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

Last updated: May 30, 2024

 

Minnesota Medicaid Long-Term Care Definition

Medicaid is a health care program for low-income individuals of all ages. While this program is available to diverse groups of Minnesota residents, the focus here is on long-term care Medicaid eligibility for MN elderly residents, aged 65 and over. 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. There are three categories of Medicaid long-term care programs for which MN seniors may be eligible.

1) Institutional / Nursing Home Medicaid – An entitlement; anyone who is eligible will receive assistance. Benefits are provided only in nursing home facilities.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; the number of participants is limited and waiting 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 – An entitlement; 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.

In Minnesota, Medicaid is called Medical Assistance (MA). While Medicaid is jointly funded by the state and federal government, it is administered by the state under federally set parameters. The Minnesota Department of Human Services is the administering agency.

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

 

Income & Asset Limits for Eligibility

The three categories of Medicaid long-term care programs have varying financial and medical (functional) eligibility criteria. Further complicating eligibility is that the financial requirements change annually, vary with marital status, and that Minnesota offers multiple pathways towards Medicaid eligibility.

 Simplified Eligibility Criteria: Single Nursing Home Applicant
Minnesota seniors must have limited income and assets, and a medical need to qualify for Medicaid long-term care. In 2024, a single Nursing Home Medicaid applicant must meet the following criteria: 1) Income under $1,255 / month 2) Assets under $3,000 3) Require a Nursing Home Level of 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 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.

2024 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 $1,255 / month (eff. 7/1/24 – 6/30/25)* $3,000 Nursing Home $1,704 / month (eff. 7/1/24 – 6/30/25)* $6,000 Nursing Home $1,255 / month for applicant (eff. 7/1/24 – 6/30/25)* $3,000 for applicant & $154,190 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $2,829 / month† $3,000 Nursing Home $5,658 / month† $6,000 Nursing Home $2,829 / month for applicant† $3,000 for applicant & $154,190 for non-applicant Nursing Home
Regular Medicaid / Elderly, Blind, Disabled $1,255 / month (eff. 7/1/24 – 6/30/25) $3,000 Help with ADLs $1,704 / month (eff. 7/1/24 – 6/30/25) $6,000 Help with ADLs $1,704 / month (eff. 7/1/24 – 6/30/25) $6,000 Help with ADLs
*With the exception of a Personal Needs Allowance of $125 / month, Medicare premiums, and potentially a Needs Allowance for a non-applicant spouse, all a beneficiary’s monthly income must go towards nursing home costs. This is called a Patient Liability.

†Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level. 

 

Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly all income from any source that a Medicaid applicant receives is counted towards the income limit. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. While many states exclude VA Aid & Attendance benefits, which is above and beyond the Basic VA Pension, MN does not exclude this income.

Treatment of Income for a Couple
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 7/1/24 – 6/30/25, the MMMNA is $2,555. If a non-applicant’s monthly income is under $2,555, income can be transferred to them 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 $766.50 / month (eff. 7/1/24 – 6/30/25). However, in 2024, a Spousal Income Allowance cannot push a non-applicant’s monthly income over $3,853.50. This is the Maximum Monthly Maintenance Needs Allowance. More on how this 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. Furthermore, there is no Monthly Maintenance Needs Allowance for a non-applicant spouse. More on how Medicaid counts income.

 

Asset Definition & Exceptions

Countable vs. Non-Countable Assets
The value of countable assets are calculated towards the asset limit. This includes cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. In Minnesota, IRA’s / 401K’s are counted. Medicaid also considers many assets to be exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, and generally one’s primary home.

 

Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. The non-applicant spouse of a Nursing Home Medicaid or Medicaid Waiver applicant, however, is permitted a Community Spouse Resource Allowance (CSRA). In 2024, this Spousal Impoverishment Rule allows the community spouse (the non-applicant spouse) to retain up to $154,140 of the couple’s assets. There is no CSRA for a non-applicant spouse of a Regular Medicaid applicant.

Medicaid’s Look-Back Rule
Minnesota has a 60-month (5-year) Medicaid Look-Back Period for Nursing Home Medicaid and Medicaid Waivers 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. The Look-Back Period is not relevant for Regular Medicaid applicants.

The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, this rule allows one to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s Look-Back Period.

 

Minnesota Medicaid Home Exemption Rules

For home exemption, the Medicaid applicant or their spouse must live in their home. If there is no spouse in the home, there is a home equity interest limit of $713,000. Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of home equity owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. There is no home equity interest limit for seniors applying for Regular Medicaid. Other exemptions exist.

While one’s home is generally 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, the Minnesota 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

 

Medical / Functional Need Requirements

An applicant must have a medical need for Medicaid long-term care. For Nursing Home Medicaid and Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Furthermore, there may be additional eligibility requirements for some program benefits. As an example, for a Medicaid Waiver to cover the cost of home modifications, an inability to safely and independently live at home without modifications may be required. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NFLOC is not necessarily required.

 

Qualifying When Over the Limits

For Minnesota elderly residents, aged 65 and over, who do not meet the financial eligibility requirements above, there are other ways to qualify for long-term care Medicaid.

1) Medically Needy Pathway – Seniors who have income over Medicaid’s limit can still become income-eligible 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, including health insurance costs, such as Medicare premiums. Effective 7/1/24 – 6/30/25, the Medically Needy Income Limit (MNIL) in MN is $1,255 / month for a single applicant and $1,704 for a married couple. The “spend down” amount, which can be thought of as a deductible, is calculated for a six-month period. Once the “spend down” is met, one will be Medicaid-eligible for the remainder of the period. 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 on non-countable ones. Examples 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 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 this rule was not violated.

 Our MN Medicaid Spend Down Calculator can assist persons in determining if they have a spend down, and if so, how much.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, 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. Connect with a Medicaid Planner.

 

Specific Minnesota Medicaid Programs

In addition to paying for nursing home care, Minnesota Medicaid offers the following programs relevant to the elderly that helps them to live at home, in adult foster care homes, or in assisted living residences.

1) Elderly Waiver (EW) – 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.

4) Money Follows the Person – Also called Moving Home Minnesota. This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.

 

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 or 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 is 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. More about applying for long-term care Medicaid.

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