Maryland Medicaid Eligibility for Long Term Care: Income & Asset Limits

Last updated: February 08, 2022

 

Maryland Medicaid Definition

In Maryland, Medicaid is also called Medical Assistance, or simply MA. The program that provides long term care for the aged, blind, and disabled is called Long Term Services and Supports (LTSS).

Medicaid is a jointly funded state and federal health care program for low-income individuals of all ages. While there are many different Medicaid coverage groups, the focus of this page is Medicaid eligibility for elderly Maryland residents, aged 65 and over. Specifically, long term care is covered. In addition to nursing home care and care services in adult foster care homes and assisted living residences, MD Medicaid pays for non-medical support services to help frail seniors remain living at home.

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

 

Income & Asset Limits for Eligibility

There are several long-term care Medicaid programs for which Maryland seniors may be eligible. These programs have varying 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 Maryland offers multiple pathways towards eligibility.

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

2) Medicaid Waivers / Home and Community Based Services (HCBS) – These programs are not entitlements; There are a limited number of participants and wait lists may exist. Intended to prevent and delay nursing home admissions, benefits are provided at home, adult day care, adult foster care, or in assisted living. More on waivers.

3) Regular Medicaid / Aged Blind and Disabled (ABD) – This is an entitlement program; Meeting the eligibility requirements ensures one 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 Maryland Medicaid / Medical Assistance 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 Medical Assistance. More.

2022 Maryland 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 Cannot exceed the cost of nursing home care* $2,500 Nursing Home Cannot exceed the cost of nursing home care* $6,000 ($3,000 per spouse). After 6 months, $2,500 per spouse. Nursing Home Cannot exceed the cost of nursing home care* $2,500 for applicant & $137,400 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $2,523 / month† $2,000 Nursing Home $2,523 / month per spouse† $3,000 Nursing Home $2,523 / month for applicant† $2,000 for applicant & $137,400 for non-applicant Nursing Home
Regular Medicaid / Aged Blind and Disabled $350 / month‡ $2,500 Help with ADLs $392 / month‡ $3,000 Help with ADLs $392 / month‡ $3,000 for the applicant Help with ADLs
*With the exception of a personal needs allowance of $84 / month, Medicare premiums, and potentially a monthly spousal income allowance for a non-applicant spouse, all of a beneficiary’s monthly income must go towards the cost of nursing home care.
†Based on one’s living setting, a beneficiary may not be able to keep monthly income up to this level.
‡Persons who are eligible for SSI are automatically eligible. In 2022, this pathway to Medical Assistance eligibility allows a single applicant income up to $841 / month and a couple up to $1,261 / month. The asset limit is $2,000 for a single applicant and $3,000 for a couple.

 

What Defines “Income”

Any income that a Medicaid applicant receives is counted. 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. Holocaust restitution payments and Covid-19 stimulus checks are an exception and do not count as income.

When only one spouse of a married couple applies for nursing home Medicaid or a Medicaid waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and does not impact their spouse’s income eligibility. 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 living in poverty. In MD, 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 to them from their applicant spouse, bringing their income up to this level.

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 cannot 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 both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. For additional information on how Medicaid counts income, click here.

 

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. There are also many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and generally one’s primary home. For home exemption, the Medicaid applicant must live in their home or have intent to return, and in 2022, their home equity interest cannot be more than $636,000. Equity interest is the value of the home in which the individual owns. The home is automatically exempt if a non-applicant spouse lives in it.

 While one’s home is usually 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, Maryland’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.

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 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.

Maryland has a 60 month Medicaid Look-Back Period that immediately precedes one’s Medicaid application date. During this period, Medicaid checks to ensure no assets were gifted or sold under fair market value. If this has been done, the Medicaid agency assumes it was done to meet Medicaid’s asset limit. For persons who violate the look-back rule, a penalty period of Medicaid ineligibility is calculated.

 Non-Financial Eligibility Requirements – For Maryland long term care Medicaid eligibility, an applicant must have a functional need for such care. For nursing home Medicaid and Medicaid waivers, a nursing facility level of care (NFLOC) is required. Furthermore, some programs benefits (i.e., home modifications) may require additional criteria be met, such as the inability to safely live independently without modifying the home. For long-term care services via the regular Medicaid program, a functional need with the activities of daily living is required, but a NFLOC is not necessarily required.

 

Qualifying When Over the Limits

For Maryland 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 – Maryland has a program called the ABD (Aged, Blind, or Disabled) Spenddown for seniors who have income over Medicaid’s limit. This program allows persons to become income-eligible for Medicaid services by spending the majority of their income on medical expenses. This may include medical care/treatment/supplies, Medicare premiums, and prescription drugs. In 2022, the medically needy income limit (MNIL) is MD is $350 / month for an individual and $392 / month for a couple. The “spenddown” amount, which can be thought of as a deductible, is the difference between one’s monthly income and the MNIL. In MD, it is calculated for a 6 month period. Once the “spenddown” is met, one will be income-eligible for the remainder of the period. The medically needy asset limit is $2,500 for an individual and $3,000 for a couple.

2) Asset Spend Down – Seniors who have assets over Medicaid’s limit can still become asset-eligible by reducing countable assets. This can be done by “spending down” extra assets on ones that are non-countable. Examples include making home accessibility and safety modifications, like the addition of wheelchair ramps, stair lifts, pedestal sinks, and replacing carpet with a more wheelchair friendly surface. Other options 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.

 Our free spend down calculator can assist persons in determining if they might have a spend down, and if so, provide an estimate of the amount. Calculate your spend down.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income”, “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 Medicaid’s estate recovery program. Read more or connect with a Medicaid planner.

 

Specific Maryland Medicaid Programs

Like all states, MD Medicaid / Medical Assistance pays for nursing home care for those persons who medically require a nursing home level of care and are financially eligible. MD also has programs for seniors who require nursing home level care or have slightly lesser care requirements and do not wish to reside in a nursing home. These programs provide care at home or “in the community”.

1) Community Options Medicaid Waiver (CO) – Also called the Home and Community Based Options Waiver (HCBOW), and previously called the Waiver for Older Adults, this program provides services to help persons live independently at home or in an assisted living residence. This program is currently only accepting applications from state residents who reside in Medicaid-funded nursing homes and wish to transition back into the community. Those who reside in the community can have their name added to a “registry” (a waiting list) and will be notified when they can submit an application for waiver services.

2) Community Personal Assistance Services (CPAS) – Personal care assistance and nurse monitoring are provided under the state Medicaid program, which means there are no wait lists for services. Program participants are able to self-direct their own care, allowing them to hire the caregiver of their choosing, including family members.

3) Community First Choice Program (CFC) – A state plan option that enables program participants to receive a variety of care assistance and support, such as personal assistance, meal delivery, home health care, nurse monitoring, and personal emergency response systems. Program participants are able to self-direct their own care, meaning they can hire, train, and supervise the care provider of their choice. Since these services are part of the regular state plan Medicaid, there are no waitlists.

4) Medical Day Care Services Waiver (MDCSW) – This waiver provides medical day care, such as nursing and rehabilitation therapy, in adult day centers for seniors and disabled adults who require a level of care consistent with nursing home care.

5) Increased Community Services (ICS) – Transitional services are available for physically disabled adults and frail seniors who wish to return to living at home or an assisted living facility from an institutional setting. Supportive services include home modifications, personal care assistance, meal delivery, and assistive technology.

6) 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 and eye care, may be available.

 

How to Apply for Maryland Medicaid

Seniors can apply for Maryland Medicaid / Medical Assistance online at myDHR, in person at their local Department of Human Resources Social Services Office, or mail a completed application to their local Social Services Office. To find the Social Services Office nearest you, click here. Seniors can download an application here for regular Medicaid, and here seniors can download a Long-Term Care / Waiver application. One’s local Area Agency on Aging office might be helping in answering questions and providing application assistance.

Before submitting a Medicaid application in Maryland, it is extremely important that seniors are confident that all eligibility requirements, as discussed above, are met. If one does not meet the criteria, or is unsure, Medicaid planning is strongly suggested. The Medicaid application process can be both complicated and lengthy, and if not done correctly, can result in denial or delay of benefits. For additional information on applying for long-term care Medicaid, click here.

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