Learn the basic vocabulary of Medicaid. Words, phrases and definitions are a lawyer’s starting point in all discussions. Take your time reading and learning each word or phrase. It will be well worth it as you read this web page.
- Activities of Daily Living (ADLs) – What each of us do daily generally and without assistance. Examples of ADL’s include bathing, eating, walking, personal grooming, etc. ADLs are an important term for Medicaid medical eligibility. If you need help with ADL’s, then Medicaid eligibility is possible.
- Aid and Attendance – A VA compensation or pension benefit awarded to a veteran (or spouse) who is determined to be in need of the regular aid and attendance of another person to perform basic functions of everyday life. It can help pay for unreimbursed medical bills like assisted living, nursing home, and other long-term care costs.
- Caregiver – A caregiver is anyone who helps care for an elderly individual or person with a disability who lives at home. Caregivers usually provide assistance with activities of daily living and other essential activities like shopping, meal preparation and housework.
- Chronically Ill – Having a long-lasting or recurrent illness or condition that causes a person to need help with activities of daily living and often the assistance of other health and support services. The condition is expected to last for a least 90 consecutive days. The term is often used under long-term care insurance policies to describe a person who needs long-term care because of an inability to do a certain number of activities of daily living without help, or because of a severe cognitive impairment such as Alzheimer’s Disease.
- Cognitive Impairment – Deficiency in short or long-term memory, orientation in person, place and time, deductive or abstract reasoning, or judgment as it relates to safety awareness. Alzheimer’s Disease is an example of cognitive impairment.
- Community Spouse – The married spouse of a nursing home or assisted living resident who is applying for Medicaid long-term care services.
- Community Based Services – Services and service settings in the community such as adult day care services, home-delivered meals, or transportation services. Often referred to as home and community-based services, they are designed to help older people and people with disabilities stay in their homes as independently as possible.
- Continuing Care Retirement Communities – A retirement community or building that offers a range of services and levels of care. Residents may move first into an independent living unit, a private apartment, or a house on the campus. The CCRC provides social and housing-related services and often also has an assisted living unit and an onsite or affiliated nursing home. If and when residents can no longer live independently in their apartment or home, they move into an assisted living or the CCRC’s nursing home.
- Countable Asset – An asset owned by the Medicaid applicant (or spouse) is counted for purposes of determining Medicaid eligibility.
- CSRA (“Community Spouse Resource Allowance”) – The amount of resources ($$$) that is permitted to be owned by the community spouse in order for the institutionalized spouse to qualify for Medicaid. This amount is adjusted annually.
- Custodial Care – Personal assistance services which are generally classified (wrongly, in my opinion) as non-skilled services or care, such as help with bathing, dressing, eating, getting in and out of bed or chair, moving around, and using the bathroom.
- Do Not Resuscitate Order (DNR) – Written order from a doctor that resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. A DNR order may be instituted on the basis of an Advance Directive from a person, or from someone entitled to make decisions on the person’s behalf, such as a healthcare proxy. In some jurisdictions, such order can also be instituted on the basis of a physician’s own initiative, unusually when resuscitation would not alter the ultimate outcome of a disease. Any person who does not wish to undergo lifesaving treatment in the event of cardiac or respiratory arrest can get a DNR order, although DNR orders are more common when a person with a fatal illness wishes to die without painful or invasive medical procedures.
- Durable Power of Attorney – A legal document where one person (the “principal”) authorizes another person (the “agent”) or “attorney-in-fact”) to act on behalf of – and in place of – the principal person. It can be either “limited” (the agent only has the specific powers listed in the document) or “general” (broad powers to do whatever the principal could have done had the principal been competent). “Durable” means that the agent will continue to have the power to act on behalf of the principal even if the principal becomes incompetent. See our webpage on Durable Powers of Attorney, https://www.hnwlaw.com/elder-law/durable-power-of-attorney.
- Elimination Period Under Long Term Care Policy – (also known as Deductible Period or Benefit Waiting Period) Specified amount of time at the beginning of a disability during which you receive covered services, but the policy does not pay benefits. A Service Day Deductible Period is satisfied by each day of the period in which you receive covered services. A Calendar Day or Disability Day Deductible Period doesn’t require that you receive covered services during the entire deductible period, but only requires that you meet the policy’s benefit triggers during that time period.
- Estate Recovery – Process by which Medicaid is allowed to recover an amount of money from the estate of a person who received Medicaid benefits. The amount Medicaid recovers cannot be greater than the amount it paid out for the person’s medical care.
- Exempt Assets – (also called Non-Countable Assets) Assets whose value is not counted in determining financial eligibility by Medicaid. They include:
- Personal belongings
- One Vehicle
- Life Insurance with a face value under $1,500.00
Your home provided that your spouse or child lives there and its equity value is less than a maximum value as established by each state.
- Financial Eligibility – Assessment of person’s available income and assets to determine if he or she meets Medicaid eligibility requirements.
- Functional Eligibility – Assessment of a person’s care needs to determine if he or she meets Medicaid eligibility requirements for payment of long-term care services. The assessment may include a person’s ability to perform activities of daily living or the need for skilled care.
- General Medicaid Eligibility Requirements – You must be:
- A resident of the state in which you are applying
- Be either a United States citizen or legally admitted alien
- Be age 65 or older
- Meet Medicaid’s eligibility rules for disability or blindness
- Gifting Power – The specific authority given to an agent in a Durable Power of Attorney to make gifts of your property to family members and/or others. This can be extremely valuable, allowing family members to do Medicaid asset protection planning for you even after you become incapacitated. Unfortunately, most Powers of Attorney fail to contain this authority.
- Group Home (also called Board and Care Home) Residential private homes designed to provide housing, meals, housekeeping, personal care services, and supports to persons with a disability or other frail residents. At least one caregiver is onsite at all times. In many states, group homes are licensed or certified and must meet criteria for facility safety, types of services provided, and the number and type of residents they can care for. Group homes are often owned and managed by an individual or family involved in their everyday operation.
- Healthcare Proxy – legal document in which you name someone to make healthcare decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions for yourself.
- Hospice Care – Short term, supportive care for individuals who are terminally ill (have a life expectancy of six months or less) Hospice care focuses on pain management and emotional, physical, and spiritual support for the patient and family. It can be provided at home or in a hospital, nursing home, or hospice facility. Medicare typically pays for hospice care. Hospice care is not usually considered long term care.
- Institutionalized Spouse – The spouse who resides in the nursing home while the other spouse resides at home and in the community.
- Activities of Daily Living – Daily Activities that are not necessary for basic functioning but are necessary in order to live independently. The activities may include:
- Doing light housework
- Preparing and cleaning up after meals
- Taking medication
- Shopping for groceries or clothes
- Using the telephone
- Managing money
- Taking care of pets
- Using communication devices
- Getting around the community
- Responding to emergency alerts such as fire alarms, sirens, etc.
- Living Will – A legal document that states a person’s wishes regarding termination of life support if the person has a terminal illness with no hope of recovery. To learn more about a Living Will and Healthcare Directive, visit our webpage, https://www.hnwlaw.com/elder-law/durable-power-of-attorney/
- Long-Term Care – Services and supports necessary to meet health and personal care needs over an extended period of time.
- Long–Term Care Facility – (also called Long Nursing Home or Convalescent Care Facility) Licensed facility that provides general nursing care to those who are chronically ill or unable to take care of daily living needs.
- Long-Term Care Insurance – Insurance policy designed to offer financial support to pay for long term care services.
- Long-Term Care Services – Services that include medical and non-medical care for people with chronic illness or disability. Long-term care helps meet health and personal needs. Most long-term care services assist people with activities of daily living, such as dressing, bathing and using the bathroom. Long-term care can be provided at home, in the community, or in a facility. For purposes of Medicaid eligibility and payment, long term care services are those provided to an individual who requires a level of care equivalent to that received in a nursing facility.
- Look Back Period – Five year period prior to a person’s application for Medicaid payment of long term care services. The Medicaid agency determines if any transfers of assets have taken place during that period that would disqualify the applicant from receiving Medicaid benefits for a period of time called the penalty period.
- Medicaid – Joint federal and state public assistance program for financing health care for low income people. It pays for health care services for those with low incomes or very high medical bills relative to income and assets. It is the largest public payer of long term care services.
- Medical Power of Attorney – Legal document that allows you to name someone to make health care decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions for yourself.
- Medicare – Federal program that provides hospital and medical expense benefits for people over age 65, or those meeting specific disability standards. Benefits for nursing home and home health services are limited.
- Non-Countable Assets – (also called exempt assets) Assets whose value is not counted in determining financial eligibility for Medicaid. They include:
- Personal belongings
- One vehicle
- Life insurance with a face value under $1,500.00
- Your home provided that your spouse or child lives there and its equity value is less than the maximum home equity balue as determined in your state.
- Nursing Home – (also called Long Term Care Facility or Convalescent Care Facility) Licensed facility that provides general nursing care to those who are chronically ill or unable to take care of daily living needs.
- Penalty Period – The period of time during which an applicant for Medicaid coverage will be disqualified from eligibility and coverage based on the amount of gifts and other impermissible transfers to others within the 5-year lookback period.
- Person with a Disability – For Medicaid eligibility purposes, a person with a disability is someone whose physical or mental condition prevents him or her from doing enough work or the type of work needed for self-support. The condition must be expected to last for a least a year or be expected to result in death. Persons receiving disability benefits through Supplemental Security Income (SSI, Social Security, or Medicare automatically meet this criteria.
- Personal Care – (Also called custodial care) Non-skilled service or care, such as help with bathing, dressing, eating, getting in and out of bed or chair, moving around, and using the bathroom.
- Respite Care – Temporary care which is intended to provide time off for those who care for someone on a regular basis. Respite care is typically 14 to 21 days of care per year and can be provided in a nursing home, adult day service center, or at home by a private party.
- Reverse Mortgage – Type of loan based on home equity that enables older homeowners (age 62 or older) to convert part of their equity in their home into tax-free income without having to sell the home, give up title, or take on a new monthly mortgage payment. Instead of making monthly payments to a lender, as you do with a regular mortgage, a lender makes payments to you. The loan, along with financing costs and interest on the loan, does not need to be repaid until the homeowner dies or no longer lives in the home.
- Skilled Care – Nursing care such as help with medications and caring for wounds and therapies such as occupational, speech, respiratory, and physical therapy. Skilled care usually requires the services of a licensed professional such as a nurse, doctor or therapist.
- Skilled Care Needs – Services requiring the supervision and care of a nurse or physician, such as assistance with oxygen, maintenance of a feeding tube, or frequent injections.
- Special Needs Trust – A trust that is specifically created to distribute its assets for the benefit of the disabled individual in such a way that the trust will not disqualify the individual from receiving various government benefits. For these purposes, “special needs” are defined as those benefits and services that supplement but do not supplant, replace, or reduce otherwise available government benefits. Also known as a Supplemental Needs Trust. To learn more, visit our webpage on Special Needs Trust, https://www.hnwlaw.com/elder-law/special-needs-trust-new-jersey/
- Spend Down – Requirement that an individual spend down most of his or her income and assets to pay for care before he or she can satisfy Medicaid financial eligibility criteria.
- Supervisory Care – Long term care service for people with memory or orientation problems. Supervision ensures that people don’t harm themselves or others because their memory, reasoning and orientation to person, place, or time are impaired.
- Supplemental Security Income (SSI) – Program administered by the Social Security Administration that provides financial assistance to needy persons with a disability or aged 65 or older.
- Transfer of Assets – Giving away property for less than it is worth or for the sole purpose of becoming eligible for Medicaid. Transferring assets during the look back period results in disqualification for Medicaid payment of long term care services for a penalty period.
- Transferring – Moving in and out of bed, chair or wheelchair. Transferring is one of the six activities of daily living.
Fredrick P. Niemann Esq.
Have questions about NJ Medicaid? If so, call our office today. Ask for Mr. Niemann to personally discuss your questions and individual situation toll-free at (855) 376-5291 or e-mail him at fniemann@hnlawfirm.com.
Written by Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold Township, Monmouth County, New Jersey Medicaid Attorney
NJ Medicaid Attorney serving these New Jersey Counties:
Monmouth County, Ocean County, Essex County, Cape May County, Camden County, Mercer County, Middlesex County,
Bergen County, Morris County, Burlington County, Union County, Somerset County, Hudson County, Passaic County