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. This page, however, is focused on Medicaid eligibility for Minnesota elderly residents, aged 65 and over. Specifically, long-term care is covered. In addition to nursing home care, assisted living services, and adult foster care services, Minnesota Medicaid pays for many non-medical supports and services that help frail seniors remain living in their homes.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Minnesota seniors may be eligible. These programs have varying financial and medical eligibility requirements, as well as 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; Anyone who is eligible will receive assistance. Benefits are provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – These are not entitlement programs; The number of participants is limited and wait lists may exist. Services and supports are intended to delay nursing home admissions and may be provided at home, adult day care, adult foster care, or in assisted living. More about Waivers.
3) Regular Medicaid / Elderly, Blind, Disabled – This is an entitlement program; Meeting the eligibility requirements ensures one will receive benefits. Various long-term care benefits, 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 Minnesota Medicaid 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 Medicaid in Minnesota. More.
|2022 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||$1,133 / month (eff. 7/1/22 – 6/30/23)*||$3,000||Nursing Home||$1,527 / month (eff. 7/1/22 – 6/30/23)*||$6,000||Nursing Home||$1,133 / month for applicant (eff. 7/1/22 – 6/30/23)*||$3,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,523 / month†||$3,000||Nursing Home||$5,046 / month†||$6,000||Nursing Home||$2,523 / month for applicant†||$3,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Regular Medicaid / Elderly, Blind, Disabled||$1,133 / month (eff. 7/1/22 – 6/30/23)||$3,000||Help with ADLs||$1,527 / month (eff. 7/1/22 – 6/30/23)||$6,000||Help with ADLs||$1,527 / month (eff. 7/1/22 – 6/30/23)||$6,000||Help with ADLs|
†Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level.
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 not considered income and do not impact Medicaid eligibility.
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 does not impact the income eligibility of their applicant spouse. However, the non-applicant spouse may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA). 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 spousal impoverishment. Effective 7/1/22 – 6/30/23, the MMMNA is $2,289. If a non-applicant’s monthly income is under $2,289, income can be transferred from their applicant spouse, bringing their income up to this level.
In Minnesota, a non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $687 / month (effective 7/1/22 – 6/30/23). However, in 2022, in no case can a spousal income allowance put a non-applicant’s monthly income over $3,435. This is the Maximum Monthly Maintenance Needs Allowance. Learn more about how the spousal allowance is calculated.
Income is counted differently when only one spouse applies for Regular Medicaid / Elderly, Blind, Disabled; The income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. More on how Medicaid counts income.
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. Medicaid also considers many assets to be 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 it or have intent to return, and in 2022, their home equity interest must not be greater than $636,000. Equity interest is the amount of the home’s value owned by the applicant. The home is also exempt, regardless of where the applicant lives or their home equity interest, if a non-applicant spouse lives in it.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. The non-applicant spouse of a nursing home Medicaid or Medicaid Waiver applicant, however, is permitted a Community Spouse Resource Allowance (CSRA). In 2022, this spousal impoverishment rule allows the community spouse (the non-applicant spouse) to retain up to $137,400 of the couple’s assets, as shown in the chart above.
Minnesota has a 60 month (5 year) 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, it is assumed it was to meet Medicaid’s asset limit and a penalty 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 – Seniors who have income over Medicaid’s limit can still qualify for Medicaid services if they have high medical bills in comparison to their monthly income. Also called a “Spenddown” program, persons “spend down” their excess income on medical bills. This may include health insurance costs, such as Medicare premiums. Effective 7/1/22 – 6/30/23, the medically needy income limit in MN is $1,133 / month for a single applicant and $1,527 for a married couple. The “spend down” amount is the difference between one’s monthly income and the medically needy income limit. Once the “spend down” is met, one will be Medicaid eligible for the remainder of the month. The medically needy asset limit is $3,000 for an individual and $6,000 for a couple.
2) Asset Spend Down – Persons who have countable assets over MN Medicaid’s limit can still become asset eligible by “spending down” extra assets. Examples of ways in which one might reduce countable assets include making home modifications to improve safety and allow for wheelchair accessibility (i.e., installing wheelchair ramps, stair lifts, pedestal sinks, roll-in showers, widening the doorways, and replacing carpet with vinyl or laminate flooring). Persons might also use excess assets to prepay funeral and burial expenses and pay off debt. Remember, assets cannot be gifted or sold under fair market value. Doing so violates Medicaid’s look back rule and can cause a penalty period of Medicaid ineligibility. It is recommended one keep documentation of how assets were spent as proof the look back period was not violated.
3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” or “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 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 via Consumer Directed Community Supports (CDCS) or going through a provider agency.
2) Personal Care Assistance (PCA) – This program will be transitioning into the Community First Services and Supports (CFSS) Program. Via both programs, program participants receive assistance with their daily living activities, which includes bathing, dressing, mobility, cooking, eating, and shopping for essential items. Program participants are able to hire and manage their own personal care assistants, including some family members.
3) 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.
How to Apply for Minnesota Medicaid
Minnesota seniors, with the exception of those on Medicare, can apply online for Medicaid / Medical Assistance at MNsure. They can also call the Minnesota Health Care Programs Member Help Desk at 1-800-657-3739 or 1-651-431-2670 to request an application or to ask program related questions. Alternatively, persons can download an application here. There is also the option to apply in-person at one’s local county or tribal human services office. For application assistance, one’s local county or tribal office can assist, as well as the Senior LinkAge Line at 1-800-333-2433.
It is vital that senior Minnesota Medicaid applicants are certain that they meet all eligibility requirements. If the requirements are not met, or one is unsure, Medicaid planning becomes an option. The Medicaid application process is often complicated and time consuming, and if not done correctly, can result in denial or delay of Medicaid benefits. For more information about applying for long-term care Medicaid, click here.