Kansas Medicaid Definition
In Kansas, the Medicaid program is also called KanCare. The Kansas Department of Health and Environment (KDHE) is the agency that administers the state’s Medicaid program.
Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. While there are several different eligibility groups, the focus of this page is strictly on Medicaid eligibility for elderly Kansas residents, aged 65 and over. In addition, the focal point will be specifically on Medicaid for long term care, whether that is at home, in a nursing home, in an adult foster care home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Kansas seniors may be eligible. These programs have slightly different financial and medical (functional) eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that Kansas offers several pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – this is an entitlement (anyone who is eligible will receive assistance) program & is provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – there are a limited number of participant slots, which means wait lists may exist. Services are provided at home, adult day care, an adult foster care home, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled (ABD) – this is an entitlement (anyone who meets the requirements is able to receive benefits) program. Services are available at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a Kansas Medicaid program. Alternatively, it might be helpful to take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible for Medicaid in Kansas. More.
|2020 Kansas Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||No set income limit. Income over $62 / month must be paid towards one’s cost of care.||$2,000||Nursing Home||No set income limit. Income over $62 / month (per spouse) must be paid towards one’s cost of care.||$2,000 (per spouse)||Nursing Home||No set income limit. Income over $62 / month must be paid towards one’s cost of care.||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||No set income limit. Income over $1,157 / month must be paid towards one’s cost of care.||$2,000||Nursing Home||No set income limit. Income over $1,157 / month (per spouse) must be paid towards one’s cost of care.||$2,000 (per spouse)||Nursing Home||No set income limit. Income over $1,157 / month must be paid towards one’s cost of care.||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$475 / month**||$2,000||None||$475 / month**||$3,000||None||$475 / month**||$3,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include cash from family and friends, Veteran’s benefits, Railroad Retirement benefits, employment wages, alimony payments, pension payments, annuity payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends.
In the situation where just one spouse of a married couple is applying for institutional Medicaid or home and community based services Medicaid, only the income of the applicant is counted. This is often referred to as the “name on the check rule” and means that the income belongs to the person whose name is on the check. Therefore, a non-applicant spouse’s income is disregarded. For clarification purposes, it is important to mention that the “name on the check rule” does not apply for aged, blind and disabled Medicaid. In this situation, the income of the non-applicant spouse is considered along with the applicant spouse’s income.
There is also a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is relevant for non-applicant spouses of those who are applying for nursing home Medicaid or home and community based services via a Medicaid waiver. The MMMNA is the minimum amount of monthly income to which the non-applicant spouse is entitled. As of July 1, 2020, this figure is $2,155.00 / month and will increase again July 1, 2021. Based on shelter and utility costs, a community spouse (the non-applicant spouse, also called the well spouse) may be entitled to a greater amount of monthly income, up to $3,216.00 / month. (This figure is effective January 2020 and will increase again in January 2021). This rule allows the applicant spouses to transfer income to their non-applicant spouses to ensure they have sufficient monthly income with which to live. For clarification purposes, the MMMNA is not relevant for couples with one spouse applying for regular Medicaid. For more clarity on how Medicaid counts income, click here.
**As one can see above, the income limit for ABD Medicaid is quite low. That said, seniors who receive Supplemental Security Income (SSI) payments automatically qualify for Medicaid. As of 2020, this pathway to Medicaid eligibility allows a single elderly person up to $783 / month in income, while it allows married couples as much as $1,175 / month in income.
What Defines “Assets”
Countable assets, sometimes called liquid assets, are those that can easily be converted to cash to help cover the cost of long-term care. Examples of countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, pension funds, and real estate in which one does not reside. However, for Medicaid eligibility purposes, there are many assets that are considered exempt, or said another way, are not counted towards the asset limit. Exemptions include personal keepsakes and belongings, household goods and furnishings, one automobile, life insurance policies with a death benefit (also called face value) up to $1,500, burial spaces, irrevocable burial plans, and one’s primary home, given the Medicaid applicant resides in the home, or expresses an “intent” to return to it, and his / her equity interest in the home is under $595,000 (in 2020). (Equity interest is the amount of the home’s value owned by the applicant). If a non-applicant spouse lives in the home, even without the applicant spouse, it is exempt regardless of the applicant’s equity interest in the home.
For married couples, as of 2020, the community spouse can retain half of the couples’ joint assets, up to a maximum of $128,640, as the chart indicates above. That said, the community spouse is able to keep 100% of the assets up to $25,728. This, in Medicaid speak, is known as the Community Spouse Resource Allowance (CSRA). This rule, like the spousal income allowance rule, is only for married couples with one spouse applying for nursing home Medicaid or a HCBS Medicaid waiver. To be very clear, there is no spousal asset allowance for non-applicant spouses of those applying for regular Medicaid.
One should be aware that Kansas has a Medicaid Look-Back Period. This is a period of 60 months (5 years) that backdates from one’s Medicaid application date. During this time frame, Medicaid checks all past asset transfers (including asset transfers made by one’s spouse) to ensure no assets were sold or given away under fair market value. This is done so one does not simply give away assets in order to meet Medicaid’s asset limit. If one is found to be in violation of the look-back period, a period of Medicaid ineligibility will result.
Qualifying When Over the Limits
For Kansas elderly residents (65 and over) who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – In Kansas, there is a Spend Down Program that is specifically intended for those that are categorically aged, blind or disabled that have income over the Medicaid limit. (As the chart indicates above, as of 2020, the income limit is $475 for a single applicant, as well as a married couple with both spouses applying for Medicaid). In a nutshell, one may still be eligible for Medicaid services even if they are over the income limit by paying their excess income (the income over the Medicaid income limit) on medical bills. Once one has met their “spend-down”, which can be thought of as a deductible, for the spend-down period, he / she will receive Medicaid benefits for the remainder of that period. (The spend-down period in Kansas is six months.)
Make note, the Spend Down Program does not assist one in spending down assets in excess of the asset limit for Medicaid qualification. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above pathway of action cannot help one become asset eligible.
However, one can “spend down” assets by spending excess assets on non-countable ones, such as home modifications for safety and accessibility purposes. Examples include the addition of wheelchair ramps, stair lifts, walk-in showers, and the addition of first floor bedrooms. Other ways to “spend down” excess assets include prepaying funeral and burial expenses, as well as paying off debt. As mentioned above, when spending down assets, it’s important that one does not give away assets or sell them for under market value. Doing so can result in a penalty period of Medicaid ineligibility.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Kansas Medicaid Programs
In addition to nursing home care, KanCare offers a program that helps nursing home qualified persons remain living outside of nursing homes. This is called the HCBS Frail Elderly (HCBS/FE) Waiver. Intended as a nursing home diversion program for Kansas seniors who require a nursing home level of care, supportive services to promote independent living are provided. Benefits may include adult day care, assisted living services, home modifications, durable medical equipment, and more.
How to Apply for Kansas Medicaid
Elderly Kansas residents are able to apply for Medicaid online via the KanCare Medical Consumer Self-Service Portal. In addition, applicants can call the Kansas Department of Health and Environment at 1-800-792-4884 for additional program information or to get an application. Completed paper applications can be mailed to KanCare Clearinghouse (P.O. Box 3599, Topeka, KS 66601-9738) or faxed to 1-844-264-6285. In addition, seniors can contact their local Aging and Disability Resource Center (ADRC) for more information or for assistance with the application process.
Prior to completing the application process for Medicaid, it is crucial that applicants are confident the eligibility criteria discussed above are met. Seniors who are over the income and / or asset limit(s), or are unsure if they meet all the requirements, should strongly consider Medicaid planning. Applying for long-term care Medicaid is frequently a complicated and lengthy process. To learn more about the application process, click here.