1. Brian G. Quinn, Esq. Quinn Estate & Elder Law, LLC 14611 Manchester Road, Manchester MO 63011 Phone: 636-394-7242 Website: www.quinnestatelaw.com Medicare, MO HealthNet (Medicaid), and VA Benefits

2. MEDICARE 101

3. What is Medicare? A health insurance program for people: o 65 years of age and older o Under age 65 and have received social security disability for at least two years o Under age 65 with certain disabilities End-Stage Renal Disease (ESRD) Lou Gehrig’s Disease (ALS)

4. PART A Generally no premiums Covers all inpatient hospitalization expenses Home health care Hospice care Skilled nursing care after a 3 day inpatient hospital stay o Observation stays do not count towards 3 day criteria o Only pays for conditions that are rehabilitative in nature o After a maximum of 100 days, you pay all costs, unless you have LTC insurance

5. PART B Covers most other medical expenses (other than impatient hospitalization and drugs) o Medical expense o Clinical laboratory services o Home health care o Outpatient hospital treatment Premium in 2015 is $104.90/month (can be more if Adjusted Gross Income exceeds certain limits)

6. PARTS C & D Medicare Part C – Medicare Advantage Plans o Include managed care, preferred provider organization (PPO), private fee-for-service, and specialty plans Medicare Part D – Prescription Drug Plans o 30 different plans available in Missouri

7. MEDICAID

8. What is Medicaid? As of August 28, 2007, the Medicaid program in Missouri became “MO HealthNet” The MO Healthnet program is a joint Federal-State program designed to provide medical coverage to those who meet certain medical and financial criteria There are many different programs offered by MO HealthNet each with different criteria to qualify o Vendor (Nursing Home payments) o Home and Community Based Waiver (HCB) o MO HealthNet for the Aged, Blind and Disabled (medical assistance) o MO HealthNet for Children and the Sara Lopez Waiver o Many other programs as well

9. How do you Qualify for Medicaid? Medical Assistance Non Financial Eligibility Requirements o Age 65 or older, blind or permanently and totally disabled; and o U.S. Citizen or legal immigrant; and o Missouri resident Medical Assistance Financial Eligibility Requirements o Income for Single Individual = $834.00 per month or less o Income for Married Individual = $1,129.00 per month or less o Asset Limits for Single Individual = $999.99 or less of non-exempt assets o Asset Limits for Married Individual = $2,000.00 or less of non-exempt assets

10. How do you Qualify for Nursing Home Medicaid? Age 65 or older, blind or permanently and totally disabled; and U.S. Citizen or legal immigrant; and Missouri resident MO HealthNet bed and disabled enough to need skilled nursing level care Same asset limits as medical assistance o Asset Limits for Single Individual = $999.99 or less of non-exempt assets o Asset Limits for Married Individual = $2,000.00 or less of non-exempt assets No income requirement Special rules apply for married couples whose spouse is not institutionalized, and for individuals with certain kinds of long term care insurance Applicant must not be under any transfer penalties o Five year “look-back period” for uncompensated transfers

11. Exempt vs. Non-Exempt Assets Exempt Assets o Home up to $552,000.00 in equity (with some exceptions) o Motor vehicle o Personal belongings o Burial lot o Prepaid funeral plan OR up to $1,500.00 of cash value in a life insurance policy o Certain income producing property Non-Exempt Assets o Almost everything else o Some exceptions for trusts and “Medicaid compliant” annuities or promissory notes

12. What does Medicaid Cover? Vendor o Provides direct payments to a skilled nursing facility o Requires a Participant to pay all of their income to the skilled nursing facility minus health insurance costs and $50.00 per month as a “Personal Needs Allowance” Medical Assistance o Provides medical services to recipients to promote good health, prevent illnesses and premature death, correct or limit disability, treat illness, and provide rehabilitation services to persons with disabilities o A list of medical care services provided is located at www.dss.mo.gov/fsd/msmed.htm The Participant Handbook located at www.dss.mo.gov/mhd/participants/pdf/hndbk_ffs.p df explains the services offered for each program

13. Special Needs Trusts First Party o Self settled with disabled person’s own funds o Requires payback to State for MO HealthNet services o Not considered a transfer and not available Second Party o Testamentary spousal trust (created through Last Will and Testament) Third Party Discretionary o Sole benefit if not to be considered a transfer o Generally set up if beneficiary is already on MO HealthNet or anticipates applying for it o Can have trigger if person later qualifies for needs-based benefits Pooled Trusts (e.g. Missouri Trust or Arcare Trust) o Not considered a transfer and not available o May be first party or third party o Disabled person can establish account o Pool or portion of it may be retained at person’s death

14. VA BENEFITS

15. What VA Benefits are Available to Seniors? VA Service Connected Disability Benefits o Veteran suffers from a disability, incurred or aggravated during active service o Veteran is rated on percentage of disability scale (0-100%) VA Pension with Aid and Attendance o Available to qualifying Veterans and their surviving spouses o Provides tax free income to assist with in-home care, independent living, assisted living, or skilled nursing care o Payment is based on the status of the claimant Married Veteran Maximum = $2,120.00 per month Single Veteran Maximum = $1,788.00 per month Surviving Spouse Maximum = $1,149.00 per month

16. How do you Qualify for VA Benefits? VA Service Connected Disability Benefits o Must show through evidence (usually medical evidence) that the Veteran currently suffers from a disability that was incurred or aggravated during service (must show the linkage of the injury and disability) VA Pension with Aid and Attendance o Service Requirement 90 days active duty, one day during wartime, discharge was under conditions other than “dishonorable” o Need of Care Veteran must have a medical need for assistance with at least two ADLs o Asset Limitations Age based analysis test, amount varies with each individual Veterans defines your assets as either Countable (Non-Exempt) or Non-Countable (Exempt) No “look-back period” for VA benefits right now, but that could change in the future o Medical Expenses vs. Income Total household medical expenses must come close to or exceed total household gross income

17. Missouri Veterans Homes Operated by the Missouri Department of Public Safety’s Veterans Commission, not the VA Missouri Veterans Homes manage a total of 1,350 beds located in St. Louis, St. James, Cape Girardeau, Mexico, Warrensburg, Cameron, and Mount Vernon Maximum resident charge is approximately $2,000.00 per month, can be reduced based on financial hardship Requirements: o Honorable Discharge o Must live or have lived in Missouri for 180 days o Require skilled nursing care o Veterans Home must have the resources to care for the Veteran