Medicaid Fee-For-Service – Long Term Care

The Medicaid Fee-For-Service Program provides coverage of long term care services to eligible recipients. Long term care are nursing home level of services provided in a nursing home or other medical institution and home and community based waiver services. There are special eligibility, coverage and recovery provisions that only apply to long term care applicants and recipients.

Fee-For-Service Program – Long Term Care – Liens 

Individuals must meet all the eligibility requirements of the Medicaid FFS Program. The need for long term care services must certified by a physician, and the need must be for a minimum of 30 consecutive days. Special eligibility provisions that only apply to applicants of long term care services include:

  • All countable assets owned by a married couple will be considered. The spouse that does not need long term care can shelter some of the assets. The unsheltered assets cannot exceed $2000.
  • Only the income of a spouse who needs long term care will be used in determining eligibility.
  • The income of parents of a child who needs long term care will count only in the first month of long term care.

Individuals who transfer assets for less then fair market value in the period prior to requesting assistance for long-term care services may be penalized for the transfer. During the term of a penalty period, Medicaid will not pay for long term care services.

The penalty period will be determined by dividing the amount of the transfer by the average cost of nursing home services in Hawaii. The application of a penalty will depend on when the asset was transferred.

The transfer of the home property will not be penalized if the home was transferred to the following relatives of the applicant:

  • Spouse
  • Minor child
  • Disabled or blind adult child
  • Adult child not blind or disabled who resided in the home 24 months prior to the institutionalization of the applicant and provided services that delayed the need for long term care
  • Sibling with an equity interest in the property who resided on the property a year prior to the institutionalization of the applicant