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Glossary of Medicaid Terms

Posted by Steve Worrall | Sep 05, 2022

CMS (f/k/a HCFA)

The Centers for Medicare and Medicaid Services, formerly known as the Health Care Financing Administration. This agency oversees the federal Medicaid program. Best-known guidance issued by HCFA is known as Transmittal 64.

Community Spouse (CS)
The spouse who remains at home and who will not receive Medicaid benefits

Community Spouse Resource Allowance
The minimum and maximum amount a community spouse is allowed to keep when the institutionalized spouse applies for Medicaid.
• There is a minimum and maximum amount: $27,840 - $137,900 in 2022.
• Some states allow the maximum.
• Other states take total countable assets and divide by 2. 

Compensated Transfer
A transfer of assets by a Medicaid applicant for which the transferor/applicant received fair market value.

DRA '05
The Deficit Reduction Act – the name of the budget reconciliation act passed by Congress in February 2006, which made sweeping changes to the federal Medicaid eligibility rules and must be adopted by all states.

Estate Recovery
The right of the state to file a lien against the Medicaid recipient's estate following the death of the Medicaid recipient to recover monies paid out by the state for the recipient's care.

Fair Hearing
A court proceeding conducted by the State when an applicant is denied Medicaid benefits. The applicant has the right to request a fair hearing up to 90 days
following a denial of benefits.

Income Cap State
A state which imposes a limit on a Medicaid applicant's income (currently $2,523 in monthly gross income in 2022).

Institutionalized Spouse (IS)
The spouse who is in a nursing home and for whom Medicaid benefits are sought.

Lookback period
The period of time Medicaid can examine an applicant's finances to determine whether any uncompensated transfers were made.

Miller Trust
An irrevocable, income only trust which holds the excess income of a Medicaid applicant (income over the allowable income cap). The excess income must be
spent on the applicant's care. Any funds left in the trust account at the applicant/recipient's death get paid back to the State.

Minimum Monthly Maintenance Needs Allowance (MMMNA)
The minimum amount of income a community spouse is entitled to. (Some states require contribution of excess income to institutionalized spouse's care.)
• In some states, the minimum is the maximum.
• 2022 MMMNA figures:  $2,288.75 – $3,435

OBRA '93
The Omnibus Reconciliation Act of 1993 – it changed the way trusts for Medicaid purposes are treated, and set the lookback period at 36 months for gifts, 60 months for trust transfers.

Personal Needs Allowance
The amount of income that a Medicaid recipient is allowed to keep each month to be used for the recipient's personal needs.

Pooled Trust
A (d)(4)(C) trust run by a non-profit organization, often used to help obtain Medicaid eligibility as the funds are not counted as assets for Medicaid purposes. In
the past these could be established with the assets of a beneficiary of any age. However, states have begun imposing a transfer penalty for funding at age 65 or
older, pursuant to 2008 CMS guidance.

SNT -- Special Needs Trust –
May be a first-party (d)(4)(A) or third-party trust (also known as a supplemental needs trust) for a disabled person. First-party SNTs must be
funded before age 65. Used to protect government benefits received currently or in the future.

SSI – Supplemental Security Income
A cash payment to disabled persons with very low income and assets (formerly called welfare).
• Persons who receive SSI automatically receive Medicaid.

SSDI – Social Security Disability Insurance
Income awarded to persons determined to be disabled according to the Social Security Administration.
•  Is not income or asset-based.
•  Persons who receive SSDI are eligible for Medicare after 2 years (not Medicaid).

Snapshot Date
The date used by Medicaid to take a snapshot of a couple's finances to determine Medicaid  eligibility.
•  Under federal law, the snapshot date is the first day the Medicaid applicant is admitted to a  health care facility for at least 30 continuous days and then applies for Medicaid.  (Hospitalization can be added to nursing home/rehab).
•  Other states use the date of application as the snapshot date.

Transfer Disclosure Period
In any state that has adopted DRA 05, the period will be 5 years from the date of transfer (this rule may apply to any transfer made on or after February 8, 2006).

SOURCE: ElderCounsel

About the Author

Steve Worrall

As a sandwich generation kid himself (caring for both children and aging parents), Marietta Georgia Estate Planning Elder Law & Probate Attorney Steve (Stephen M.) Worrall KNOWS the struggles you are facing as you raise children, balance the demands of your job, and take care of your aging parent...