For Missouri nursing home residents receiving Missouri Medicaid (also called Mo Healthnet) assistance, Medicaid eligibility works in the following way. First, the Medicaid applicant must be currently residing in a skilled nursing facility in a Medicaid bed. By “residing in a Medicaid bed,” the person must be receiving care in the nursing home, and must be listed among the Medicaid recipients or potential Medicaid recipients by the long-term care facility/care provider. Additionally, the potential Medicaid applicant must meet all asset limit limitations and apply for and achieve Medicaid eligibility. This vendor Medicaid will pay for any long-term care in a Medicaid nursing home setting, including memory care for residents suffering from Alzheimer’s disease.
Once the family member in need has achieved full Medicaid/MO Healthnet long-term care eligibility, the state of Missouri’s Medicaid program will pay for the Medicaid recipient’s long-term care services in the long-term care facility. The recipient receives full Medicaid services for personal care and long-term care costs while in the nursing home.
The nursing home resident, however, is required to pay a monthly co-pay to the long-term care facility to contribute to the cost of care. The base co-pay each month is equal to the long-term care recipient’s monthly income, consisting of his or her social security plus any pension income they receive. (When the Social Security payment rises annually due to the rise in cost of living, the co-pay rises correspondingly.) From this base amount, the Medicaid recipient is allowed a credit to pay any Medicare monthly premiums, plus a credit for any supplemental health care plans the Medicaid recipient may be receiving.
Additionally, the Medicaid long-term care program will give a further credit for a monthly personal needs allowance. This allows the Medicaid beneficiary to pay for small items on a month-to-month basis in order to take care of personal care (such as grooming, hair salons, for social services or even for personal caregivers). In Missouri the personal needs allowance is fifty dollars ($50.00) per month. This amount can be allowed as a credit, reducing the amount of Social Security pension the Medicaid beneficiary must pay to the nursing home on a monthly basis.
Some state Medicaid recipients make the nursing facility the “Representative Payee” for the resident’s Social Security monthly pension; in fact, some long-term care facilities require this of all Medicaid recipients receiving residential care. When the Social Security is being paid directly to the nursing home, the nursing facility will typically set up an internal trust account for the nursing home resident’s benefit. Funds can be expended internally at the nursing home, or may be withdrawn for cash purposes outside the facility.
It should be noted that this $50.00 personal needs allowance is not the only monthly income available when a Medicaid long-term care recipient is married. The spouse still living in the community will always receive their own income to live independently, and may also receive a portion of the Medicaid recipient’s monthly income as part of a Community Spouse Resource Allowance or Marital Monthly Maintenance Needs Allowance. This calculation and grant of monthly income to the community spouse is made as part of a Division of Assets and other Medicaid planning and is separate from the Medicaid personal needs allowance. Fortunately, if a portion of the Medicaid recipient’s income is granted to the community spouse to live on on a monthly basis, the Medicaid recipient will STILL receive their personal needs allowance ($50.00 per month) to pay for personal care and personal items.
It should be noted that these regulations only apply to full long-term care recipients. Other state Medicaid programs cover assisted living and residential care in an assisted living facility. Additionally, separate rules apply to home and community-based services (HCBS) for assistance with activities of daily living in the home through Medicaid waivers. Those rules are the subject of other informational entries on this website.