Washington DC Medicaid Long Term Care Eligibility

District of Columbia Long Term Care

Eligibility:

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1. Residency and Citizenship – the applicant must be a resident of Washington D.C. and a U.S. citizen or a lawful permanent resident who has lived in the U.S. for at least five years.

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 monthly income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than $980.83 (100% the Federal Poverty Level) to become eligible for Medicaid. Even when someone becomes eligible for Medicaid, most of their income must be used to pay nursing home bills, with Medicaid paying remaining costs.

There is a personal needs allowance of $70.00/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. 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 Washington D.C. include:

i. $4,000 or less in cash/non-exempt assets if single. If married and both spouses need nursing home level of care, the limit is raised to $6,000.

ii. One home is exempt (equity limit $828,000) 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 of the residence will not be considered an available resource for up to three months if the applicant gets another residence during this period and the residence sold was an excludable resource in the first place.

iii. Any land attached to the applicant’s principle residence, or any buildings on that land, are completely excluded as being considered an available resource to the applicant no matter what the value of the land or the buildings. Any contiguous land will be considered part of the applicant’s principle residence even if some of that land is owned under a separate deed or was acquired at a different time.

iv. The value of an income-producing property is excluded as long as it produces a return consistent with the income limitations described above.

v. One automobile with a value of $4,650 or less is excluded. 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 it is exempt no matter the value.

vi. Irrevocable burial trust or other burial funds, maximum value of $1,500.

vii. Non-saleable assets, household furnishings, furniture, clothing, and other personal effects are not counted. It is important to note that one wedding ring and one engagement ring per applicant with any value will not be counted. The rings do not have to be the actual rings used in the wedding, so purchasing a high-value wedding ring can shield some assets.

viii. Cash surrender value of life insurance policies and the face value of the life insurance policy will not be counted.

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Spousal Rules:

Amount of assets community spouse may retain: The community spouse can keep one-half of countable assets with a maximum value of $119,220. If the community spouse’s assets do not equal $23,844, the community spouse is able to retain up to half of the 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 a monthly income of less than $2,980.50. The maximum amount of income that can be retained is $2,980.50.

Further Reading:

D.C. Department of Health Care Finance (2012): http://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/publication/attachments/DCMedicaidAllianceFactSheet.pdf

Medicaid Regulations as listed by the D.C. Department of Health Care Finance: http://dhcf.dc.gov/page/dhcf-medicaid-regulations

Medicaid Application sites for Residents of Washington D.C.: https://www.dchealthlink.com/
http://dds.dc.gov/page/hcbs-waiver-provider-application-process