Medicaid/MaineCare Planning & Applications

Applying for MaineCare for an individual in need of long-term care can be a confusing and daunting task. Carlin & Associates, P.A., has extensive experience with the MaineCare process, from planning for incapacity and developing a plan for eligibility, to submitting the application and supporting materials.

What is MaineCare?
MaineCare is Maine's Medicaid program. MaineCare may subsidize the cost of long-term care for an individual who meets all of the criteria set forth in the MaineCare regulations. There are several different types of long term care programs for which MaineCare offers assistance. The main programs are for nursing home level of care and residential care (also referred to as assisted living and boarding home care). The nursing home program also encompasses a program called Medicaid Waiver (MedWaiver) which pays for nursing home level of care services in one's home.

Determining eligibility
In order to qualify for MaineCare, an individual must meet both the medical and financial criteria. The medical condition of the individual seeking eligibility will be assessed by a State agency. The person may be assessed at nursing facility level of care (highest medical need). If the individual does not meet this level of care, he may still be eligible for residential care. Next, for any of long-term care programs, the individual must meet financial criteria; he must have less than $10,000 in countable assets. Countable assets include, but are not limited to, bank account balances, values of IRAs, fair market values of boats, cash values of life insurance policies, etc. In addition, some or all of the value of certain assets are exempt from the individual's countable assets, most notably a primary residence. Finally, the spouse of a MaineCare applicant may also retain assets in his/her name. What the spouse may keep depends on the program for which the applicant is applying. Even if an individual meets both the financial and medical criteria, he may still be disqualified from receiving MaineCare benefits if he has given away a certain amount of money or assets. Generally, when a person makes a gift, the State will impose a penalty period in which that person is not eligible to receive benefits (a person, may, however, transfer assets to certain individuals, such as a spouse, without penalty). Pursuant to the new federal rules, this penalty will start running as of the date of application, and not the date of transfer, as previously calculated. These changes are slated to take effect as early as September 1, 2006. Therefore, transferring assets without adverse and unexpected MaineCare consequences requires careful adherence and knowledge of the MaineCare rules. Carlin & Associates, P.A. can help guide you through these rules to ensure that a future penalty is not assessed for someone who may otherwise be eligible for benefits.

Changes to the Estate Recovery Program
In addition to the changes to the MaineCare application rules, there have been some significant changes to the Maine Estate Recovery rules. If a person receives MaineCare assistance during his lifetime, the state of Maine may make a claim against his estate, after he passes away, for the money paid for his care during his lifetime. Pursuant to the recent changes to these rules, the State will be more aggressive in considering the value of a jointly held interest and life estate interest in the estate as a means of recovering more funds. Carlin & Associates, P.A. can analyze your current situation and assist you in creating a plan to address these issues.