Oklahoma Medicaid Long-Term Care Eligibility for 2025

Oklahoma Long-Term Care

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Oklahoma is an income-cap state, requiring Medicaid long-term care applicants to meet a hard income limit. Unlike non-income cap states, where applicants can spend down excess income on care costs, income cap states require income to be under the limit at the time of application.

Programs for 2025:

Oklahoma offers the following waivers for eligible individuals:

  • My Life My Choice Waiver: Supports adults with physical disabilities transitioning to community-based living under the Living Choice program.
  • ADvantage Program: Serves frail elderly individuals (65 or older) and adults (21 or older) with physical disabilities requiring nursing facility-level care.
  • Medically Fragile Waiver: Provides services for individuals who meet hospital or skilled nursing facility-level care requirements.
  • Sooner Seniors Waiver: Designed for adults 65 and older transitioning to community-based services through the Living Choice program.

Eligibility for 2025:

  • Residency and Citizenship: Applicants must be Oklahoma residents and U.S. citizens or have proper immigration status.
  • Age/Disability: Applicants must be 65 years or older, blind, or disabled. They must meet medical requirements consistent with the level of care requested and require care for thirty (30) consecutive days.
  • Income Limitations:
    • Single applicants’ income must not exceed $3,021/month to qualify for full Medicaid coverage.
    • Couples applying together may have higher income limits.
    • Income exclusions include:
      • A personal needs allowance of $52/month.
      • A veteran’s pension allowance of $90/month, in addition to the personal needs allowance.
  • Asset Limitations:
    • Applicants must have $2,000 or less in countable assets if single and $3,000 if married.
    • The state enforces a 5-year look-back period, penalizing transfers of assets below fair market value or gifts.
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Exempt Assets in 2025 for an Applicant in Oklahoma:

  • $2,000 or less in countable assets if single; $3,000 if married.
  • One home (equity limit $788,000) is exempt if the applicant intends to return or if a spouse, child under 21, or disabled dependent resides there.
  • One automobile (no equity limit specified).
  • Burial funds:
    • $1,500 or less in burial funds.
    • Irrevocable burial trusts up to $7,500 are exempt.
  • Non-saleable property: Includes household furnishings, clothing, jewelry, and personal effects.
  • Life insurance: Face value up to $1,500 is exempt. Policies exceeding this amount count their cash value as a resource.
Spousal Rules for 2025:

Community Spouse Asset Allowance: The community spouse may retain up to $152,020 in non-exempt resources. If resources fall below $30,027, additional resources from the institutionalized spouse may be transferred.

Community Spouse Income Protection: If the community spouse’s income is below $2,389/month, they may retain part of the institutionalized spouse’s income to meet this threshold. The maximum income the community spouse may retain is $3,898.50/month, depending on living expenses.

Income First Rule: Oklahoma requires the community spouse to use the nursing home spouse’s income to meet their income needs before petitioning for an increased Community Spouse Resource Allowance (CSRA).

Oklahoma Long-Term Care Insurance Partnership for 2025:

The Oklahoma Long-Term Care Partnership Program allows policyholders to protect assets dollar-for-dollar based on the policy’s maximum benefit payout. For example, a policy with a $165,000 maximum benefit exempts $165,000 in assets from Medicaid eligibility calculations.

Further Information: