Medicaid Married Couple Redetermination Challenges – Part 1

Last year I wrote about the challenge of keeping Medicaid after you’ve been approved.   Whenever I give prospective clients an overview of the Medicaid rules and what is necessary to qualify, I also explain that the rules must be followed even after Medicaid eligibility is achieved.  You can’t let your guard down and completely forget about the Medicaid rules.

Medicaid does a redetermination once a year.  For many years the redeterminations were sporadic.  I had clients on Medicaid who never received a redetermination notice.  I’ve noticed, however, in the last 5 years or so that just about every county in which I file Medicaid applications now sends annual redetermination notices like clockwork.  While the” redets” as we call them are much easier to work thru (since the process doesn’t involve providing 5 years of records), most of our clients either handle it themselves or the facilities take care of it, especially in the case of single Medicaid recipients where all the income goes directly to the facility and they have most of the information needed to process it. 

There are several reasons redeterminations are necessary.  Some of the numbers change from year to year.  For example, Social Security and pensions typically have a cost of living adjustment.  Health insurance premiums, which can be deducted from income before turning the remainder over to the facility, can also change, usually increasing from year to year.  Medicaid must then recalculate the amount to be given to the facility as part of the cost share which then changes the amount the State gives to the facility as its share.

Additionally, as I wrote about last year (3/11/19 and 3/18/19 posts), the State reviews the QIT statements for the past year to be sure the QIT is being used properly.  If not, then Medicaid benefits can be lost.

Medicaid also wants to take a look at the assets.  Did the Medicaid recipient receive additional assets, such as from a lawsuit settlement or an inheritance?  If so, then the assets may exceed the $2000 limit which also causes a loss of Medicaid. Married couple cases, in which there is a non-Medicaid spouse living in the community, are especially tricky when it comes to Medicaid redeterminations.  This is where we have seen a disturbing uptick in former clients calling us after receiving Medicaid termination notices following a Medicaid redetermination.  Next week I’ll tell you why.