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Medicaid Spend Down

  • Are you disabled or elderly, or have been approved for Social Security benefits, and your medical bills are too high? Eligibility Bands: Child under 19 years of age, Adults over 65 years of age, aged, blind or disabled, or pregnant.
  • Do you have MediCARE, and no way of covering the 20% that MediCARE doesn't cover?
  • Did you get your Social Security Disability, have to wait 24 months for your Medicare to become effective and your Social Security check is to high to become eligible for MediCAID?
  • Or did you apply for Medicaid, and receive a Share of Cost Medicaid plan?
  • A MediCAID Spend Down is your answer. Under Section 1902(a)(17) of the Social Security Act, an individual is permitted to use medical or certain insurance policies to Spend Down their monthly income. The State of Nebraska will only accept certain policies.
  • I have many MediCAID Compliant policies that The State of Nebraska accepts, and are guarantee issue (zero to little underwriting).
  • I do not charge for my services.
  • Cash and other liquidable cash assets (life insurance cash value, 401(k), pension, IRA, and more) are looked at equally as much as monthly income. Always refer to Medicaid about assets, and if they are counted as lump assets or not, or to an elder law attorney. A medicaid compliant annuity may be needed, which I would also suggest an elder law attorney. We have a medicaid compliant annuity if needed.
As a licensed insurance agent, I have been working with (but not for) the State of Nebraska for my clients since April of 2010, to help them receive MediCAID. I enjoy helping people with this because I have genuinely made other peoples' lives better. Now let me give you some examples from some of my clients, who have given me permission to talk about their story.

Aaron G.
Aaron has M.S. and is 41, is in a wheelchair and has to go to the hospital monthly where his medical bills are $6,000 a month. His MediCARE only coves 80% of each bill. Leaving him with a bill of $1,200 a month. His disability check is only $1,076, not enough to cover the bills, but at the same time, how is he supposed to pay for rent, food, utilities, medications. etc.. He is too young to get MediGAP, and has only 2 options 1.) not go to the hospital and get the necessary medical help he needs, or 2.) purchase private insurance to make his income low enough for MediCAID and cover the 20% that MediCARE doesn't cover.
As of 2015 the new maximum for someone to make is $1001 a month ($981 + $20 buffer). So Aaron spent $77 in private insurance  to cover the $1,200 monthly bill.  Also the state gives him back $19 in food stamps a month.  Aaron is also on MediCAID waiver, which allows him to receive a full time caregiver (69 hours a week, Aaron started at 18 hours a week; this is based on needs, and I have no influence on approval nor the hours approved. I will however help you through the process, no charge) (see Private In Home Care tab for more information).

Tom and Charles
When I first meet Charles, he told me about his best friend Tom who he lived with and had not only Alzheimer's but a hernia that needed emergency surgery.  On top of that Charles going to work was a trigger that caused him to tear the house up.  So going to work was needed to pay the bills, but a worrisome time. He is 62 and his 24 month waiting period for Medicare hasn't passed yet.  And he made $130 over the MediCAID income limits.  Even if he had his MediCARE and MediGAP policy that you need to be 65 to have, it wouldn't cover the constant supervision that he needs. 
Charles tried for 2 years to be Tom's caregiver but couldn't get it nor the MediCAID. I was able to get it set up in 6 weeks.  Working with the state can be a complected process.  But with my experience I know how to get through the bureaucracy  and red tape, and get it done quickly.

V.L. (allowed to do story but not whole name)
She was a 78 year old woman that had advanced arthritis that kept her confined to a wheel chair.  She could not perform more than 3 A.D.L's (adult daily living activities). She already had MediCARE and MediGAP and was paying $480 a month for private in home care, but only for 4 hours a week.
She had built up savings in her working years through a 401(k), that had become annuitized, and with her Social Security Check was making $230 over the MediCAID limits. So she purchased $230 of insurance from me and became eligible for MediCAID.  As an added service, she only hired me for the spend down, I got her on MediCAID waiver got her 31 hours a week of care, saving  her $250 a month, and I also got her a free Life Alert system. Sadly she passed away a year later, but I did what I could to make her final days better than those prior to me meeting her.