Kansas Medicaid Definition
In Kansas, the Medicaid program is called KanCare. The Kansas Department of Health and Environment (KDHE) is the agency that administers KanCare.
Medicaid is a jointly funded state and federal health care program for low-income individuals of all ages. While there are several coverage groups, the focus of this page is strictly on Medicaid eligibility for elderly Kansas residents, aged 65 and over. Specifically, Medicaid for long term care is covered. In addition to care services in nursing homes, assisted living facilities, and adult foster care homes, KS Medicaid pays for non-medical services and supports to help frail seniors remain living in their homes.
Income & Asset Limits for Eligibility
There are different Medicaid long-term care programs for which Kansas seniors may be eligible. These programs have differing financial and medical (functional) eligibility requirements, as well as 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 program; Anyone who is eligible will receive assistance. Benefits are provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – These are not entitlement programs; There are a limited number of participant slots and wait lists may exist. Intended to delay the need for nursing home admissions, services are provided at home, adult day care, an adult foster care home, or in assisted living. More on Waivers.
3) Regular Medicaid / Aged Blind and Disabled (ABD) – This is an entitlement program; Anyone who meets the requirements will receive benefits. Limited long-term care services, such as personal care assistance or adult day care, may be available.
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, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Kansas. More.
|2022 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*
|$2,000||Nursing Home||No set income limit*
|$3,000||Nursing Home||No set income limit*
|$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||No set income limit†||$2,000||Nursing Home||No set income limit†||$3,000||Nursing Home||No set income limit†||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$475 / month‡||$2,000||Help with ADLs||$475 / month‡||$3,000||Help with ADLs||$475 / month‡||$3,000||Help with ADLs|
†Any income over $2,523 / month must go towards care costs. An exception may exist for paying for private health insurance and potentially a spousal income allowance for a non-applicant spouse.
‡While the income limit for Regular Medicaid is quite low, seniors who receive Supplemental Security Income (SSI) payments automatically qualify for Medicaid. In 2022, this pathway to Medicaid eligibility allows a single elderly person up to $841/ month in income, while it allows married couples as much as $1,261 / month in income.
What Defines “Income”
Any income that a Medicaid applicant receives is counted. 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. Holocaust restitution payments and Covid Stimulus checks do not count as income, and therefore, do not impact Medicaid eligibility.
When just one spouse of a married couple applies for Institutional Medicaid or a Medicaid Waiver, only the income of the applicant is counted. This is often called 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 and does not impact the income eligibility of their applicant spouse. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse. The MMMNA is a spousal impoverishment provision and is the minimum amount of monthly income a non-applicant spouse is said to require to avoid spousal impoverishment. In KS, the MMMNA is $2,288.75 (effective 7/1/22 – 6/30/23). If a non-applicant’s monthly income falls under $2,288.75, income can be transferred from their applicant spouse, bringing their income up to this level.
In Kansas, a non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $686.63 / month (effective 7/1/22 – 6/30/23). However, in 2022, a spousal income allowance put a non-applicant’s monthly income over $3,435. This is the Maximum Monthly Maintenance Needs Allowance. Learn more about how the spousal income allowance is calculated.
Income is counted differently when only one spouse applies for Regular Medicaid / Aged Blind and Disabled; The income of the non-applicant spouse is considered along with the applicant spouse’s income. For more clarity on how Medicaid counts income, click here.
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 include cash, stocks, bonds, investments, credit union, savings, and checking accounts, pension funds, and real estate in which one does not reside. There are also many assets that are considered exempt; They 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 generally one’s primary home. For home exemption, the Medicaid applicant must reside in the home or have intent to return, and in 2022, their home equity interest must be under $636,000. Equity interest is the amount of the home’s value owned by the applicant. If a non-applicant spouse lives in the home, it is automatically exempt
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, spousal impoverishment rules permit the non-applicant spouse of a Medicaid nursing home or Waiver applicant a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can retain 50% of the couples assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s half of the assets is under $27,480, 100% of the assets, up to $27,480 can be retained by the non-applicant.
Kansas has a 60 month (5 year) Medicaid Look-Back Period that immediately precedes the date of one’s Medicaid application. During this period, Medicaid checks all past asset transfers, including asset transfers made by one’s spouse, to ensure no assets were gifted or sold under fair market value. This is done to discourage persons from gifting assets to meet Medicaid’s asset limit. Violating the look back rule, even unintentionally, results in a penalty period of Medicaid ineligibility.
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 – Kansas has a Spend Down Program for persons categorically aged, blind or disabled who have income over the Medicaid limit. This program allows persons to become income-eligible for Medicaid services by spending the majority of their income on medical bills. In 2022, the medically needy income limit, called the protected income level in KS, is $475 / month for an individual, as well as a couple. The “spend down” amount is the difference between one’s monthly income and the protected income level. This can be thought of as a deductible and is calculated for a 6 month period. Once one has met their “spend down”, they are eligible for Medicaid benefits for the remainder of the period. The medically needy asset limit is $2,000 for an individual and $3,000 for a couple. Learn more about the medically needy pathway.
2) Asset Spend Down – Persons who have assets over Medicaid’s limit can “spend down” assets and become Medicaid eligible. This can be done by spending excess assets on non-countable ones, such as home modifications for safety and accessibility purposes. This includes installing wheelchair ramps, stair lifts, walk-in showers, and the addition of first floor bedrooms. Other ways to “spend down” assets include prepaying funeral and burial expenses and paying off debt. Remember, assets cannot be gifted or sold under fair market value, as doing so violates Medicaid’s look back rule. It is recommended one keep documentation of how assets were spent as proof the look back rule was not violated.
3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” or “over-asset” or both, but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from the Medicaid estate recovery program. Read more or connect with a Medicaid planner.
Specific Kansas Medicaid Programs
In addition to nursing home care, KanCare offers two other programs that help nursing home qualified persons remain living outside of nursing homes.
1) HCBS Frail Elderly (HCBS/FE) Waiver – Supportive services to promote independent living are provided. Benefits may include adult day care, assisted living services, adult foster care services, home modifications, durable medical equipment, and more.
2) Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care services, and Medicare are combined into one program. Additional benefits, such as dental care and eye care, may be available.
How to Apply for Kansas Medicaid
Elderly Kansas residents can apply for Medicaid online via the KanCare Medical Consumer Self-Service Portal. Applicants can call the Kansas Department of Health and Environment at 1-800-792-4884 for additional program information or to request 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. Seniors can contact their local Aging and Disability Resource Center (ADRC) for more information or for application assistance.
Prior to applying for Kansas Medicaid / KanCare, it is vital that one is confident that 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.