Each state has many different types of Medicaid programs, each with different eligibility requirements. Medicaid, not to be confused with Medicare, is a state-run health insurance program utilizing federal money to provide medically needy low-income and low-asset individuals, families, pregnant women, and disabled children and adults with health care services. All Medicaid programs have financial eligibility requirements, and most state plans have asset limits for both individuals and married couples. Some programs also vary their asset limits based on family size, for plans that cover entire families. For plans requiring income eligibility, gross income, along with the federal poverty level, is used to determine eligibility.
For vendor Medicaid, also known as nursing home care Medicaid or long-term care Medicaid, asset limits vary by state. In Missouri, the asset limit is just over $6,000. Countable assets include bank accounts, investments, and life insurance policies. In Missouri, the spouse of the Medicaid beneficiary is entitled to keep one-half of the couple’s total assets, known as the community spouse resource allowance. This ensures that the spouse not receiving Medicaid (the community spouse) does not become impoverished. There is no income limit for vendor Medicaid, however, most monthly income must be paid directly to the nursing facility in which the Medicaid beneficiary resides, as a co-pay towards care costs. Exceptions include Medicare premiums and a small monthly allowance for personal items and services that the care facility does not provide.
Federal laws impose a look-back period of 60 months (5 years) preceding a Medicaid application, meaning that any transfers of assets must be at fair market value and assets cannot be gifted away to meet eligibility criteria for Medicaid. If assets are improperly transferred within the look-back period, Medicaid can impose a penalty period. Medicaid planning strategies can be utilized at any point prior to a Medicaid application, but are most useful when done more than 5 years prior to the application. In addition to preserving assets during a Medicaid beneficiary’s lifetime, planning strategies can prevent Medicaid estate recovery, which is when Medicaid retains remaining assets after a beneficiary’s death. Quality Medicaid Care is a firm licensed in Missouri to help determine Medicaid eligibility for your family member who may be seeking a higher level of care in a nursing facility.