Maine Medicaid Definition
Medicaid in Maine is called MaineCare. Medicaid is a wide-ranging, jointly funded federal and state health care program for low-income individuals of any age. However, this page is focused on Medicaid eligibility for elderly Maine residents who are a minimum of 65 years old who require long-term care, whether that is at home, in a nursing home or in an assisted living residence.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Maine seniors may be eligible. These programs have medical and functional eligibility requirements, although the exact requirements differ, as do the programs’ benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that Maine offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – is an entitlement (anyone who is eligible will receive assistance) and is provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services – Limited number of participants. Provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – is an entitlement (meeting the eligibility requirements guarantees one will receive services) and is provided at home or adult day care.
Eligibility for these programs is complicated by the facts that the criteria vary with marital status and that Maine offers multiple pathways towards eligibility. The table below provides a quick reference to allow seniors to determine if they are immediately eligible for long term care from a Medicaid program. Alternatively, 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 Maine. More.
|2019 Maine 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||$2,313 / month||$10,000||Nursing Home||Each spouse may have up to $2,313 / month||$15,000||Nursing Home||$2,313 / month for applicant||$10,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,313 / month||$10,000||Help w/ 2 Activities of Daily Living||Each spouse may have up to $2,313 / month||$15,000||Help w/ 2 Activities of Daily Living||$2,313 / month for applicant||$10,000 for applicant & $126,420 for non-applicant||Help w/ 2 Activities of Daily Living|
|Regular Medicaid / Aged Blind and Disabled||$1,041 / month||$10,000||None||$1,410/ month||$15,000||None||$1,041 / month for applicant||$10,000||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 employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. (For more information on how income is counted for Medicaid eligibility purposes, click here). There is also a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which the non-applicant spouse is entitled. As of July 2018, this figure is $2,057.50 / month. (This figure is set to increase again in July 2020). That said, the non-applicant spouse may be entitled to an even greater spousal allowance, up to $3,160.50 / month, based on one’s mortgage / rent and utility costs. (This greater figure won’t increase again until January 2020). This spousal impoverishment rule allows the Medicaid applicant to transfer income to the non-applicant spouse to ensure he or she has sufficient funds with which to live.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, two automobiles (one must be needed for a specific purpose, such as transportation to medical appointments), irrevocable burial trusts, and one’s primary home, given the Medicaid applicant or his or her spouse lives in the home and the home is valued under $878,000 (in 2019). For married couples, as of 2019, the community spouse (the non-applicant spouse) can retain up to a maximum of $126,420 of the couple’s joint assets, as the chart indicates above. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA).
Make note, Maine is unique in that the state allows a single individual an exemption of $8,000 in liquid assets and married couples an exemption of $12,000. (Liquid assets include checking and savings accounts). These amounts are in addition to the Medicaid asset limit of $2,000 for a single individual and $3,000 for a married couple. Hence, the $10,000 asset limit shown above for a single senior and the $15,000 asset limit for a married couple in which both spouses are applying for Medicaid.
It’s important to be aware that Maine has a 5-year Medicaid Look-Back Period. This is a period of time in which Medicaid checks to see if any assets were sold, gifted, or transferred. If any assets were sold, transferred, or given away under fair market value during this time frame, violating the look-back period, a period of Medicaid ineligibility for long-term care will ensue.
Qualifying When Over the Limits
For Maine 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 – This program allows seniors who meet all other Medicaid eligibility requirements, but have income over the limit to still be eligible for Medicaid if they have high medical expenses. Often referred to as a “Spend-Down” Program, one’s “excess income,” (their income over the Medicaid eligibility limit), is used to cover medical bills. Examples include Medicare premiums, eyeglasses, dental services, and doctor visits. Once one has met his or her spend-down, sometimes called a deductible, one becomes eligible for Medicaid.
Make note, the Medically Needy Pathway does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in “spending down” extra assets. However, there are several ways one can “spend down” non-exempt assets and still qualify for MaineCare. Examples include paying for home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt.
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 Maine Medicaid Programs
MaineCare covers the cost of nursing home care for all state residents that 1) require the level of care provided in a nursing home and 2) are financially eligible for the program. However, for some residents MaineCare will instead pay for home care, home modifications, adult day care, and other supportive services that allows nursing home-qualified persons to live in their homes. This service is provided through the Elderly and Adults with Disabilities Medicaid Waiver.
Another non-nursing home program relevant to seniors is a benefit called Consumer Directed Attendant Services or CDAS. Under CDAS, beneficiaries can receive assistance with their activities of daily living (attendant care) in their home. Beneficiaries are also given the option to “consumer direct” their care provider. Stated another way, beneficiaries can choose their care provider and can even hire family members to provide care.