Oklahoma Medicaid Long Term Care Eligibility
Oklahoma Long Term Care
Oklahoma 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.
There are four waivers for the frail elderly or adults with physical disabilities age 21+ who do not have mental retardation or a cognitive impairment:
- ADvantage – Serves frail elderly individuals age 65 or older and adult Oklahomans age 21 and older with physical disabilities that otherwise require placement in a nursing facility.
- Medically Fragile – This program serves qualifying individuals who meet hospital or skilled nursing facility level of care.
- Sooner Seniors Waiver – Adults 65 and older who transitioned to community-based services in the Living Choice program are eligible for Sooner Seniors.
- My Life My Choice Waiver – This program is for those adults with physical disabilities who transitioned to the community under the Living Choice program.
1. Residency and Citizenship – the applicant must be an Oklahoma resident and 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 and living alone, the applicant’s monthly income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than $2,205 to get full coverage paid by Medicaid. If married and both spouses require care the limit is raised. Income that is not considered countable includes a personal needs allowance ($50.00/month per individual). If the applicant receives a veteran’s pension they can keep $90 per month in addition to the $50 personal needs allowance.
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. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is listed as exempt.
Exempt Assets for an applicant in Oklahoma include:
i. $2,000 or less in cash/non-exempt assets if single. If married, the asset limit is $3,000. 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, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum. The home may also be transferred to a sibling who has lived in the home during the preceding year or who holds equity interest in the home; or to a child who has provided care giving services and lived in the home for at least two years, thus preventing the applicant from entering a nursing home environment.
- NOTE: In Oklahoma, the home loses its exempt status after the nursing home resident has been in the nursing home for a period of one full year. After one year, the state can then make a claim against it for Medicaid costs spent on the owner’s behalf.
iii. One automobile, no equity amount specified.
iv. A burial fund for an applicant and spouse with a value of $1,500 or less, each. If the money is placed in an irrevocable burial trust then $7,500 is exempt.
v. Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted.
vi. Value of life insurance if face value is $1,500 or less. If it exceeds $1,500 in total face amount, then the cash value in these policies is countable.
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 $128,640. If the community spouse’s assets do not equal the minimum of $25,000, 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 $3,216.00 per month. The maximum amount of income that can be retained is $3,216.00. Oklahoma 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.
Oklahoma 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.
Oklahoma Health Care Authority phone number: 800-522-0114
Long term care waiver operations: http://www.okhca.org/individuals.aspx?id=530
General Oklahoma Medicaid rules: http://www.okhca.org/xPolicy.aspx?id=83
Frequently asked questions: http://www.okhca.org/provider/contracts/pdflib/FAQ.pdf
Further financial Guidelines for Eligibility