Maine Medicaid (MaineCare) Income & Asset Limits for Nursing Homes & Long Term Care

Last updated: May 30, 2024

 

Maine Medicaid Long-Term Care Definition

Medicaid is a health care program for low-income individuals of any age. While there are varying coverage groups, the focus here is long-term care Medicaid eligibility for elderly Maine residents, aged 65 and over. In addition to nursing home care, ME Medicaid (MaineCare) pays for non-medical services and supports to help frail seniors live in their homes or in residential care facilities (including assisted living residences and adult family care homes). There are three categories of Medicaid long-term care programs for which Maine seniors may be eligible.

1) Institutional / Nursing Home Medicaid – An entitlement; anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.

2) Medicaid Waivers / Home and Community Based Services – Not an entitlement; there are a limited number of participant slots. Intended to delay nursing home admissions, benefits are provided at home and in adult day care. More on Waivers.

3) Regular Medicaid / Aged Blind and Disabled – An entitlement; meeting the eligibility requirements guarantees one will receive benefits. Various long-term care services, such as personal care assistance or adult day care, may be available.

Medicaid in Maine is called MaineCare. While jointly funded by the state and federal government, it is administered by the state within federally set parameters. The State of Maine Department of Health and Human Services (DHHS) is the administering agency.

  The American Council on Aging now offers a free, quick and easy Medicaid Eligibility Test for seniors.

 

Income & Asset Limits for Eligibility

The three categories of Medicaid long-term care programs have varying medical (functional) and financial eligibility requirements. Further complicating financial eligibility is that the criteria changes annually, varies with marital status, and that Maine offers multiple pathways towards eligibility.

 Simplified Eligibility Criteria: Single Nursing Home Applicant
Maine seniors must have limited income and assets, and a medical need to qualify for Medicaid long-term care. In 2024, a single Nursing Home Medicaid applicant must meet the following criteria: 1) Income under $2,829 / month 2) Assets under $10,000 3) Require a Nursing Home Level of 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 MaineCare / ME Medicaid program. Alternatively, taking the Medicaid Eligibility Test can prove helpful. IMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Maine. More.

2024 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 $2,829 / month* $10,000† Nursing Home $2,829 / month per spouse* $15,000 if sharing a room / $20,000 ($10,000 each) if in separate rooms or facilities† Nursing Home $2,829 / month for applicant* $10,000 for applicant & $154,140 for non-applicant† Nursing Home
Medicaid Waivers / Home and Community Based Services $2,829 / month‡ $10,000† Nursing Home $2,829 / month per spouse‡ $15,000† Nursing Home $2,829 / month for applicant‡ $10,000 for applicant & $154,140 for non-applicant† Nursing Home
Regular Medicaid / Aged Blind and Disabled $1,255 / month $10,000† Help with ADLs $1,704 / month $15,000† Help with ADLs $1,704 / month $15,000† Help with ADLs
*All of a beneficiary’s monthly income, minus a monthly Personal Needs Allowance of $40, Medicare premiums, and potentially a Needs Allowance for a non-applicant spouse, must go towards nursing home costs. This is called a Patient Liability.
While the asset limit is technically $2,000 for an individual and $3,000 for a couple, Maine allows an extra exemption of $8,000 in savings for an individual and $12,000 for a couple.
Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level.

 

Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly any income from any source that a Medicaid applicant receives is counted towards Medicaid’s income limit. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in ME, the VA Aid & Attendance Pension, which is above and beyond the Basic VA Pension, does not count as income.

Treatment of Income for a Couple
When only one spouse of a married couple applies for Nursing Home Medicaid or a Waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and does not impact the income eligibility of their 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 Rule and is the minimum amount of monthly income a non-applicant spouse is said to require to avoid spousal impoverishment.

The MMMNA is $2,555 (eff. 7/1/24 – 6/30/25). If a non-applicant’s monthly income falls under $2,555, income can be transferred to them from their applicant spouse, bringing their income up to this level. In Maine, a non-applicant spouse can further increase their Spousal Income Allowance if their housing and utility costs exceed a “shelter standard” of $766.50 / month (eff. 7/1/24 – 6/30/25). However, in 2024, a Spousal Income Allowance cannot push a non-applicant’s total income over $3,854 / month. This is the Maximum Monthly Maintenance Needs Allowance. More about how this allowance is calculated.

Income is counted differently when only one spouse applies for Regular Medicaid / Aged Blind and Disabled; the income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. Furthermore, there is no Monthly Maintenance Needs Allowance for a non-applicant spouse. More on how Medicaid counts income.

 

Asset Definition & Exceptions

Countable vs. Non-Countable Assets
The value of countable assets are added together and counted towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. In Maine, IRAs / 401Ks are counted. There are also many assets that Medicaid considers to be 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), prepaid burial contracts up to $12,000, and generally one’s primary home.

Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. The non-applicant spouse of a Nursing Home Medicaid or Medicaid Waiver applicant, however, is permitted a Community Spouse Resource Allowance (CSRA). This is a Spousal Impoverishment Provision, and in 2024, allows the community spouse (the non-applicant spouse) to retain up to $154,140 of the couple’s assets. There is no CSRA for a non-applicant spouse of a Regular Medicaid applicant.

Medicaid’s Look-Back Rule
Maine has a 5-year Medicaid Look-Back Period that immediately precedes the date of one’s Nursing Home Medicaid or Medicaid Waiver application. 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 this rule has been violated, the Medicaid agency assumes it was done to become asset-eligible and a Penalty Period of Medicaid ineligibility for long-term care will be calculated. There is no Look-Back Period for Regular Medicaid.

The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, this rule allows individuals to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s Look-Back Period.

 

Maine Medicaid Home Exemption Rules

For home exemption, the Medicaid applicant or their spouse must live in their home. If there is no spouse in the home, there is a home equity interest limit of $750,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of home equity owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. For Regular Medicaid, there is no home equity interest limit. Other exemptions exist.

While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, Maine’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

 

Medical / Functional Need Requirements

An applicant must have a medical need for long-term care Medicaid. For Nursing Home Medicaid and Medicaid Waivers, a Nursing Home Level of Care (NHLOC) is required. Furthermore, additional criteria may need to be met for specific program benefits. For example, for a Waiver to cover the cost of home modifications, an inability to safely live at home without modifications may be necessary. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NHLOC is not necessarily required.

 

Qualifying When Over the Limits

For elderly Maine residents (aged 65+) who do not meet the financial eligibility requirements above, there are other ways to qualify for Medicaid.

1) Medically Needy Pathway – Also called a Spend-Down Program, this program allows seniors who are over Medicaid’s income limit to still become income-eligible by spending the majority of their income on medical expenses. This may include Medicare premiums, eyeglasses, dental services, and doctor visits. In 2024, the Medically Needy Income Limit (MNIL), also called a Protected Income Level in ME, is $315 / month for an individual and $341 / month for a couple. The “spend down” amount, which can be thought of as a deductible, is the difference between one’s monthly income and the MNIL. In ME, it is calculated for a 6-month period. Once the “spend down” is met, one will be Medicaid-eligible for the remainder of the period. The Medically Needy Asset Limit is $2,000 for an individual and $3,000 for a couple.

2) Asset Spend Down – Persons who have assets over MaineCare’s limit can still become asset-eligible by spending down extra assets on non-countable ones. Examples include paying for home modifications, like the addition of wheelchair ramps or stair lifts, 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 this rule was not violated.

 Our MaineCare Spend Down Calculator can assist persons in determining if they might have a spend down, and if so, provide an estimate of the amount.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, but they still cannot afford their cost of long-term 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 Medicaid’s Estate Recovery Program. Connect with a Medicaid Planner.

 

Specific Maine Medicaid Programs

In addition to paying for nursing home care, Medicaid in Maine offers three programs relevant to the elderly that provide services and supports at home and in the community.

1) Elderly and Adults with Disabilities Medicaid Waiver – This program pays for home care, home modifications, personal emergency response systems, respite care, and other supportive services that allows nursing home-qualified persons to live in their homes.

2) Consumer Directed Attendant Services (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. This allows beneficiaries to choose their care provider and can even hire family members to provide care.

3) Money Follows the Person – Also called Homeward Bound in Maine. This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.

 

How to Apply for Maine Medicaid

MaineCare eligibility is determined by Maine’s 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. Alternatively, applications can be downloaded here. There are separate applications for Regular Medicaid (MaineCare Application) and Nursing Home Medicaid / HCBS Medicaid Waivers (Long Term Care Application). Completed applications can be dropped off at one’s local DHHS OFI office or submitted by fax or mail. The appropriate fax number and mailing address can be found on the application. The application process may vary based on the program for which one is applying.

Before submitting a MaineCare 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. Familiarizing oneself with general information about the application process for long-term care Medicaid can be helpful.

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