Long-term care (LTC) services include both home and community-based services (HCBS) and LTC facility services (also called nursing facilities). A person who needs LTC services may apply for Medical Assistance (Medicaid) and payment of LTC services, but must meet all eligibility requirements. You can apply for benefits online using COMPASS, the online website to gain access to cash assistance, the Supplemental Nutrition Assistance Program (SNAP), help with child care, health care coverage, home heating assistance (LIHEAP), school meals, SelectPlan for Women and long-term living services or complete the Medical Assistance (Medicaid) Financial Eligibility Application for Long Term Care, Supports and Services. You may also mail or give your application to your local county assistance office. The county assistance office will then determine your eligibility.
Please note: The following Medicaid LTC eligibility criteria do not apply to the Adult Community Autism Program (ACAP). See Medical Assistance General Eligibility Requirements for additional information.
A person must:
The financial eligibility factors are:
NOTE: Any transfer of assets (income and resources) for less than fair market value in a 5-year period prior to applying for Medicaid long-term care services could affect eligibility. See additional information under "Transfer of Assets" below.
Most income is counted, including:
Income Limits (for one person)
Examples of resources that are counted:
Examples of resources not counted:
Resource Limits (for one person)
NOTE: The resources of a parent who is applying for or receiving home and community-based services and is living with their child who is under the age of 21 are excluded.
Transfer of Assets (Income and Resources)
Any asset that was transferred, sold, or given away within the past 60 months (look back period) must be reviewed by the county assistance office when a person applies for Medicaid long-term care. The look back period is determined by the date a person is admitted to a long-term care facility or assessed eligible for home and community-based services and has applied for Medicaid long term care.
The county assistance office will review the exchange of assets to determine if fair market value has been received. If fair market value has not been received, a period of ineligibility, known as a penalty period, takes place. During the penalty period DHS will not pay for long-term care services. The uncompensated value (UV) of the asset is used to figure the penalty period. UV is the difference between the fair market value and the amount received. The penalty period is figured by dividing the UV by the average daily private pay rate for long-term care services. The penalty period begins on the date a person is eligible for Medicaid long term care.
Special Rules for Married Couples (Spousal Impoverishment)
Special Medicaid rules apply to couples to ensure that the spouse who stays in the community (known as the "community spouse") is not made poor when one spouse (known as the "institutionalized spouse") is admitted to a long-term care facility or assessed eligible for home and community-based services. All resources owned by the institutionalized spouse and the community spouse (CS) are reviewed to determine the part of the resources (called the “spousal share” or the “protected share”) that the CS may keep.The spousal share is one-half of the couple’s total countable resources, but no less than $23,184 (for 2013) and no more than $115,920 (for 2013). These minimum and maximum figures are revised annually. You can file a Resource Assessment Form (PA 1572) to determine the spousal share. A couple should file this form when one of them enters a long-term care facility or is assessed eligible for home and community-based services.
The CS is not required to pay for the institutionalized spouse’s long-term care services. The CS is allowed to keep all of his/her own earnings, regardless of the amount, and that income is not included in determining the institutionalized spouse’s eligibility for Medicaid long-term care. If the institutionalized spouse is in a long term care facility, the CS may be eligible for a community spouse monthly maintenance needs allowance (CSMMNA). The county assistance office will use the CS’s income and shelter costs to determine the amount of the CSMMNA. If the institutionalized spouse has enough income to pay the CSMMNA, the institutionalized spouse’s income must be used first. However if a shortfall still exists after the institutionalized spouse gives all of his/her available income, an additional amount of resources exceeding the protected share of the couple’s resources can be made available to the CS to generate additional monthly income up to the CSMMNA. In addition, if the community spouse needs more income in excess of the CSMMNA because of exceptional circumstances that result in significant financial duress, you may request an increase in the CSMMNA. An application must be submitted for Medical Assistance long term care and a hearing requested.
What Medical Assistance Long Term Care Pays For