Qualifying for Medicaid Long-Term Care Benefits

May 26, 2022 | Health Care

Learn what’s needed to qualify for Medicaid long-term care benefits.

By Jason M. Gray, Esq.

In Idaho, Medicaid benefits are administered by the Department of Health and Welfare.  Medicaid provides a wide range of potential benefits, but this article is focused on Medicaid eligibility for individuals who are over the age of 65 and need assistance paying for long-term care.  If you, or a loved one, may need financial assistance paying for in-home care, care in an assisted living facility, or care in a nursing home, it is important to consider speaking with an attorney before applying.  If you are ineligible for benefits and apply, there could be negative consequences in the future.  An attorney with experience in Medicaid estate planning can help guide you through this process.

Income and Asset Tests 

In order to qualify for Medicaid, the individual who is applying must meet both the income and asset tests.  For a single individual, the income limit is typically going to be $2,543 per month.  If the income is higher than that, you will need to look at the Medicaid regulations in order to determine if there is a way to get below the income level.  One possible strategy might be setting up a special type of trust called a Miller Trust.  However, a Miller Trust may not be your best option, especially if you are well above the income level or if you are also over the asset limit.  For a married couple where one spouse is applying for Medicaid, the applicant’s income must be under $2,543, but there is no limit on the non-applicant spouse’s income.  Types of income that would count against the spouse applying for Medicaid would include wages, pension payments, income from Social Security, investment income, and other similar sources of income.

Determining Value of Assets

Once it is determined that the individual qualifies for Medicaid based on income level, the next step is determining the value of any assets.  For a single individual, there is a limit of $2,000 on countable assets in order to qualify for Medicaid.  The term “countable assets” is used because not all assets held by an individual will count against the individual for Medicaid eligibility purposes.  For a married couple where one spouse is applying for Medicaid, the non-applicant spouse may potentially keep up to $137,400 in countable assets.  The reason for allowing the non-applicant spouse to keep a higher amount of assets is because that spouse still needs to provide for their living expenses while their spouse is in an assisted living facility or a nursing home.  The definition of what constitutes a countable asset generally includes cash, stock brokerage accounts, bank accounts, and similar assets.  Non-countable assets may include personal belongings, a vehicle, a prepaid funeral services contract, and potentially the family residence if the other spouse is residing there or the applicant intends to return home at some point.

Medicaid can be a great option for families struggling to pay for long-term care, but the process for qualifying and applying can be complicated. If you have any questions, please do not hesitate to contact an attorney that has experience assisting people with Medicaid benefits.  Even if you think your Medicaid application is relatively straightforward, it can be useful to have a consultation with an attorney before applying.

Jason M. Gray is an Estate & Long-Term Care Planning, Business Law, and Land Use Attorney with Smith + Malek, PLLC in Coeur d’Alene. If you have questions about these areas of law, contact Jason at 208-215-2411, jason.gray@smithmalek.com.

This has been presented as general information and not as legal advice. Do not engage in legal decision-making without the advice of a competent attorney after discussion of your specific circumstances.