Idaho Medicaid Long Term Care Eligibility
Idaho Long Term Care
Idaho is an income cap state, meaning that in order to be eligible for Medicaid long term care benefits there is a hard income limit. Non income cap states allow applicants to spend down money for their care, whereas income cap states require the amount to be no higher than their limit at time of application.
1. Residency and Citizenship – the applicant must be an Idaho resident and a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested.
3. Income Limitations – if single, the applicant’s income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, IRAs, etc.) must be less than $2,219 per month. Persons with income in excess of $2,219 can still qualify for Medicaid coverage if excess income is placed into a Qualifying Income Trust (QIT). The trust must be irrevocable and Idaho Medicaid must be the designated recipient when the beneficiary dies. Only income in excess of $2,219 must be placed in the trust.
- There is personal needs allowance of $40/month that is not factored into the total countable income.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The applicant cannot simply give away their excess assets as Medicaid looks into financial records as far back as 60 months prior to the application date. The applicant cannot sell anything below fair market value as this will result in ineligibility as well.
Exempt Assets for an applicant in Idaho include:
i. $2,000 or less in cash/non-exempt assets if single; 4,000 for a married couple.
ii. Personal effects and household goods.
iii. One home (equity value limited to $828,000) is exempt if expecting to return, a spouse, a child under 21, or a disabled person resides in it. The house can be transferred with no penalty to the spouse; a natural, adopted, or step child who is under 21, or blind or disabled; a sibling who has equity interest in the home and lived with the institutionalized individual one year prior to institutionalization; another adult, who lived with the resident and provided care for at least two years thereby delaying institutionalization.
iv. One motor vehicle if the vehicle is used for the long term care recipient’s medical treatment, employment, modified to accommodate a disability, or the primary vehicle of the community spouse.
vi. Burial spaces and irrevocable pre-paid burial trusts if tied to specific funeral or burial services.
Amount of assets community spouse may retain: The maximum value of assets a community spouse can retain for self-support without disqualifying the nursing home spouse from eligibility is $119,220. If the community spouse’s assets do not equal a minimum of $23,844, he/she may be able to keep some of the nursing home spouse’s resources until the minimum is met.
Community spouse impoverishment protection: If the community spouse’s income does not equal at least $1,966.25 per month, he/she may keep some of the institutionalized spouse’s income in order to meet the minimum of $1,966.25. If the community spouse’s living expenses are exceptionally high, he/she can appeal to keep more of the institutionalized spouse’s income, up to $2,980.50.
Idaho long term care insurance partnership:
This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used you may apply for Medicaid with $155,000 worth of assets exempted.
Eligibility for all Idaho benefit programs: http://www.healthandwelfare.idaho.gov/FoodCashAssistance/ApplyforAssistance/Applyforservices/Whoiseligible/tabid/1556/Default.aspx
Long Term Care and Managed Care-Department of Health and Welfare: http://healthandwelfare.idaho.gov/Medical/Medicaid/LongTermCareManagedCare/tabid/1910/Default.aspx