“We simply want to put to rest the misinformation, the confusion that has been raised.”
-David Church

Whether you are researching Medicaid for yourself or a loved one, the process can be overwhelming. There are the emotions surrounding the decision making process. There is the physical work of collecting what seems like a mile-long list of required documents, (‘Five years of bank statements! We threw everything away when Mom moved two years ago!’) And there is the false information surrounding the application process which can be the most disheartening.

Dispelling these “Medicaid Myths” is the greatest way to help seniors and their families arrive at the best long term care plan. Here are a few of the most common myths about Medicaid.

MYTH #1 – “I don’t need Medicaid, I have had Medicare and a supplemental insurance since I retired.”

FACT- Medicare provides 20 days of full coverage if you have been admitted and spend at least three days in the hospital and need skilled care; an “Observation only” admission does not count. If you need additional skilled care, you can receive up to 80 days of partial coverage from Medicare. The co-pay will usually be covered by your supplemental insurance. After the 100th day, you will have to pay for services through your savings, long term care insurance (if applicable) or Medicaid, if you qualify. Medicare does not cover long term care.

MYTH #2 – “I have to be destitute to be eligible for Medicaid.”

FACT- As of December 1, 2014, individuals in New Jersey with an income 300% of the Social Security Income (SSI) Federal Benefit Rate ($2199/mo for 2015 gross income) are now eligible for Medicaid Managed Long Term Services and Support (MLTSS). A person cannot have more than $2,000 in liquid assets.

MYTH#3 – “So if I meet the financial guidelines, I am guaranteed Medicaid.”

FACT– There is also a “clinical” eligibility requirement. Your primary care physician will need to document your need for assistance in at least three activities of daily living (ADLs). A clinical assessment screen will also be completed by an Office of Community Choice nurse.

MYTH#4 – “My daughter moved in to care for me because I didn’t want to go into a nursing home three years ago. Medicaid is going to take my house if I need to go into a facility now.”

FACT – Medicaid is not in the business of “taking” homes. If a child has been caring for their loved one for two years or more, and their physician documents that this care has kept the patient out of a facility, Medicaid will allow the family member to remain in the home.

MYTH #5 – “I can hide my assets and get Medicaid.”

FACT – Intentional misrepresentation in a Medicaid application is a crime and can be costly. The Division of Social Services Medicaid Unit which grants Medicaid is able to contact the IRS for any information concerning income or assets.

MYTH #6 – “I can only ‘spend-down’ my assets on medical or nursing home bills.”

FACT – Prepaying funeral or burial costs by setting up an Irrevocable Trust at the funeral home of your choice is a legal option for spend-down. Employing an agency, such as Family & Children’s Service Medicaid Application Assistance Program (MAAP), to complete your Medicaid application is also an allowable spend-down item.

To learn more about FCS’s MAAP program and schedule your confidential appointment with our MAAP coordinator, call 732-222-9111 today!

Phyllis Noviello is Coordinator of FCS’s Medicaid Application Assistance Program (MAAP). A licensed social worker, Phyllis has more than 20 years experience working with senior populations, helping them navigate their long-term care choices.