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, an adult foster care 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, which means there may be a waitlist for benefits. Provided at home, adult day care, adult foster care, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – is an entitlement (meeting the eligibility requirements ensures one will receive assistance) 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, one can 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.
|2020 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||$2,349 / month*||$2,000||Medically necessary||Each spouse is allowed up to $2,349 / month*||$3,000||Medically necessary||$2,349 / month for applicant*||$2,000 for applicant & $128,640 for non-applicant||Medically necessary|
|Medicaid Waivers / Home and Community Based Services||$2,349 / month||$2,000||Help w/ 2 Activities of Daily Living||Each spouse is allowed up to $2,349 / month||$3,000||Help w/ 2 Activities of Daily Living||$2,349 / month for applicant||$2,000 for applicant & $128,640 for non-applicant||Help w/ 2 Activities of Daily Living|
|Regular Medicaid / Aged Blind and Disabled||$1,063 / month||$2,000||None||$1,437 / month||$3,000||None||$1,437 / month||$3,000||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.
When only one spouse of a married couple is applying for home and community based services via a Medicaid waiver or for Medicaid nursing home care, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. However, the calculation of income is done differently for couples in which only one spouse is applying for regular Medicaid. In this situation, the income of both spouses is calculated together to determine the income eligibility of the applicant spouse. (If you’d like to learn more about how Medicaid counts income, click here).
Also relevant to married couples with one spouse applying for nursing home Medicaid or a HCBS Medicaid waiver is a Minimum Monthly Maintenance Needs Allowance (MMMNA). This is the minimum amount of monthly income to which the non-applicant spouse is entitled. As of July 2020, this figure is $2,155.00 / month. (It is set to increase in July 2021). For non-applicant spouses that have shelter costs that are significant, there is also a maximum monthly maintenance needs allowance, which allows non-applicant spouses to receive income up to $3,216.00 / month. (This higher figure is effective January 2020 and will increase again in January 2021). This rule, known as a 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. That said, this rule is not applicable for all pathways to Medicaid eligibility. It does not apply for married couples with one spouse applying for regular Medicaid.
*Please note that although there is a monthly income limit of $2,349 / month (in 2020) per applicant for nursing home Medicaid, beneficiaries are not able to keep monthly income up to this level. Rather, they must pay all of their income, minus a personal needs allowance of approximately $60.00 / month, and possibly a monthly maintenance needs allowance for a non-applicant spouse, to the nursing home to help cover their care costs.
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 specific criteria is met. The home is exempt if the Medicaid applicant resides in it or has “intent” to reside in it in the future, and his / her equity interest in the home is not more than $595,000 (in 2020). (Equity interest refers to the amount of the home’s value owned by the applicant). If a non-applicant spouse lives in the home, it is also exempt, and this holds true regardless of where the applicant resides or the applicant’s equity interest in the home.
There is a spousal asset allowance for married couples with one spouse applying for institutionalization Medicaid or home and community based services via a Medicaid waiver. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA). As of 2020, the community spouse (the non-applicant spouse) can retain up to half of the couple’s joint assets, up to a maximum of $128,640, as the chart indicates above. However, if the couple has more limited assets, the non-applicant spouse is able to keep 100% of the couple’s assets, up to $25,728. As with the spousal income allowance, this spousal asset allowance is not for married couples with one spouse applying for regular Medicaid.
It’s important that one does not 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 persons who have 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 reducing their 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 tubs), 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, MI Health Link, and the Home Help Program.
1. MI Choice Waiver Program – this “HCBS waiver” for the elderly and disabled 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. MI Health Link – a managed care program for persons who are dually eligible for Medicaid and Medicare, a variety of supportive services are available to promote independent living. Benefits may include personal care assistance, meal delivery, chore services, and personal emergency response systems. This is not a statewide program.
3. Home Help Program – this is the formal name for a benefit under the state’s regular Medicaid program. It is an entitlement for those who are qualified and provides for personal care, laundry, and housekeeping in one’s home.
How to Apply for Michigan Medicaid
Elderly residents of Michigan should contact their Michigan Department of Health & Human Services county office. To locate your local office and to obtain contact information, click here. Seniors can also reach out to their local Area Agency on Aging office for Medicaid program information or to request application assistance. Currently, there is not an online option for applying for long-term care Medicaid.
When applying for Medicaid in Michigan, it is extremely important that seniors are certain that they meet all of the eligibility criteria, as discussed in detail above. If one has income and / or assets over the limit(s), or are unclear as to whether the requirements are met, Medicaid planning becomes crucial. Applying for Medicaid can be complicated and time consuming, and if the application is completed incorrectly and all required documentation is not provided, Medicaid benefits may be denied or delayed. Learn more about applying for long-term care Medicaid.