2023 Financial Eligibility Criteria for Institutional Medicaid & HCBS Waivers (Long Term Care)

Summary

• FBR Income Limits – The majority of states use 300% of the Federal Benefit Rate (FBR) as their income limit. The FBR for 2023 will be $914 / month for an individual and $1,371 / month for a couple. Therefore, for states using 300% of the FBR as the income limit, a single applicant will be limited to $2,742 / month, and a married couple (with both spouses as applicants) will be limited to $5,484 / month.
• FPL Income Limits – Some states use a percentage of the Federal Poverty Level (FPL) as their income limit. We do not have projected FPL limits for 2023, but these figures are generally released and effective mid-late January.
• Assets Limits – Most states will not change their asset limits for single or married applicants for 2023. For states using $2,000 and $3,000 limits in 2022, those assets limits will remain the same in 2023.
• Minimum Monthly Maintenance Needs Allowance – For those states that use a Min. MMNA, the minimum for 2023 is $2,288.75 / month and it will remain so until July 1, 2023.
• Maximum Monthly Maintenance Needs Allowance – For those states that use a Max. MMNA, the new maximum for 2023 is $3,715.50 / month effective Jan. 1, 2023.
• Minimum Community Spouse Resource Allowance – For those states that use a Min. CSRA, the new minimum for 2023 is $29,724.
• Maximum Community Spouse Resource Allowance – For those states that use a Max. CSRA, the maximum for 2023 is $148,620.
• Home Equity Limits – For those states that use $636,000 or $955,000 in 2022, the new 2023 limits are $688,000 and $1,033,000, respectively. California will continue to have no upper limit on home equity. WI and ID are addressed in the full article.

Federal Benefit Rate-Based Income Limits and the States that Use Them

The federal government caps the income limit for Institutional Medicaid and HCBS Waivers at 300% of the Federal Benefit Rate (FBR) for an individual. While states can set a lower monthly income limit, most states elect to use 300% of the FBR.

In 2022, the FBR was $841 / month for an individual, and 300% of the FBR for an individual was $2,523 / month. In 2023 the FBR is $914 / month for an individual, and 300% of the FBR for an individual is $2,742 / month.

When both spouses of a married couple are applicants, the income of each spouse is limited to $2,742 / month ($5,484 / month as a couple).

For married couples with just one spouse as an applicant, the applicant spouse is limited to $2,742 / month in income, and the non-applicant spouse’s income is disregarded. Furthermore, spousal impoverishment rules apply. For income, it is the monthly maintenance needs allowance that is relevant.

We break the states that use the FBR as income limits into two groups 1) Those that use 300% of the FBR 2) Exceptions.

Group 1 – Will use the income limits of $2,742 / month for an individual and $5,484 / month for a couple (with both spouses as applicants) eff. Jan. 1, 2023. These states include Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, District of Columbia, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Nevada, New Hampshire, New Jersey, New Mexico, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. While most of these states use 300% of the FBR for their income limit for both Institutional Medicaid and HCBS Waivers, some states may use this figure for only one of these programs. This means that one of the programs may have an income limit based on the FBR while the other program has an income limit based on the Federal Poverty Level (FPL).

Group 2 – Delaware uses 250% of the FBR as their income limit. Effective Jan. 1, 2023, DE’s income limit will be $2,285 / month for an individual and $4,570 / month for a couple (with both spouses as applicants). Missouri uses a FBR percentage as their income limit, but the percentage differs based on the program.

Federal Poverty Level-Based Income Limits and the States that Use Them

A handful of states use a percentage of the Federal Poverty Level (FPL) as their income limits. Many of these states use 100% of the FPL, which in 2022, is $1,133 / month for a household of one and $1,526 / month for a household of two. For married couples, with just one spouse as an applicant, the applicant is limited to $1,133 / month in income. When both spouses of a married couple are applicants, the couples’ combined income is limited to $1,526 / month. For married couples with just one spouse as an applicant, the applicant spouse is limited to $1,133 / month in income and the non-applicant spouse’s income is disregarded. Furthermore, spousal impoverishment rules. For income, it is the monthly maintenance needs allowance that is relevant.

While we do not have projections for the 2023 FPLs, we expect the figures to be released mid-late January. When a state chooses to implement the new income limits is state-specific. Some states implement their new limits immediately, while others wait until later in the year. For example, California and Illinois change their income limits in April.

We break the states that use the FPL as income limits into two groups 1) Those that use 100% of the FPL 2) Exceptions.

Group 1 – States that use 100% of the FPL: Illinois, Massachusetts, Minnesota, Nebraska, North Carolina, and Utah. Hawaii also uses 100% of the FPL, but the FPL for Hawaii differs from the rest of the states. In 2022, 100% of the FPL in Hawaii is $1,303 / month for an individual.

Group 2 – States that use the FPL as their income limit, but do not use 100%. We include the FPL percentage that is used as the income limit in parenthesis following a state’s name. California (138%), North Dakota (83%), and New York (82%). While NY is currently using 82% of the FPL for their income limit in 2022, this limit will increase to 138% of the FPL effective Jan. 2023.

States may use the FPL income limit for both Institutional Medicaid and HCBS Waivers or for just one of the programs. This means that one of the programs may have an income limit based on the FPL while the other program has an income limit based on the Federal Benefit Rate (FBR).

Asset Limits

Medicaid asset limits typically do not change from year to year. When they do change, it is based on state rules rather than federal rules. In 2023, the asset limit in most states is $2,000 for an individual and $3,000 for a married couple (with both spouses as applicants). Note that some states use $4,000 as the asset limit for couples with both spouses as applicants ($2,000 / spouse). For married couples with just one spouse as an applicant, the applicant spouse is limited to $2,000 in assets, while the non-applicant spouse is allocated a larger amount of the couple’s assets. This is a spousal impoverishment rule called the community spouse resource allowance.

There are a couple of significant exceptions to the asset limits mentioned above. In 2022, New York has an asset limit of $16,800 for an individual and $24,600 for a couple (with both spouses as applicants). These limits are expected to increase nearly 50% effective Jan. 1, 2023. NY Health Access and Kaiser Family Foundation (KFF) project the new limits to be $28,134 for an individual and $37,908 for a married couple with both spouses as applicants. California is another exception. The state increased their asset limits on July 1, 2022 to $130,000 for an individual and $195,000 for a couple (with both spouses applying). The state plans to eliminate the asset limit altogether effective Jan. 1, 2024.

Minimum & Maximum Monthly Maintenance Needs Allowance

The monthly maintenance needs allowance (MMNA) is a spousal impoverishment rule that allows an applicant spouse to transfer a portion of their income, or in some cases, all of their income, to their non-applicant spouse as a spousal income allowance to prevent spousal impoverishment. Currently, the federally set minimum MMNA is $2,288.75 and the maximum MMNA is $3,715.50 for 2023. The minimum MMNA increases annually effective July 1, and we currently have no projection for this figure for July 1, 2023. The maximum MMNA increases each year effective Jan. 1, 2023. This amount is determined based on the Consumer Price Index (CPI). All states fall into one of three groups 1) Those that use the federally set minimum and maximum MMNAs 2) Those that use only the maximum MMNA 3) Exceptions.

Group 1 – In 2023, $2,288.75 is the minimum MMNA and $3,715.50 is the maximum MMNA effective Jan. 1, 2023. These states include the following: Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Idaho, Indiana, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah, Vermont, Virginia, Washington, and West Virginia (only applies to Institutional Medicaid).

Group 2 – In 2023, the maximum MMNA of $3,715.50 is effective Jan. 1, 2023. These states are Alaska, California, Georgia, Hawaii, Iowa, Louisiana, Mississippi, New York, Oklahoma, South Carolina, Texas, and Wyoming.

Group 3 – Wisconsin, in 2023, uses a minimum MMNA of $3,051.66 and a maximum MMNA of $3,715.50. Alabama and the District of Columbia use one standard MMNA, which is the minimum MMNA of $2,288.75. This figure will increase effective July 1, 2023, but we currently have no projection of the new figure. North Dakota uses a standard MMNA of $2,550, and Illinois uses a standard MMNA of $2,739. We are unsure if these figures will change in 2023.

Minimum & Maximum Community Spouse Resource Allowance

The community spouse resource allowance (CSRA) is a spousal impoverishment rule that allows a non-applicant spouse to keep a greater amount of a couple’s assets to prevent spousal impoverishment. (All assets of a married couple are considered to be jointly owned). In 2023, the federally set minimum CSRA is $29,724 and the maximum CSRA is $148,620. CSRAs increase each year eff. January 1.

All states fall into one of four groups 1) Those that use the federally set minimum and maximum CSRAs 2) Those that use minimum and maximum CSRAs, but the minimum differs from the federally set amount 3) Those that use only the federally set maximum CSRA 4) Those that use a standard figure between the federally set minimum and maximum CSRAs.

Group 1 – In 2023, uses $29,724 as the minimum CSRA and $148,620 as the maximum CSRA eff. Jan. 1, 2023. These states include the following: Alabama, Arizona, Arkansas, Delaware, District of Columbia, Idaho, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Utah, Virginia and West Virginia.

Group 2 – In 2023, uses $148,620 as the maximum CSRA eff. Jan. 1, 2023. These states use a minimum CSRA greater than the federally set minimum CSRA. We are unsure if any of these figures will change in 2023. We include 2022 minimum CSRAs in parenthesis following a state’s name. The following states fall under this group: Connecticut ($50,000), New Mexico ($31,290), New York ($74,820), Washington ($59,890), and Wisconsin ($50,000).

Group 3 – In 2023, uses $148,620 as the standard CSRA figure eff. Jan. 1, 2023. To be clear, these states do not use a minimum and maximum CSRA; they use only one standard figure. These states include the following: Alaska, California, Colorado, Florida, Georgia, Hawaii, Louisiana, Maine, Minnesota, Mississippi, Vermont, and Wyoming.

Group 4 – Illinois uses a standard CSRA of $109,560, and South Carolina uses a standard CSRA of $66,480. In Washington, a standard figure of $59,890 is used for HCBS Waivers. We do not know if these figures will change in 2023.

Home Equity Limits

The home equity limit is the limit on the current value of one’s home after subtracting any outstanding debt against it. In 2022, the federally set minimum home equity limit was $636,000 and the maximum home equity limit was $955,000.

In 2023, these numbers are $688,000 and $1,033,000 respectively.

All states fall into one of three groups 1) Those using the minimum home equity limit 2) Those using the maximum home equity limit and 3) Those using neither limits.

Group 1 – Uses $688,000 as the home equity limit in 2023 and includes the following states: Alabama, Alaska, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, West Virginia, and Wyoming.

Group 2 – Uses $1,033,000 as the home equity limit in 2023 and includes the following states: Connecticut, District of Columbia, Hawaii, Maine, Massachusetts, New Jersey, New York, and Washington.

Group 3 – California does not have a home equity limit. Wisconsin and Idaho both use a home equity limit between the minimum and maximum home equity limits set by the federal government. In 2022, they both have a home equity limit of $750,000. We are unsure if this will change in 2023.