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.
|2020 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||$1,064 / month||$3,000||Nursing Home||$1,438 / month||$6,000||Nursing Home||$1,064 / month||$3,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,349 / month||$3,000||Nursing Home||$4,698 / month||$6,000||Nursing Home||$2,349 / month for applicant||$3,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Regular Medicaid / Elderly Blind and Disabled||$1,064 / month||$3,000||None||$1,438 / month||$6,000||None||$1,438/ month||$6,000||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 Medicaid nursing home care or a HCBS Medicaid waiver, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. To be clear, income is not calculated this way when there is a non-applicant spouse of a regular Medicaid applicant. In this case, the income of both the applicant and non-applicant spouses are calculated together to determine the income eligibility of the applicant spouse. (Learn more here about Medicaid and income).
For married couples, with non-applicant spouses that have insufficient income from 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 $2,155.00 / month, which is set to increase in July 2021. However, if shelter costs are high, non-applicant spouses may receive as much as $3,216.00 / month (this figure will increase in January 2021) for a spousal allowance. This rule, is strictly for non-applicant spouses of those applying for nursing home Medicaid or a HCBS Medicaid waiver and prevents non-applicant spouses from becoming impoverished. To be clear, this rule does not extend to non-applicant spouses of regular Medicaid applicants.
As indicated in the chart above, there is a monthly income limit for nursing home Medicaid. However, 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 $104.00 / month, and potentially an income allowance for a non-applicant spouse, to the nursing home to help cover their cost of care.
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 lives in the home or has “intent” to return to it, and his / her equity interest in the home is not greater than $595,000 (in 2020). (Equity interest refers to the amount of the home’s value owned by the applicant). The home is also exempt if a non-applicant spouse lives in it, and this holds true regardless of where the applicant resides or the applicant’s equity interest in the home.
For married couples, as of 2020, the community spouse (the non-applicant spouse of a nursing home Medicaid or HCBS Medicaid waiver applicant) can retain up to a maximum of $128,640 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). As with the income allowance for non-applicant spouses, the asset allowance is not available to married couples with one applicant spouse for regular Medicaid.
It is 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. As of July 2020, the medically needy income limit is $862 for a single applicant and $1,161 for a married couple.
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 allow for wheelchair accessibility. 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 Look-Back Period that prevents applicants from doing so.
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.
How to Apply for Minnesota Medicaid
For those wishing to apply for Medical Assistance in Minnesota, there are several ways to go about it. First, seniors, with the exception of seniors on Medicare, can apply online at MNsure. Persons 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 be sent to them 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.
When applying for Minnesota Medicaid, it is extremely important that senior applicants are certain that they meet all of the eligibility requirements, as discussed in detail above. If the eligibility criteria is not met, or one is not certain if the requirements are met, 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.