Are You Applying For Medicaid Coverage?

Getting Started

There are three types of Medicaid: (1) Community Health Insurance (2) Custodial Long-Term Care and (3) Home-Based Care Waiver Programs. Most likely, you are interested in information about Custodial Long-Term Care or the Waiver Programs offered in the applicant’s home state.

Medicaid is a public benefits program. The rules are very complicated, and for you or your loved one, there is a lot at stake. The costs of long-term custodial care are going nowhere but up, quickly approaching $150,000 per year. There are only three ways to pay for long-term custodial care: (1) private pay (2) long-term care insurance; or (3) Medicaid. If you are in a crisis situation, it is recommended that you consult with an elder law attorney familiar with Medicaid eligibility rules before you apply for Medicaid.

Income

The general rule, subject to variations among jurisdictions, is that if an applicant’s income is less than the private pay rate of the nursing home, then he/she is income qualified. It is important to know that this general rule applies only to long-term care applicants residing in a nursing home. Some states have income limits for their home-based Waiver Programs

For couples, Medicaid follows the “name on the check rule;” that is, there is no commingling of income between spouses.

Medicaid eligibility rules provide for a shifting of income from the Institutionalized Spouse to the Community Spouse to assure that the Community Spouse has a base income. The maximum base income guaranteed the CS is $3,948.00 (2025). The minimum guaranteed amount, known as the Minimum Monthly Maintenance Needs Allowance (MMMNA), is $2,555.00 (2025).

Resource Eligibility for a Married Couple: The Community Spouse Resource Allowance

The individual in (or applying for) long-term custodial care is identified as the “Institutionalized Spouse ” and the spouse at home is the “Community Spouse.” All of their resources, regardless of whose name is on the title, are counted for purposes of Medicaid eligibility. This includes resources titled jointly with any third party, including children.

The Institutionalized Spouse cannot have assets exceeding the applicant’s resource limit. The Community Spouse is permitted keep a portion of the couple’s assets. In very basic terms, the Community Spouse is allowed to keep a Community Spouse Resource Allowance in an amount between $31,584.00 and $157,920.00 (2025). The amount of the Community Spouse Resource Allowance will depend on the value of the couple’s total countable resources when the Institutionalized Spouse first became institutionalized for a period of thirty days or more.