Minnesota Medicaid Definition
In Minnesota, Medicaid is called Medical Assistance (MA) and is administered by the Minnesota Department of Human Services.
Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. However, this page is focused on Medicaid eligibility for Minnesota elderly residents, aged 65 and over, and specifically for long term care, whether that be at home, in a nursing home, in an adult foster care home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Minnesota seniors may be eligible. These programs have slightly different financial and medical eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the requirements vary with marital status and that Minnesota offers multiple pathways towards Medicaid eligibility.
1) Institutional / Nursing Home Medicaid – this is an entitlement program, meaning anyone who is eligible will receive assistance, and is provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – these programs limit the number of participants. Therefore, wait lists may exist. Services are provided at home, adult day care, in adult foster care, or in assisted living.
3) Regular Medicaid / Elderly Blind and Disabled – this is an entitlement program, which means meeting the eligibility requirements ensures one can receive benefits, 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 Minnesota Medicaid program. Alternatively, one might want to take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible for Medicaid in Minnesota. More.
|2019 Minnesota 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||$1,012 / month||$3,000||Nursing Home||$1,372 / month||$6,000||Nursing Home||$1,012 / month||$3,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,313 / month||$3,000||Nursing Home||$4,626 / month||$6,000||Nursing Home||$2,313 / month for applicant||$3,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$1,012 / month||$3,000||None||$1,372/ month||$6,000||None||$1,012 / month for applicant||$3,000 for the applicant||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. (Learn more here about Medicaid and income). For married couples, with non-applicant spouses’ with insufficient income in which to live, there is what is called a Minimum Monthly Maintenance Needs Allowance (MMMNA). This is the minimum amount of monthly income to which the non-applicant spouse is entitled, and it allows applicant spouses to transfer a portion of their income to their non-applicant spouses. At the time of this writing, the MMMNA is $2,057.50 / month, which is set to increase again July 2020. However, if shelter costs are high, non-applicant spouses may receive as much as $3,160.50 / month (this figure will not increase again until January 2020) for a spousal allowance. This rule prevents non-applicant spouses from becoming impoverished.
*Please note: The income limits in the chart above for regular Medicaid / aged, blind and disabled & nursing home Medicaid are effective until 6/30/19. Beginning 7/1/19, the income limit for a single applicant will increase to $1,041 / month, and for a married couple with both spouses applying for benefits, the income limit will be $1,409 / month.
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 equity value is under $585,000 (in 2019). For married couples, as of 2019, the community spouse (the non-applicant spouse) can retain up to a maximum of $126,420 of the couple’s joint assets, as the chart indicates above. This, in Medicaid terminology, is referred to as the Community Spouse Resource Allowance (CSRA).
It’s important to note that Minnesota has a Medicaid Look-Back Period. This is a period of 60 months (5 years) that dates back from one’s Medicaid application date. During this time frame, Medicaid checks to ensure no assets were sold or given away under fair market value. If one is found to be in violation of the look-back period, a period of Medicaid ineligibility will ensue.
Qualifying When Over the Limits
For Minnesota elderly residents, aged 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 – In a nutshell, one may still be eligible for Medicaid services even if they are over the income limit if they have high medical bills in comparison to their monthly income. In Minnesota, this program is referred to as a “Spenddown” program. Basically, persons must pay down their “excess income,” (their income over the Medicaid eligibility limit, which is often referred to as a deductible) on medical bills. This may include health insurance costs, such as Medicare premiums, as well as bills to cover medical services. Once one has paid down his or her excess income to the Medicaid eligibility limit, he or she will receive Medicaid benefits for the remainder of the spenddown period. This program, regardless of name, provides a means to “spend down” one’s extra income in order to qualify for Medicaid.
Make note, 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 “spending down” extra assets. However, one can “spend down” assets by spending excess assets on ones that are non-countable, such as home modifications to improve safety and make the home wheelchair accessible. Examples include adding wheelchair ramps, stair lifts, pedestal sinks, roll-in showers, widening the doorways, and replacing carpet with vinyl or laminate flooring. One may also use excess assets to prepay funeral and burial expenses and pay off debt. As mentioned above, one cannot simply give away assets or sell them for significantly less than their value, as Minnesota has a 5-year Medicaid Look-Back Period that prevents applicants from doing so. If one is found in violation of the look-back period, this may result in a period of ineligibility.
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 Minnesota Medicaid Programs
1. Elderly Waiver (EW) – This Medicaid Waiver allows MN seniors to receive long-term care services in their own home, adult foster care, or assisted living. Program participants have the choice of self-directing their own care or going through a provider agency.
2. Community Access for Disability Inclusion Waiver (CADI) – CADI is a Medicaid Waiver for adults under 65 years old who require a nursing home level of care. A number of home and community based services are available to promote independent living in a variety of settings.
3. Personal Care Assistance (PCA) – Not a MN Medicaid program in and of itself, Personal Care Assistance is an option available to MN residents who are participants in one of four MN Medicaid programs. This option enables participants to hire and manage their own personal care assistants, including some family members.
4. Managed Care: MSC+ & MSHO – These managed care programs for seniors provide regular Medicaid services, such as doctor visits and acute care, as well as long-term care services, like in-home personal care assistance. Those enrolled in MSHO, can receive both Medicaid and Medicare services through one plan.