We know navigating Medicaid eligibility can be challenging so we’ve documented a breakdown of the basic financial and non-financial requirements.
The good news: If you’re an individual or couple who receives or needs long-term care in a nursing facility, Medicaid assistance is available to you, and you do not need to lose all your assets to receive benefits.
Note: The vast majority of people considering long-term care Medicaid are over the income or asset limits, or both, have given a gift, have too much property, one too many vehicles, excess life insurance, and most still cannot afford the cost of long-term care. We can help!
For Medicaid eligibility all income that an applicant receives is counted. This income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Retirement Income (RSDI), annuities, rental income, mineral right earnings, and stock dividends.
(Income limits as of January 1, 2023)
Couple (both in the nursing home):
All resources of both you and your spouse, regardless, if joint or separate, are considered countable. Some resources may be excluded such as a homestead, vehicle, certain types of life insurance and burial funds.
Asset Limits as of 1 January 2023:
Medicare and Medicaid are two separate, government-run programs. They are operated and funded by different parts of the government and primarily serve different groups.
Medicare and Skilled Nursing Care (rehabilitation)
Here is the difference between Medicare vs Medicaid for long-term care.
Medicare is a federally funded only health insurance program that provides healthcare services for all Americans aged 65 and older regardless of their income or have meet a disability determined by the Social Security Administration.
Most people are under the assumption that Medicare covers nursing home costs. Not true. Medicare does cover (to a limited extent) some coverage for a stay in a skilled nursing facility (SNF) primarily for rehabilitation. To qualify for Medicare coverage in a skilled nursing facility you must:
Medicare coverage for a Skilled Nursing Facility includes:
*Note: There are some additional coverages available to people with a specific Medigap supplemental insurance that helps with the co-pay between days 21-100.
Spousal Protected Resource Amount (SPRA) — The portion of a couple's combined countable resources reserved for the community spouse and deducted from the couple's combined countable resources in determining eligibility.
Spousal Income Protections: There is a rule that allows the Medicaid applicant to transfer income to the community spouse to ensure he or she has sufficient funds with which to live. This is called the Minimum Monthly Maintenance Needs Allowance (MMMNA) and this is the minimum amount of combined monthly income to which the community spouse is entitled to retain.
What this means for you: When applying for Medicaid as a married couple there are some added protections for the spouse at home to prevent impoverishment (i.e. leaving the spouse at home with little or no income or resources). The spouse at home is called the community spouse. Medicaid allows for the community spouse to keep some of the income and assets from the partner entering the nursing home. Medicaid income eligibility is based on the spouse applying for long-term care Medicaid AND the combined resources of both spouses. This includes marital/community property or separate/pre-marital property OR the spouse’s respective ownership interest in community property.
This program will affect only long-term care services and supports you receive after the age of 55, and only if you applied after March 1, 2005.
When a person applies for Medicaid and long-term services and supports, the state provides a notice that explains MERP. When the person dies, the state sends a different notice to the estate representative or heirs to let them know that the state intends to file a claim. The notice will ask the representative for information so the state can decide whether to file a MERP claim.
An estate is property, such as money, a house, or other things of value that a person leaves to family members or others (heirs) when he or she dies. MERP does not apply to all property that a person may own.
Examples of property that the state will not collect on include:
Yes, the state will not ask for money when:
Also, the state will not ask for money when this would cause an undue hardship for the heirs.
Giving away resources for no compensation, or refusing to accept income, or reducing income you could receive before moving into a nursing home may result in:
The state may "look back" up to 60 months before you applied for nursing home, ICF/IID or waiver services to determine when your income was reduced, and resources were transferred.
We know this is a lot of information. Do not hesitate to reach out as there are ways to protect you before you apply for Medicaid.
Disclaimer: Graceful Medicaid Solutions (GMS) specializes in assisting families qualify for nursing home Medicaid in the state of Texas. The information contained in this site is provided for informational purposes only and should not be construed as legal advice on any subject matter. We do not offer legal or tax advice. You should not act or refrain from acting on the basis of any content included in this site without seeking legal or other professional advice.