Michigan Medicaid Long Term Care Eligibility
Michigan Long Term Care
1. Residency and Citizenship – the applicant must be a Michigan 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, the applicant’s income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be less than $1,293 per month. Income in excess of $1,293 can still qualify for Medicaid coverage if excess income is spent down to pay for care. There is a personal needs allowance of $60/month for the spouse receiving nursing home care that is not figured 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. Michigan 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. Michigan considers anything owned as an asset, barring exemptions. Financial eligibility is reviewed once a year with no time limit on how long care services can be given.
Exempt Assets for an applicant in Michigan include:
i. $2,000 or less in cash/non-exempt assets if single. 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 is exempt (equity limit $560,000) 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 up to $11,072.
vi. Life insurance policies for both spouses if the total face value for each is $1,500 or less.
vii. A joint bank account if records show that the co-owner of the account contributes an equal or greater amount of money to the account. Simply having a child or spouse’s name on the account is not enough to make it exempt.
viii. Real estate, or other tangible assets, if you have attempted to sell them at fair market value for at least one month will not disqualify you from Medicaid benefits.
Community spouse resource protection: Unlike other states, Michigan determines resource limits on a case by case basis. After confirming the total value of countable assets, a caseworker will determine a protected spousal amount. The protected spousal amount is the maximum amount the community spouse is allowed to keep while the nursing home spouse continues to remain eligible for long-term care under Medicaid.
- If the total value of a couple’s countable assets is $43,824 or less, the protected amount is $21,912. If the total value of a couple countable assets are over $43,824, but under $219,120 then the protected spousal amount is one half of the total value. If the value of countable assets is over $219,120 then the protected amount is $109,560.
Amount of income community spouse may retain: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has an income of less than $1,966 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 $2,981. Michigan is an “income first” state, meaning the state limits the right to petition for an increased community spouse resource amount (CSRA) to couples whose combined income fails to meet the community spouse’s income needs. Basically, this means a community spouse can petition for an increased CSRA where there’s an income gap only after factoring in the nursing home spouse’s income first.
Michigan 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.
More information, including applications and asset declaration forms: https://www.michigan.gov/documents/miseniors/MedicaidLTC_274718_7.pdf