Applying for Help with Long Term Care Expenses

SoonerCare (Oklahoma Medicaid) pays for nursing home services. However, it does not pay for nursing home care for everyone.

If you would like to find out if Oklahoma Medicaid will help pay for your nursing home care, you or your representative should apply at your local county office of the Oklahoma Department of Human Services (OKDHS). The OKDHS caseworker can assist you in completing your application.

If your application is approved, your eligibility for SoonerCare usually begins with the month you apply. You will receive a medical card that you can use for your medical expenses. However, you may be eligible for SoonerCare for up to three months before the month you apply. If you have medical expenses during any of the three months before the month you apply, be sure to tell your caseworker so OKDHS can decide whether SoonerCare will pay for those bills. It may be necessary for you to pay part of your income to the nursing home for your care.

Obtaining a medical eligibility determination

The OKDHS nurse must complete a medical eligibility determination prior to you being approved for SoonerCare nursing home benefits. He/she will assess your specific needs and, if appropriate, provide you with information about the ADvantage waiver program, which is an alternative home and community-based service program. This information is provided to give you a choice to remain in your home, if appropriate, and receive care in relation to your needs. Even though you may be informed of the alternative home and community-based services, you retain the right to enter or remain in the nursing home.

Using your own money

The Oklahoma Department of Human Services will tell you how much of your own money you will have to pay to the nursing home each month. You will be able to keep $50 each month for your personal needs. If you are married, some of your money may be used each month to help support your husband or wife.

If you are helping support other members of your family, you may be allowed to use some of your income to support these dependent family members. Dependent family members must be living with your spouse and include dependent children under age 21, dependent adult children and dependent parents or brothers or sisters of you or your spouse.

Depending on circumstances, for 2005 you may give up to $1,687 of your income per month to your spouse.

Protecting property for a spouse

When you go into a nursing home, your spouse may be able to keep your home, your car and your household furnishings. The OKDHS will then determine the value of your other assets, such as bank accounts and certificates of deposit. Depending on how much property you and your spouse have (not counting things like the house and the car) your spouse may be able to retain assets valued up to $95,100 for 2005. This amount will increase each year. The OKDHS will tell you the actual amount your spouse may retain.

Transfer of assets to qualify for medical assistance

Transfers of assets my affect your eligibility. An asset transfer occurs when a client or their spouse buys, sells, gives away, or changes the way assets are held. Assets include home and other property, bank accounts, certificates of deposit, cash, etc. If you or your spouse have transferred assets for less than their worth, you may be subject to a penalty period for nursing home services or the ADvantage waiver program. If otherwise eligible, you remain entitled to other covered medical services. Transfers that may affect your eligibility are those made 36 months (60 months for specific trusts) prior to the date you apply for nursing home assistance or the Advantage waiver program or those made within 36 months (60 months for specific trusts) of your entry into a nursing home.

If the OKDHS decides that you are subject to a penalty period, the penalty begins with the month of the transfer and equals the number of months of the uncompensated value of the transferred assets divided by $2,000. However, if a transfer is made during a penalty period and the OKDHS decides that you are subject to an additional penalty period, the penalty begins with the month following the month the previous penalty period ends. If you request or receive SoonerCare, the OKDHS will inform you of the penalty period.

Liens and claims

The State of Oklahoma has the legal right to recover the amount of assistance persons receive through the SoonerCare nursing home program. The state can file a lien on your homestead and make a claim against your estate or the estate of your deceased spouse. The state will seek to recover money equal to the amount of SoonerCare benefits you received from the time you enter the nursing home. For more information on liens and claims, contact the Oklahoma Health Care Authority at (800) 522-0114.