Medicaid Eligibility for Long-Term Care – The Basics

Medicaid is a federal- and state-funded healthcare program that is independently operated by each state. Generally, Medicaid programs are for lower-income individuals of any age, provided they meet specific requirements. Because Medicaid has become the primary source of funding for long-term and nursing home care, this article explains basic eligibility requirements for elderly individuals seeking assistance.

Medicaid Eligibility Factors

To qualify for Medicaid as an older individual, you must meet certain criteria. These criteria are based on:

• Age
• Citizenship
• Income
• Disability
• Household size
• Applicant’s role in the household

For purposes of this article, the age requirement would generally be 65. Younger individuals may qualify, if they possess specific disabilities.

While each state differs, Medicaid is only available to U.S. citizens, state residents, permanent residents, or legal immigrants.

Income and Assets

Generally speaking, if you make under 100-200% of the federal poverty level and are elderly, you will likely qualify for your state’s Medicaid program. In certain circumstances, if you make less than 133% of the federal poverty level, you may also be eligible. As of 2020, the federal poverty levels are as follows:

In general, a married couple’s incomes are counted separately, if only one spouse is applying for Medicaid. In that case, the non-applicant is allotted some of the applicant spouse’s income. This is referred to as the Minimum Monthly Maintenance Needs Allowance and enables the non-applicant spouse to continue living at home, while their spouse is in a nursing home.

To determine eligibility, the state will look at your modified adjusted gross income. This is your taxable income, minus certain deductions like:

• individual retirement contributions
• tax-exempt interest
• non-taxable Social Security benefits

In addition to income, the state will look at your assets. Assets are divided into exempt (“non-countable”) and non-exempt (“countable”). Typically, a home, vehicle and furnishings are exempt. A couple’s assets are counted together, and the government will look at any asset transfers for a period of up to five-years (two and a half in California). This is called the “Lookback Period.”

Applying for Medicaid

You can apply for Medicaid at any time. The state has 45-days to approve or deny your application and 90-days, if you are disabled. To apply, you will need, at a minimum:

• Your birth certificate or driver’s license
• Recent pay stubs or tax returns
• Bank statements
• Proof of address (for example, a lease, utility bill, credit card statements or mortgage bill)
• Medical records (to prove disability)

To check your state’s guidelines, visit the Medicaid Website.

Resources:

Policygenius. “A state-by-state guide to Medicaid: Do I qualify?” (Accessed November 29, 2019) https://www.policygenius.com/blog/a-state-by-state-guide-to-medicaid/

American Council on Aging. “Medicaid Eligibility: 2019 Income, Asset & Care Requirements for Nursing Homes & Long-Term Care” (Accessed November 29, 2019)  https://www.medicaidplanningassistance.org/medicaid-eligibility/

The Finance Buff. “2018 2019 2020 Federal Poverty Levels (FPL) For ACA Health Insurance”  (Accessed November 29, 2019)  https://thefinancebuff.com/federal-poverty-levels-for-obamacare.html