What is Medicaid?

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What is Medicaid?
Medicaid is a health insurance program provided by the state and federal government. Medicaid is not the same as Medicare, which is a health insurance program provided by the Social Security Administration. (Medicaid eligibility is based on need. Medicare recipients are entitled to coverage no matter how much income and wealth they have.) Medicaid in Kentucky is called KyHealth Choices and is run by each county’s Department for Community Based Services, formerly known as the “Welfare Department”. All the county offices are supervised by the Cabinet for Health and Family Services. For your local office contact information see https://apps.chfs.ky.gov/office_phone/

Can I get Medicaid?
There are several ways that you can become eligible for Medicaid:
  • All families receiving K-TAP benefits are automatically eligible for Medicaid.
  • Many low-income children and pregnant women may be eligible for Medicaid.
  • Low-income persons over age 65 may be eligible for Medicaid.
  • Low-income persons, who are blind or disabled, may be eligible for Medicaid.
  • Moderate-income persons, who are over 65, blind, or disabled, may be eligible for Medicaid if their medical expenses are greater than the difference between their income and the Medicaid guideline.
Do I make too much money to get Medicaid?
  • Resources – you can only have a limited amount of resources and get Medicaid. The current limit is $2,000 for a single person and $4,000 for a married couple. Resources include things like land, money, bank accounts, insurance policies, and some vehicles. Resources don’t include the house you live in, furniture, one vehicle, and clothing. If you are a nursing home resident, your spouse may keep more assets. 
  • Income – The Medicaid income guideline for one person is $217 per month. For a married couple, the limit is $267 per month. Additional amounts are added to the income limit for additional children/people in the house. This extra amount can be added for minor children, children between 18-21 who are in school, and for other people in the house who are providing "essential services" in the home. If you are a nursing home resident, your spouse may keep more income. It is possible to be eligible for Medicaid even if you are over the income limit. Under the spend-down rule, if you can show each month that you acquire substantial medical bills that exceed your extra income, you may still be eligible for Medicaid.
What about Medicaid paying for nursing home costs?
If you are a resident of a nursing home, you may qualify for Medicaid if your income is.
  • Less than $2022 each month (2009 amount; three times SSI payment).
  • Over $2022 each month if the excess amount is placed in a Qualifying Income Trust (QIT).
What is a Qualifying Income Trust (QIT)?
Medicaid requires you to put the amount of income that is over $2022 (2009 amount; changes every year) per month in an irrevocable trust. You place this income in a bank account and you designate a trustee (family member or friend) who then pays bills from this account as the Medicaid office directs. At death, any amount left in the bank account must be paid to the state Medicaid office. You must have a trust document called the QIT. The Medicaid office will not prepare a QIT. You should contact your local legal aid office or the KY state-wide Legal HelpLine 800 200-3633 or a private attorney for information on this trust.

If I am in a nursing home, can any of my income be given to my spouse?
If you are in a nursing home and your spouse lives at home, Medicaid allows your spouse to keep at least $1,750 each month (2009 amount). This amount changes each year in July. Your spouse may get more than $1,750 of your income if your rent or mortgage, taxes, home insurance and utilities exceeds $525 each month. The maximum income allowed for a spouse is $2,739 each month. You may also be allowed a monthly amount for any minor or disabled children at home.

If I am in a nursing home, can my home or savings be given to my spouse?

When you apply for Medicaid, the Medicaid office (Department for Community Based Services in your county) will assess your resources. That means the Medicaid office will have you list your checking account, savings, certificate of deposits, life insurance, and any other resource. Your spouse can then keep one-half of all resources up to $109,560 (2009 amount). This figure changes each year. If you have less than $21,912, then the whole amount can be kept by your spouse. Your home is not considered a "resource" in this assessment and can be kept by your spouse.

What if I am single and live in a nursing home? Can I keep my home?

Medicaid only allows you $2,000 in resources. You can keep your home, but after six months in a nursing home Medicaid requires that you sell the home UNLESS you have a dependent family member living there or you give a written statement to Department for Community Based Services that says you intend to return to your home. There are some other resources you may be able to keep such as pre-paid burial arrangements, a car, $1500 burial reserve, and tax deferred retirement plans.

What if I need home health?
If you are aged or disabled, Medicaid can pay for home health. It only pays if your doctor states that you need the same level of care as a nursing home. The Medicaid home health program is called Home and Community Based Waiver Program. You apply at your county's Department for Community Based Services or you may contact a local home health agency in your area. See www.khha.org

What is Consumer Directed Option?

If you are on the Home and Community Based Waiver Program you may have many choices as to who will provide you with home health services. You can even hire family members, friends, neighbors or others to provide you with services such as meal preparation and housekeeping or respite care or personal care. To explore this new program you should call your local Agency on Aging or Medicaid Member Services (800) 635-2570.

Are there other Medicaid programs for the elderly or disabled?
Yes. Certain low-income Medicare recipients may qualify for one of the limited Medicaid programs. This coverage includes payment of all or part of the Medicare Part B premiums, and may include payment of Medicare deductibles and co-payments. To learn more, ask your caseworker if you qualify for QMB, SLMB, QI1 or QI2.

Can I give or transfer my resources to someone else so I can get Medicaid?

Medicaid puts penalties on you if you give away resources. If you give away resources or sell them for less than their value, you may lose Medicaid coverage for nursing home care and for some in-home services.

What does Medicaid cover?

Different Medicaid programs provide different levels of coverage. Medicaid for the aged, blind, or disabled provides comprehensive coverage including physician services, hospitalization, prescription medications, transportation, therapy, and nursing home care. Your doctor or hospital should be able to tell you whether a service is covered, as long as you let them know what type of Medicaid you have.

What happens if I apply for Medicaid and my application is denied?
You have the right to appeal if your application for Medicaid is denied, or if you do not receive a decision in 90 days (45 days for persons over 65). You have 30 days from the mailing date of the notice to appeal. You can appeal in writing or by calling the local county Department for Community Based Services. If you call, you must follow up with a written request. The county office should assist you with your appeal. However, you may send your request for a fair hearing directly to Administrative Hearings Branch, 275 East Main Street, 1E-C, Frankfort, Kentucky 40621. Write that you want to appeal the denial of Medicaid, and include your name, address and social security number. Keep a dated copy of your request. Once your request is received, a hearing will be scheduled, usually at the county office. For help with your hearing, contact your local legal aid program or the representative of your choice as soon as your application for Medicaid is denied.

Reviewed August 2009