Are You Eligible For Long-Term Care Medicaid?

We at SRP are here to assist you in determining whether or not you are eligible for Medicaid. If not, we will see if there is anything we can do to help you in meeting the eligibility requirements.  Approval of long-term care services in Medicaid provides access to many benefits and care.

Who Is Eligible?

To be eligible for Medicaid long term care, one must be both financially qualified and have a medical need for care. Eligibility requirements are specific to the state, the Medicaid program or waiver, and one’s age group. Therefore, there are hundreds of different sets of eligibility rules for Medicaid long term care services throughout the USA. Having said that, there are some general rules that apply.

Meet the physical criteria based on an assessment

Be 65 or older, have a permanent disability, or be blind

Be a US citizen or (qualified non-citizen)

Meet residency rules in your state

Meet the income and asset limits

Medical Qualifications

The medical requirements  for Medicaid long-term care differ significantly by state. In general, any individual who requires continuing skilled nursing care has Alzheimer’s or dementia or cannot care for themselves qualifies. If professional nursing care is not required, then many Medicaid programs link eligibility to the number of ADLs (activities of daily living) with which an individual requires assistance. This can include dressing, bathing, eating, cooking, etc. The majority of states demand a “nursing home level of care,” but each state defines it differently.

Financial Qualifications

When determining eligibility for Medicaid long-term care, each state considers finances differently.  However, in all states, both one’s income and assets are considered factors for elderly applicants. Therefore, it is essential to recognize that even if one’s income or assets exceeds the prescribed limits, many individuals can still qualify for Medicaid with careful planning.

Medicaid Income Limits

States use one of two approaches to determine if an individual meets their Medicaid income limits. There are income cap states, which are said to have “categorically needy” Medicaid. And there are non-income cap states, which have “medically needy” or “spend-down” Medicaid. Income cap states, which may also be called special income rule states, set a hard income limit at 3 times the SSI payment amount, also called the Federal Benefit Rate (FBR). In 2021, this limit is $2,382 a month. Please note, in most cases, this figure is for nursing home Medicaid and Medicaid HCBS Waivers. Those applying for personal care assistance and other long-term care support via a state Medicaid plan generally have a lower income limit. Which varies based on the state in which one resides. 

Being over the income limit does not mean one cannot still qualify for Medicaid in income cap states.

Non-income cap / medically needy states allow applicants who have income over the limit to still qualify for Medicaid if they have high medical bills relative to their income. 

In simple terms, one can “spend down” their excess income (the income over the Medicaid limit) on medical bills / care assistance. Once one has spent their income down, in Medicaid-speak, to the Medically Needy Income Limit (MNIL), they are eligible for Medicaid for the rest of the spend down period. (This period differs based on the state but is between one and six months.) The MNIL limit varies greatly based on the state in which one resides but tends to be somewhere between approximately $107 and $1,050 / month.

In both Income Cap and Spend Down states, it is still possible to qualify for Medicaid if the applicant is “over-income” by working with us.

In both Income Cap and Spend Down states, it is still possible to qualify for Medicaid if the applicant is “over-income” by working with us.

It is still possible to qualify for Medicaid if the applicant is “over-income” by working with us – get started now.

Medicaid Asset Limits

Medicaid applicants’ financial resources are also a major factor in eligibility. 

Resources are also referred to as “assets” and “countable assets.” Most states’ asset

If a senior’s financial assets exceed the Medicaid eligibility requirement, but his or her income does not cover their long-term care costs, he or she is considered to be in the “Medicaid Gap.” In this situation, some seniors will “’spend down” their assets on their long-term care costs (pay for their care costs out of pocket) until they become eligible.(For other ways to “spend down” excess assets,  Can I save assets and income). It’s important that one does not give away assets or sell them under fair market value to meet Medicaid’s asset limit. Past asset transfers for up to 5 years preceding the application date are considered. This is called the Look-Back Period, and if violated, can lead to a period of Medicaid ineligibility.

Married couples can have considerably higher asset limits, but only if one spouse is not applying for Medicaid. The non-applicant is referred to as the “community spouse”.  In 2022, in most states, the community spouse is permitted up to $137,400 in countable assets. This is in addition to the assets the applicant spouse is able to keep.  whose assets exceed Medicaid’s countable limits should not automatically consider themselves ineligible.

It is still possible to qualify for Medicaid if the applicant is “over-income” by working with us – get started now.

CALL US AT 973-898-5959