Michigan Medicaid Definition
In the state of Michigan, Medicaid is often called Medical Assistance (MA) but the program provides for more benefits than simply medical assistance. Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income families and individuals of all ages. That being said, this page is focused strictly on Medicaid eligibility for elderly Michigan residents who are a minimum of 65 years of age. The focal point is also on long-term care, whether that be at home, in a nursing home or in an assisted living facility. Eligibility for Medicaid in Michigan is determined by the Michigan Department of Human Services.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Michigan seniors may be eligible. These programs have slightly different eligibility requirements and benefits. Further complicating eligibility are the facts that the criteria vary given one is single or married, and that Michigan offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – is an entitlement (anyone who is eligible will receive assistance) & 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 and is provided at home or adult day care.
As mentioned previously, eligibility for these programs is complicated by the facts that the criteria vary with marital status, and that Michigan 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 Medical Assistance in Michigan. More.
|2018 Michigan 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||$2,250 / month||$2,000||Medically necessary||$3,375 / month||$3,000||Medically necessary||$2,250 / month for applicant||$2,000 for applicant & $123,600 for non-applicant||Medically necessary|
|Medicaid Waivers / Home and Community Based Services||$2,250 / month||$2,000||Help w/ 2 ADLs||$3,375 / month||$3,000||Help w/ 2 ADLs||$2,250 / month for applicant||$2,000 for applicant & $123,600 for non-applicant||Help w/ 2 ADLs|
|Regular Medicaid / Aged Blind and Disabled||$1,012 / month||$2,000||None||$1,372/ month||$2,000||None||$1,012 / month||$2,000||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. 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 falls between $2,057.50 / month and $3,090 / month). This 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, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the home is valued under $572,000 (in 2018). For married couples, as of 2018, the community spouse (the non-applicant spouse) can retain up to a maximum of $123,600 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).
It’s important that one cannot give away assets or sell them under fair market value in order to reach the Medicaid asset limit. In Michigan, doing so puts one in violation of Medicaid’s 5-Year Look-Back Period, resulting in a period of Medicaid disqualification.
Qualifying When Over the Limits
For Michigan residents who are 65 years of age 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 – The Medically Needy Pathway provides a means for one who has income over Medicaid’s income limit to still qualify for services if they have high medical expenses respective to their income level. In Michigan, this program is known as Medicaid Spend-down. In simple terms, once a Medicaid applicant has spent his or her excess income (the amount of income over the established income limit) on medical bills and care services, he or she will become eligible for Medicaid services for the remainder of the month.
Unfortunately, Michigan’s Medicaid Spend-down program does not provide assistance in spending down extra assets for Medicaid qualification. Therefore, if income requirements are met for eligibility purposes, but not the asset requirement, the Medically Needy Pathway cannot assist one in “spending down” extra assets. However, there is a way in which one can “spend down” excess assets in order to meet the asset limit for Medicaid eligibility; Spend excess assets on non-countable assets. Examples include home repair (fixing a leaking roof), home modifications (addition of wheelchair ramps or walk-in tub), 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 Michigan Medicaid Programs
Nursing home care is an entitlement covered by the Michigan Medicaid / Medical Assistance program. For all state residents that meet the financial and functional requirements, the state will pay for their care regardless of their length of residency in Michigan. In addition, Michigan offers several other Medicaid funded programs that provide for care outside of nursing homes. These include MI Choice and the Home Help Program.
1. MI Choice Waiver Program – this “HCBS waiver” provides supportive services to help nursing home qualified persons avoid nursing home placement. It includes benefits such as adult day care, home modifications to enable aging in place and many other supports. Enrollment is limited.
2. Home Help Program – is the formal name for a benefit under the state regular Medicaid program. It is an entitlement for those who are qualified and provides for personal care in one’s home.