Missouri Medicaid Long Term Care Eligibility
Missouri Long Term Care
1. Residency and Citizenship – the applicant must be a Missouri 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. Persons must need care for thirty (30) consecutive days.
3. Income Limitations – if single, all of the applicant’s income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must go towards cost of care. If married and only one spouse needs care, the allowances described above take effect. There is a personal needs allowance of $50/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. Missouri 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. All non-exempt assets of both spouses are available as payment for long-term care expenses.
Exempt Assets for an applicant in Missouri include:
i. $1,000 or less in cash/non-exempt assets if single. $2,000 if married. If the assets exceed the limit on the first of the month the applicant is ineligible for the entire month.
ii. One home is exempt (equity limit $585,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it.
ii. One car.
iii. Pre-paid funeral plans, no amount specified.
v. Life insurance policies for both spouses if the total face value for each is $10,000 or less. The value of term life insurance is exempt regardless of value.
vi. Personal property may be excluded if the equity value is $5,000 or less.
Amount of assets community spouse may retain: The community spouse can keep non-exempt resources owned by one or both spouses with a maximum of $126,420. If the community spouse’s assets do not equal the minimum of $25,284, the community spouse is able to retain assets from the institutionalized spouse until the minimum is reached.
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 $2,057.50 per month. If the community spouse can document exceptionally high living costs, their monthly income may be raised to a maximum of $3,160.50. Missouri 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.
Spend Down Coverage:
Spend down refers to the amount of long-term care related expenses that are a person’s financial responsibility, similar to the deductible of an insurance policy. The amount of the spend down is determined by how much an applicant’s net income exceeds the non-spend down income limit. A person’s spend down obligation can be met by either: 1) submitting incurred medical expenses to any FSD office or regional spend down unit (SDU) that serves the participant’s residence county on a monthly basis; or 2) paying the monthly spend down amount to the Missouri HealthNet Division, much like an insurance premium payment.
If a person chooses to meet their spend down with incurred medical expenses, medical coverage for that month begins the date on which the spend down is met and ends on the last day of that month. Missouri HealthNet will not pay expenses used to meet the spend down.
If a person does choose to pay the monthly spend down, payment prior to the first day of the month will ensure continuous coverage. Pay-in can be by check, money order, or automatic withdrawal from a bank account.
Medicaid basics for Missouri: http://insurance.mo.gov/consumers/LongTerm/FAQ.php