Medicaid’s 2024 Financial and Functional Eligibility Requirements for Long Term Care

 

Medicaid is intended for individuals with limited financial resources, so seniors have to meet two financial requirements in order to qualify – an asset limit and an income limit. These limits are updated on an annual basis and they can vary depending on multiple factors that we will discuss below. Medicaid long-term care applicants also need to meet a functional, or medical, requirement in order to qualify. This requirement stays fairly consistent, but there are still some variations that we will cover in this article. Seniors must meet these requirements when they apply for Medicaid and they must continue to meet them when they undergo their annual Medicaid Renewal in order to maintain their eligibility.

Factors that Can Impact Medicaid Eligibility Requirements

There are three major variables that can affect Medicaid eligibility requirements – the type of Medicaid program the applicant is applying for, the applicant’s marital status and the applicant’s state of residence.

Medicaid Programs Relevant to Seniors

There are three types of Medicaid long-term care coverage relevant to seniors – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers and Aged, Blind and Disabled (ABD) Medicaid. Nursing Home Medicaid covers all expenses related to living and receiving care in a nursing home, including room and board. HCBS Waivers and ABD Medicaid will both provide long-term care in the Medicaid beneficiary’s home, the home of a loved one and, depending on the state, in other settings in the community. The differences between these two programs are that HCBS Waivers offers a little more coverage than ABD Medicaid and has less severe financial requirements, but HCBS Waivers have stricter functional requirements than ABD Medicaid. These differences will be detailed more below.

 

Marital Status

Medicaid’s financial requirements can also change if an applicant is single or married. If they are married, the requirements will be different if both spouses are applying for Medicaid or if just one spouse is applying. Medicaid’s functional requirements are not affected by marital status.

 

State of Residence

Medicaid’s financial requirements also vary by state. States set their financial limits based on guidelines from the federal government, so there are many shared financial limits across states for various programs, but there are many states that have unique financial limits, including some of the most populous like California, New York and Illinois.

 

Understanding Medicaid’s Asset Limit

In most states (CA & NY are notable exceptions) in 2024, the individual asset limit for all three Medicaid long-term care programs relevant to seniors is $2,000. This means that in order to qualify, the value of an individual’s countable assets must add up $2,000 or less. Most assets are countable, including bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and anything that can be easily converted into cash. Some assets are non-countable, or exempt, including the applicant’s clothing, personal items (like wedding rings), primary vehicle, essential household furniture and appliances and, in many cases, the home itself, which is discussed in more detail below.

The asset limit for married couples with both spouses applying for all three types of Medicaid in most states in 2024 is either $3,000 or $4,000. For married couples with only one spouse applying for Medicaid, the 2024 asset limit in most states for the applicant spouse is $2,000 and the asset limit for non-applicant spouse in most states is $154,140, thanks to the Community Spouse Resource Allowance (CSRA). Medicaid considers all assets of a married couple to be jointly owned, but the CSRA allows the non-applicant spouse to keep more of those assets to help prevent them from living in poverty. However, the CSRA only applies to Nursing Home Medicaid and HCBS Waivers applicants. It does not apply to ABD Medicaid applicants.

The CSRA can change depending on the state, as can the asset limits. In New York, for example, the individual asset limit for all three Medicaid programs relevant to seniors is $31,175 and the married asset limit is $42,312. In California, there is no asset limit for Medicaid, but California will, like all states, try to collect reimbursement for the long-term care it paid for through Medicaid after the beneficiary’s death, a process known as Medicaid Estate Recovery, so those assets will eventually come into play for Medi-Cal (California Medicaid) beneficiaries.

Some states use “standard” asset limits for some programs and not others, like Florida, where the asset limits for Nursing Home Medicaid and HCBS Waivers are $2,000 for an individual and $3,000 for a married couple with both spouses applying, but the asset limits for ABD Medicaid are $5,000 for an individual and $6,000 for a married couple (with either one or both spouses applying).

 

Home Ownership and the Asset Limit

If the home was counted against the asset limit, most homeowners would not be able to qualify for Medicaid. However, one’s home will not be counted against the asset limit in many situations:

• If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than the state’s home equity interest limit ($713,000 or $1,071,000 in most states in 2024) than the home is exempt from the asset limit.
• If the applicant’s spouse, minor child, or blind or disabled child of any age lives in the home, than it is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
• If none of the individuals mentioned above live in the home, the home can be exempt if the applicant/beneficiary files an “Intent to Return Home” statement with the state Medicaid offices and the home equity interest is at or below the state’s home equity interest limit.

These guidelines apply to both Nursing Home Medicaid and HCBS Waivers applicants, but they DO NOT all apply to ABD Medicaid applicants. The home’s value does not matter for ABD Medicaid applicants, so they can disregard the home equity interest limit.

Just because a home is protected from the asset limit doesn’t mean it’s protected from Medicaid Estate Recovery. As mentioned above, every state is required to try and collect reimbursement for the long-term care they paid for via Medicaid after the death of the beneficiary. States attempt recovery via the deceased beneficiary’s estate, and if they were a homeowner the home is usually the most valuable asset in the estate. Click here to learn more about protecting a home from estate recovery.

 

Understanding Medicaid’s Income Limit

In most states in 2024, the individual income limit for Nursing Home Medicaid and Home and Community Based Services (HCBS) Waivers is $2,829/month. Most income is counted toward the limit, including Social Security benefits, IRA payments, pension payments, wages, salary, stock dividends and annuity payments. For married applicants with spouses applying for Nursing Home Medicaid or HCBS Waivers, the income limit is $2,829/month per spouse in most states in 2024.

For married applicants with just one spouse applying for Nursing Home Medicaid or HCBS Waivers, the income limit for the applicant spouse is $2,829/month in most states in 2024 and the income limit for the non-applicant spouse is $3,853.50 in most states in 2024, thanks to the Minimum Monthly Maintenance Needs Allowance (MMMNA). The MMMNA actually allows the applicant spouse to have income above the limit as long as they transfer that income to the non-applicant spouse until their income reaches that $3,853.50/month total. Like the CSRA discussed above, the MMMNA is intended to make sure non-applicant spouses, often known as the Community Spouse, have enough financial resources to avoid living in poverty. To better understand the MMMNA, which can complicated to calculate and varies depending on the state, contact one of our Certified Medicaid Planners by clicking here now.

  ATTENTION: Nursing Home Medicaid beneficiaries are required to give almost all of their income to the state to help pay for the cost of care. They are only allowed to keep a small personal need allowance ($30-$200/month depending on the state), enough to make Medicare premium payments if they are dual eligible and enough to make MMMNA payments, if that applies to their situation.

The individual income limits for ABD Medicaid in 2024 range from $943/month to $1,751/month. The married income limits in 2024 range from $1,415/month to $2,593/month, and that’s for married couples with one or both spouses applying. The MMMNA does not apply to ABD Medicaid applicants.

As with the asset limit, income limits can vary greatly depending on the state. In Illinois, for example, the income limits for all three types of Medicaid relevant to seniors from April 2024 to March 2025 is $1,255/month for an individual and $1,703/month for married couples with both spouses applying. In California, there is no income limit for Nursing Home Medicaid (but beneficiaries still have to give almost all of the income to the state to help cover the cost), but the income limits for HCBS Waivers and ABD Medicaid are $1,732/month for an individual and $2,352/month for a married couple with both spouses applying.

 

Understanding Medicaid’s Functional Requirements

The functional, or medical, requirement for Nursing Home Medicaid and most HCBS Waivers is needing a Nursing Facility Level of Care (NFLOC). This means the applicant requires the kind of 24/7 care and supervision that is normally associated with a nursing home. However, how a NFLOC is is defined and measured. Requiring help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) is a standard requirement, but some states may consider an NFLOC as needing help with two of those Activities of Daily Living, while another state may consider it to be needing help with three of them. States also use different methods and forms to evaluate level of care need. Some may place more emphasis on the in-person evaluation, others may weigh the opinion of the applicant’s primary care provider more heavily.

A few HCBS Waivers only require applicants to be “at risk” of needing a NFLOC. This requirement is subject to the same variables in definition and measurement as needing a NFLOC itself.

There is no functional criteria to receive basic healthcare coverage through ABD Medicaid, which will cover things like doctor’s visits, medications and short hospital stays. However, for ABD Medicaid applicants or beneficiaries who want long-term care, the functional requirement is showing a need for that long-term care. Basically, ABD Medicaid applicants and beneficiaries qualify for long-term care services and supports one at a time and as needed. For example, a healthy ABD Medicaid beneficiary wouldn’t qualify for a personal in-home caregiver to help with the Activities of Daily Living, but if their health condition worsened and they needed assistance with getting out of bed, they could qualify for the number of hours of in-home caregiving that it might take to help them with that mobility issue. If their condition worsened and they also needed help with bathing, the number of hours of in-home caregiving could increase.

 

Finding Your Medicaid Eligibility Requirements

As mentioned above, the easiest way to find the Medicaid eligibility requirements for your specific situation is to use this free search tool. It will ask you the relevant questions about state of residence, marital status and Medicaid program, and then provide you with your eligibility requirements.

Even if you or your loved one don’t meet your Medicaid financial criteria, there are still ways to become eligible. Click here to connect with our team of professionals at Eldercare Resource Planning to find out how.

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