The caseworker will explore protection
of marital assets and income.
Q: What happens to my home if I go into a nursing home?
A: The home must be listed for sale after a person has been
in the nursing facility for 6 months with the following
exceptions:
*The spouse lives there.
*A child under age 21 or an adult child between
21 and 65 who is disabled lives there.
*An adult child over 65 who is financially dependent
on his/her parent for housing lives there.
*A sibling has lived in the house for at least one
year immediately before the date the individual
was admitted to the nursing home. Also, the sibling
must have verified equity interest in the home.
Q: If I have provided care for the nursing home patient,
can the home be transferred to me?
A: The home can be transferred only to an adult child
who lived in the house and provided care for at least
two years prior to the nursing home admission. The
caseworker will inform the adult child of the necessary
documents to process this exemption.
Q: Will Medicaid pay for my bed if I am temporarily
absent from the nursing home/
A: Yes, each Medicaid nursing home patient has 30
calendar days per year for which Medicaid will pay
to hold the bed while in the hospital or for physician
pre-approved therapeutic visits with family or friends.
Additional days can be authorized for residents in an
ICF/MF facility.
Q: Can I transfer to another nursing facility after
Medicaid is approved?
A: Yes, an individual is free to choose any
certified Medicaid nursing facility in the state of Ohio.
The Medicaid case will be transferred to the supervising
county.
Q: If there an alternative to nursing facility placement?
A: Yes, Wavier Programs are available to patients who
require nursing home care and have the support to stay
in their home. They must quality for long term care
Medicaid. Such services are: Passport for those age
60 and over, Ohio Homecare Waiver for those under
age 60 or those deemed medically fragile at any age,
and Individual Options & OBRA for individuals with
mental retardation or developmental disabilities.
Services are provided - such as: nursing, transportation,
housing modifications, homemaker and chore services.
Discuss this option with the nursing home discharge
planning staff or the caseworker and to receive the
ODHS 2399 referral.
Q: Will the Home Care Program offer services to
regular or delayed spend down Medicaid recipients?
A: Yes, for Community Medicaid consumer, the
Ohio Home Care Program offers core services:
Nursing, daily care and therapy are provided to
patients for 14 hours or less a week, when their
physician orders core services for more than 14
hours a week, the Core Plus Benefit Package is
another option. Call Care Star Inc. at
330.492.4530 or toll free at 1.800.492.4530.
Q: Will I be eligible for any assistance after I am
discharge from the nursing home?
A: The caseworker can determine if you are eligible
for Community Medicaid and Food Stamps.
Q: What can I do if I disagree with a decision made
regarding my application?
A: You can request a state hearing by contacting the
caseworker, the county hearing officer, or the
Bureau of State Hearings or Ohio Department of
Human Services.