Medicaid when you’re under 65?

Nursing home Medicaid has basic eligibility rules that require the recipient to be either age 65 or over, blind or disabled.  Unfortunately, we have seen an increasing number of families come to us because a family member needs long-term care at a “young” age.  Many have early onset Alzheimer’s disease, Frontotemporal dementia or had a debilitating stroke.  Some have ALS or an accident induced traumatic brain injury. Unfortunately, the circumstances that lead one to require long-term care are not always predictable and are sometimes a direct result of a crisis. Regardless of the underlying cause, finding and paying for long-term care is a struggle.  Our road trip today will explore the possibility of Medicaid when you’re under 65.

Is Nursing Home Medicaid an option for someone under age 65?

Absolutely! If a Medicaid applicant is under age 65 then they have the option to prove that they are disabled in order to qualify. This adds an extra layer to the processing of the Medicaid application. Verification of disability can be obtained through what is referred to as “prima facie” evidence. Examples of this type of evidence are as follows:

  • Proof of determination of disability by the Social Security Administration
  • Proof of determination of disability by Railroad Retirement Board
  • Proof of receipt of Medicare benefits while under age 65

A Medicaid applicant can provide verification of the above by submitting their disability award letter, proof of their Social Security disability income or confirmation of their Railroad Retirement disability income. The applicant may also provide a copy of their Medicare card. This will allow the Department of Family and Children Services to process the Medicaid application without obtaining further evidence of disability.

What if I have not been declared disabled prior to the Medicaid application? Do I still have options?

Yes!  There are provisions in Georgia Medicaid law to receive an expedited disability rating through the State Medicaid Eligibility Unit (SMEU).  The process includes submitting supporting medical information, employment data and a Social Data Report to the SMEU in order to determine eligibility.

How long does this process take?

Eligibility should be processed as soon as all verification has been received by the assigned case worker AND the SMEU has made a disability determination. You should prepare for additional time to be required for an SMEU application to be approved. These applications take considerably longer than a standard ABD Medicaid Application.

My spouse has been admitted to a long-term care facility after a stroke and we have young children. How will my family be able to continue to pay our bills if he is required to pay a portion of his income to the facility each month?

Good News! Diversion of income is permitted when a Medicaid recipient who has a spouse and/or dependents resides in a nursing home, Institutionalized Hospice or CCSP. The amount of diversion is calculated based on either the Community Spouse Maintenance Need Standard (CSMNS) or the Dependent Family Member Maintenance Need Standard (DFMNS). These figures are updated on an annual basis. In order to qualify as a dependent, the family member must fall within the acceptable degree of relationship. The degree of the relationship can be either to the recipient or the community spouse and is restricted to the following:

  • a minor child
  • dependent child
  • dependent parent
  • dependent sibling, including half-sibling

The family member must be claimed as a dependent on the most recent IRS tax return and have income below $794.00 (2021 limit) in order to be considered financially dependent.

Don’t try this at home!

SMEU Medicaid applications are notoriously tricky and require specialized expertise.  Working with a Certified Elder Law (CELA) attorney can help ensure the application is submitted correctly and the case is worked appropriately.  In addition, if a Medicaid Fair Hearing is required,  representation by an experienced attorney at the hearing is essential.

Getting help through the process

Atypical diagnoses present differently, require unique interventions, and progress unexpectedly, finding the proper care providers and resources can be difficult. Many of our clients in this situation were forced to stop working even though they were not financially, socially, or psychologically ready to do so.  The extra stressors of a complex diagnosis require our team to plan for more than Medicaid.  Helping a family transition their loved one into a long-term care facility where they are the youngest resident by two decades can be emotionally devastating for everyone involved.  Having a team of care coordinators to support and guide a family is critical to establishing a new normal.

This side road on our Medicaid road trip is always one of the more difficult journeys we travel as a practice.  Our clients who are in their 40s, 50s, and 60 may have teenage or college-age children, and their spouses usually still work full-time and run a busy household.  At Hurley Elder Care Law, we utilize a multi-disciplinary approach which combines expert legal advice and care coordination.  For families facing an unexpected diagnosis, debilitating stroke or injury, collaborating with a holistic elder law practice can bring order to a chaotic time.  Contact us at 404-843-0121 to learn more about Medicaid when you’re under 65.



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