Financially Eligible but Still No Medicaid (Part 1)

Many of my blog posts on Medicaid focus on the financial part of eligibility – meeting both the income and asset requirements.  There are instances, however, in which meeting those requirements still won’t get someone Medicaid.  That’s because there are other hurdles to get over.

One is the medical requirement, establishing the need for assistance with at least 3 of the activities of daily living (ADLs).  The ADLs are transferring (ambulating), dressing, bathing, toileting, feeding (different than preparing meals which is not an ADL), and incontinence.  A Medicaid nurse must conduct an evaluation of the applicant to make the medical determination.

Despite common misconceptions, having someone administer medications is not an ADL and by itself, is not enough to meet Medicaid’s medical test.  The need for medication monitoring, however, does often indicate or lead to the need for assistance with the ADLs.

As I always explain to families, even if we meet all the financial requirements, spend down the assets and establish a qualified income trust when income exceeds Medicaid’s monthly income cap or limit, if you are “too healthy” you still won’t get Medicaid.  That’s because you can’t meet the medical test.

But, the medical requirement is not the only non financial requirement.  Next week I’ll tell you about another one that, while not as common, can also prevent Medicaid eligibility.