Maryland Medicaid Long Term Care Eligibility
Maryland Long Term Care
1. Residency and Citizenship – the applicant must be a Maryland resident and be 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, and seeking care in a nursing home facility, the applicant’s income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be less than $350 per month. Income in excess of $350 can still qualify for Medicaid coverage if excess income is spent down to pay for care. For home and community based waivers the income limit is 300% of the SSI benefit level for a household of one (e.g. $2,199 in 2015). There is a personal needs allowance of $71/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. Maryland has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away.
Exempt Assets for an applicant in Maryland include:
i. $2,500 or less in cash/non-exempt assets if single. For home and community based waivers the asset limit is $2,000. There is no spend-down for assets, if the assets exceed the limit on the first of the month the applicant is ineligible for the entire month.
ii. Personal effects and household goods
iii. One home (equity value limited to $560,000) is exempt if 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, 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—no matter the value.
v. Burial spaces and irrevocable pre-paid burial trusts of any value. If the money is simply in a burial account then the limit is $1,500.
Amount of assets community spouse may retain: The community spouse can keep non-exempt resources owned by one or both spouses with a minimum of $23,844 and a maximum of $119,220. If the community spouse’s resources do not reach the minimum value of $23,844 then he/she can retain some of the nursing home spouse’s assets.
Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has an income of less than $1,967 per month. If the spouse can document high shelter expenses (rent, utilities, phone, etc.) then the income limit may be raised to a maximum of $2,980.
Maryland 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.
Maryland Money Follows the Person:
Money Follows the Person (MFP) helps people transition from an institution to community living in an apartment, home, or small group setting. MFP allows the long-term care recipient to continue receiving benefits even if they no longer need to live in a traditional nursing home.
Further information about Medicaid in Maryland: https://mmcp.dhmh.maryland.gov/SitePages/Medicaid%20Eligibility%20and%20Benefits.aspx
More information on eligibility: https://mmcp.dhmh.maryland.gov/sitepages/medical%20care%20programs%20eligibility.aspx
Division of Eligibility Policy/MCHP, OES
Department of Health and Mental Hygiene
201 W. Preston Street
Baltimore, MD 21201
Toll Free: 1-800-492-5231 extension 1463