Long-Term Care

Nursing home and Home and Community Based Services (HCBS) are available only when there is a medical need for nursing-home level care. HCBS may be available to help a recipient stay in his/her home, but only when the cost to the program is less than the cost of a nursing home. Twenty-four hour care is not available in the home, since it would cost more than nursing home care. Because of the cost of long-term care, the income limit for eligibility is three times the SSI payment level (approximately $1,737), but see the Estate Planning section below for exceptions. There was a recent change to require proof of disability for long-term care.

Program of All-Inclusive Care for the Elderly (PACE)

Another option available to frail elders is known as the Program of All-Inclusive Care for the Elderly or PACE. This program provides comprehensive health care and supportive services for persons 65 years and older. In Colorado, the PACE contract is currently managed by Total Long-term Care (TLC) and is only available in the Denver metropolitan area and Colorado Springs. For more information, contact Total Long-term Care at (303) 869-4664, or inquire about this program through your local County Department of Social Services.

Estate Planning

Even with the higher income cap, many people who have income too high to qualify for Medicaid long-term care are still unable to pay for nursing home care, since nursing homes charge more than $1,737 per month. In those cases a trust, sometimes known as a “Miller trust,” may set aside enough income to make an individual eligible. Other forms of estate planning may preserve some assets. However, transfers to create eligibility can result in severe penalties, particularly if made within three years before applying for Medicaid, or five years if the transfer involves a trust. Because of the possible penalties, any financial planning should be done by an attorney with Medicaid expertise.

Spousal Protection

The “Spousal Protection rule” allows a spouse who remains at home to avoid poverty by keeping between $1,561.25 and $2,377.50 of the couple’s monthly income, while the institutionalized spouse receives Medicaid. The community spouse generally may also keep his/her IRA’s, pensions, other exempt property as described above under general Medicaid eligibility rules, and up to $92,760 in non-exempt resources. The spousal protection rules are indexed to the Consumer Price Index and change yearly. 

Estate Recovery

Under a program known as the “Colorado Estate Recovery Program,” the state can recover Medicaid expenditures from the recipient’s estate after he/she dies. The estate recovery program applies to persons who were 55 years of age or older when they received such assistance, as well as to all institutionalized individuals. The program permits the state to file a claim against an individual Medicaid recipient’s estate, including a lien on the home. After the person dies, the state can enforce the lien and recover the expenses paid by Medicaid from the proceeds of the sale of the property. No action is taken against the property while the Medicaid recipient is still living.      

The home may be protected from recovery if a surviving spouse or dependent child is still living there. There are other exceptions to recovery. It is important to consult with an attorney knowledgeable about Medicaid eligibility concerning these provisions, since they are complex and subject to change.