Nevada Medicaid Long Term Care Eligibility
Nevada Long Term Care
Nevada 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.
- Nevada’s Assisted Living Waiver: This is a Medicaid program that provides assisted living supportive services to individuals in a residential facility that offers 24/7 care. To be eligible for this waiver an applicant must be: 65 years or older, require nursing home level of care, meet Medicaid’s income and asset limits as listed below, and live in an assisted living facility receiving a Low-Income Housing Tax Credit. Not all assisted living facilities meet these criteria and some do not qualify for the waiver program. If the home does not qualify for the waiver Medicaid will not pay and the individual will have to pay privately.
- Nevada’s Home and Community Based Waiver (HCBW): This waiver provides non-medical services and helps older Nevada residents keep their independence and remain in their own homes. To be eligible for this waiver the applicant must be: at least 65 years old, require nursing home level of care within 30 days if HCBW services were not available, have a continued need for services, and meet the Medicaid income and asset limits listed below. Since this waiver is for non-medical services skilled nursing care is not available. A social worker is assigned to each case and will coordinate and determine which services are needed. Services available under this waiver include help with activities of daily living (ADLs) such as bathing, homemaking, eating, grooming, laundry, shopping, etc. Adult companions, medical alerts, and non-medical adult day care are also available under the HCBW. There are limited spaces available for this waiver program so the Aging and Disability Services Division uses a wait list to determine recipients based on level of care needed, risk factors for the individual, and the date of application submission.
- Nevada’s Waiver for Elderly Adult Living in Residential Care (WEARC): This waiver offers payment for services given in a group home setting. Applicants must be: at least 65, ambulatory (able to move without the assistance of a caregiver or transfer independently into a wheelchair), need an intermediate level of care, and meet Medicaid’s income and asset limits listed below. This program does not provide services from a nurse. The Nevada Aging and Disability Services Division assess each individual to determine their medical neediness and whether or not they are qualified for an intermediate level of care. Once approved, recipients are assigned a case manager who will then coordinate the care with the group home where the person resides. Not all group homes accept the WEARC waiver and Medicaid will only pay for care in WEARC approved homes. The WEARC program has a wait list similar to the HCBW program mentioned above.
1. Residency and Citizenship – the applicant must be a Nevada 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, there is an income limit of $2,349 (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.). Although Nevada is an income cap state, an applicant may still be eligible if they place excess income into a Qualified Income Trust. For married couples, when the institutionalized spouse has an income above the limit, Medicaid combines the income of both spouses and uses the average. If the average is less than the limit then the applicant will qualify. If the nursing home spouse has an income under the limit then the income of the community spouse is not taken into consideration. There is a personal needs allowance of $35/month which is not factored into the total countable income for the spouse receiving nursing home care.
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 state 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 Nevada 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. One home is exempt (equity limit $595,000) if planning to return. If a spouse, a child under 21, or a disabled dependent resides in it then there is no value limit.
iii. One car.
iv. Pre-paid funeral plans and irrevocable burial trusts.
v. Personal effects and household goods.
Amount of assets community spouse may retain: The community spouse can keep non-exempt resources owned by one or both spouses worth a minimum of $25,728 and a maximum of $128,640. If the community spouse’s assets do not equal the minimum, the long-term care spouse is able to transfer assets 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 $2,113.75 per month. If certain financial hardships are documented, the community spouse may keep up to $3,216.00 per month.
Nevada 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.
Nevada Aging and Disability Services local offices: http://adsd.nv.gov/Contact/Contact_AgingDisability/