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 65 years old and older 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 (functional) and financial 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.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a Medicaid program. Alternatively, taking the Medicaid Eligibility Test can prove helpful. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible for Medicaid in Maine. More.
|2021 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||$2,382 / month*||$10,000||Nursing Home||Each spouse may have up to $2,382 / month*||$15,000 if in the same room. $10,000 each if in separate rooms / facilities.||Nursing Home||$2,382 / month for applicant*||$10,000 for applicant & $130,380 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,382 / month||$10,000||Nursing Home||Each spouse may have up to $2,382 / month||$15,000||Nursing Home||$2,382 / month for applicant||$10,000 for applicant & $130,380 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$1,074 / month||$10,000||None||$1,452 / month||$15,000||None||$1,452 / month||$15,000||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. An exception exists for Covid-19 stimulus checks, which do not count as income, and therefore, do not impact Medicaid eligibility.
When only one spouse of a married couple is applying for Medicaid waiver services or nursing home care, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. For clarification, income is not counted in this manner when just one spouse is applying for regular Medicaid. In this situation, the income of both the applicant and the non-applicant spouse is counted towards the income eligibility of the applicant spouse. For more information on how income is counted for Medicaid eligibility purposes, click here.
Relevant to married couples with only one spouse applying for nursing home Medicaid or HCBS waiver services, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA). This is the minimum amount of monthly income to which the non-applicant spouse is entitled and allows the Medicaid applicant to transfer income to the non-applicant spouse to ensure he or she has sufficient funds with which to live. From July 2021 – June 2022, the MMMNA is $2,177.50. That said, the non-applicant spouse may be entitled to an even greater spousal allowance (income allowance), up to $3,259.50 / month, based on one’s mortgage / rent and utility costs. (This figure is effective January 2021 – December 2021). Please note, this spousal impoverishment rule is not applicable when one spouse of a married couple is applying for regular Medicaid benefits.
*Note from the chart above that the income limit for nursing home Medicaid is $2,382 / month (in 2021) per applicant. That said, all of a beneficiary’s monthly income, minus a monthly personal needs allowance of $40, and potentially a monthly maintenance needs allowance for a non-applicant spouse, must be paid towards nursing home care.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, IRAs, 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 lives in it, or expresses an “intent” to return to it, and his / her equity interest in the home is under $906,000 (in 2021). (Equity interest refers to the amount of the home’s value owned by the applicant). If the applicant has a spouse who lives in the home, it is exempt regardless of where the applicant lives or the applicant’s equity interest in the home.
For married couples, with one spouse as a Medicaid nursing home applicant or Medicaid waiver applicant, the community spouse (the non-applicant spouse) can retain up to a maximum of $130,380 (in 2021) of the couple’s joint assets, as the chart indicates above. (Medicaid considers all assets of a married couple to be jointly owned). This, in Medicaid speak, is called the Community Spouse Resource Allowance (CSRA) and is intended to prevent spousal impoverishment of non-applicant spouses. As with the income allowance, the resource allowance does not apply to married couples with one spouse applying for regular Medicaid.
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 exemptions are in addition to the Medicaid asset limit of $2,000 for a single individual and $3,000 for a married couple. Hence, the higher asset limits show in the chart above.
It’s important to be aware that Maine has a 5-year Medicaid Look-Back Period. This is a period in which Medicaid checks to ensure no assets were transferred for less than fair market value. This includes assets that were gifted. If any assets were sold, transferred, or given away under fair market value (by the applicant or his / her non-applicant spouse) during the 60-months immediately preceding the date of one’s Medicaid application, a penalty 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, he or she becomes eligible for Medicaid for the remainder of the spend down period, which in Maine is 6 months.
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 reducing their countable 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 and to protect their home from Medicaid’s estate recovery program. 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, personal emergency response systems, 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 homes. 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.
How to Apply for Maine Medicaid
In Maine, MaineCare eligibility is determined by the Department of Health and Human Services’ (DHHS) Office for Family Independence (OFI). Persons can apply for Medicaid benefits online at My Maine Connection or in person at their district OFI office. Click here to find the office nearest you. In addition, persons can download an application here. There is an application for Regular Medicaid (MaineCare Application), as well as an application for nursing home Medicaid and HCBS Medicaid Waivers (Application for Long Term Care MaineCare). Completed applications can be dropped off at one’s local DHHS OFI office. Alternatively, applicants can return the completed application by fax or mail. The appropriate fax number and mailing address can be found on the application.
Before submitting a Medicaid application, it is vital that Maine seniors be certain that all eligibility requirements, as discussed above, are met. If one does not meet the income and / or asset limit(s), or are unsure if the eligibility criteria is met, Medicaid planning is strongly suggested. The Medicaid application process can be complicated, and if not done correctly, can result in a denial or delay of benefits. For more information on applying for long-term care Medicaid, click here.