Missouri Medicaid / MO HealthNet Income & Asset Limits for Nursing Homes & In-Home Long Term Care

Last updated: July 05, 2022

 

Missouri Medicaid Definition

Medicaid is a wide-ranging health care program that is jointly funded by the state and federal government. Through Medicaid, many groups of low-income people, including pregnant women, families, and the blind, disabled, and elderly are able to receive medical and care assistance. This page, however, is focused strictly on Medicaid eligibility for senior Missouri residents who are 65 years of age and over. Specifically, long-term care is covered. In addition to nursing home care and assisted living services, MO Medicaid pays for many non-medical support services that help frail seniors remain living in their homes.

Medicaid in Missouri is called MO HealthNet. The Missouri Department of Social Services is the agency who administers this program.

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

 

Income & Asset Limits for Eligibility

There are several different Medicaid long-term care programs for which Missouri seniors may be eligible. These programs have varying eligibility requirements, as well as benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that Missouri offers multiple pathways towards eligibility.

1) Institutional / Nursing Home Medicaid – This is an entitlement program; Anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.

2) Medicaid Waivers / Home and Community Based Services – These are not entitlement programs; There are a limited number of participants and wait lists may exist. Intended to delay the need for nursing home admission, services and supports are provided at home, adult day care or in assisted living. More on Waivers.

3) Regular Medicaid / Aged Blind and Disabled / MO HealthNet for the Aged, Blind, and Disabled (MHABD) – This is an entitlement program; Meeting the eligibility requirements ensures one will receive benefits. Various long-term care services, 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 MO HealthNet program. Alternatively, one can take the Medicaid Eligibility Test.  IMPORTANT: Not meeting all of the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Missouri. More.

2022 Missouri Medicaid (MO HealthNet) 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 All available income must be paid towards care* 5,301.85 Nursing Home All available income must be paid towards care* $10,603.70 Nursing Home All available income must be paid towards care* $5,301.85 for applicant & $137,400 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $1,470 / month† 5,301.85 Nursing Home $2,940 / month ($1,470 / month per spouse)† $10,603.70 Nursing Home $1,470 / month† $5,301.85 for applicant & $137,400 for non-applicant Nursing Home
Regular Medicaid / Aged, Blind, and Disabled $963 / month (eff. 4/1/22 -3/31/23)‡ 5,301.85 Help with ADLs $1,297 / month (eff. 4/1/22 -3/31/23)‡ $10,603.70 Help with ADLs $1,297 / month (eff. 4/1/22 -3/31/23)‡  $10,070 Help with ADLs
* With the exception of a personal needs allowance of $50 / month, Medicare premiums, and potentially an income allowance for a non-applicant spouse, all a beneficiary’s monthly income must go to the nursing home to help cover care costs.

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

‡These limits are only relevant for the aged and disabled. For blind persons, the income limit is $1,074 / month for a single applicant and $1,452 / month for a married couple.

 

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 counted as income and do not impact Medicaid eligibility.

When only one spouse of a married couple applies for nursing home Medicaid or a HCBS Medicaid Waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and does not impact the income eligibility of their spouse. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse. 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. The MMMNA is $2,178 (effective 7/1/21 – 6/30/22). If a non-applicant’s monthly income is under $2,178, income can be transferred from their applicant spouse, bringing their income up to this level.

In Missouri, a non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $653 / month (effective 7/1/21 – 6/30/22). 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 / MO HealthNet for the Aged, Blind, and Disabled; The income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. More about how Medicaid counts income.

 

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. There are also many assets that Medicaid considers 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 be no greater than $636,000. Equity interest is the amount of the home’s value owned by the applicant. If a non-applicant spouse lives in the home, it is exempt regardless of where the applicant spouse lives and their home equity interest.

 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, Missouri’s 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.

All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, spousal impoverishment rules allow the non-applicant spouse of a Medicaid nursing home or Waiver applicant a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can retain 50% of the couples’ assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s half of the assets is under $27,480, 100% of the assets, up to $27,480 can be retained by the non-applicant.

Missouri has a 5-year Medicaid Look-Back Period that immediately precedes one’s Medicaid application date. This is a period in which Medicaid checks to ensure no assets were gifted or sold under fair market value. If this has been done, Medicaid assumes it was to meet Medicaid’s asset limit. Violating the look-back period results in a period of Medicaid ineligibility.

 Non-Financial Eligibility Requirements – For long-term care Medicaid in Missouri, an applicant’s functional need is considered. For nursing home Medicaid and HCBS Medicaid Waivers, a nursing facility level of care (NFLOC) is required. Some program benefits, such as home modifications, may have additional eligibility criteria. For example, for a Waiver to cover the cost of home modifications, an inability to safely live independently without modifying the home might be required. For long-term care services via the regular Medicaid program, a functional need with the activities of daily living is required, but a NFLOC is not necessarily required.

 

Qualifying When Over the Limits

For Missouri elderly residents, 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 – Missouri has a Spend Down Program for seniors applying for Regular Medicaid / MO HealthNet for the Aged, Blind, and Disabled who have income over the Medicaid limit. Persons can become income-eligible for Medicaid services by “spending down” their income on medical expenses. This includes prescription drugs, dental and eye care services, durable medical equipment, home nursing services, and hospital bills. If a Medicaid applicant is married, medical bills accrued by one’s spouse can also be used. Effective 4/1/22 – 3/31/23, the medically needy income limit is $963 / month for an individual and $1,297 / month for a couple. The “spend down” amount, which can be thought of as a deductible, 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 $5,301.85 for an individual and $10,603.70 for a couple.

2) Qualified Income Trusts (QIT’s) – Also called Miller Trusts, QITs offer a way for seniors over the Medicaid income limit to still qualify for nursing home Medicaid or a Medicaid Waiver. Money deposited into an irrevocable QIT does not count towards Medicaid’s income limit. Irrevocable means that once the trust has been established, it cannot be changed or canceled. In basic terms, one’s excess income (over the Medicaid limit) is directly deposited into a trust, in which a trustee is named, giving that individual legal control of trust funds. The money can only be used for very specific purposes, such as contributing towards the cost of nursing home care, long-term home and community based services, and medical expenses and items not covered by MOHealth Net, such as wheelchairs. Upon the death of the Medicaid participant, or in the event of Medicaid disenrollment, the remainder of the funds must be paid to the state of Missouri.

3) Asset Spend Down – Persons who have countable assets over MO HealthNet’s asset limit can “spend down” excess assets on non-countable ones and become asset eligible. Ways in which this can be done include making home modifications (wheelchair ramps, stair lifts, and widening of doorways to allow wheelchair access), vehicle modifications (hand controls and pedal extenders), prepaying funeral and burial expenses, and paying off debt. Our organization’s free spend down calculator can assist persons in determining if they might have a spend down, and if so, provide an estimate of the amount. Remember, assets cannot be gifted or sold under fair market value. Doing so violates the look back rule and can result in a penalty period of Medicaid ineligibility. It is recommended one keep documentation of how assets were spent as proof the look back rule was not violated.

4) Medicaid Planning – The majority of persons considering Medicaid are “over-income” or “over-asset” or both, yet 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 estate recoveryRead more or connect with a Medicaid planner.

 

Specific Missouri Medicaid Programs

Like all states, Missouri Medicaid / MO HealthNet will pay for nursing home care for those residents who are medically and financially eligible for such care. MO HealthNet also offers several programs that help seniors who require the level of care provided in a nursing home or have slightly lesser care requirements and do not wish to reside in a nursing home. These program provide care at home or “in the community”.

1) Aged and Disabled Waiver (ADW) – Provides adult day care and respite care to help families who wish to care for a loved one at home. These supports are intended to enable persons to maintain full-time employment while still providing care. Supports, such as homemaker services and home delivered meals, are also available to help seniors live independently.

2) Supplemental Nursing Care (SNC) Assistance – This is a cash benefit intended to help persons afford the cost of assisted living residences and residential care facilities. It will not cover the full cost, but can be combined with other sources of income.

3) Home and Community Based Services – The services available under this program are similar to the Aged and Disabled Waiver. However, these services are under the state’s regular Medicaid program, and therefore, are entitlements. On the downside, the financial eligibility criteria are more restrictive.

4) Consumer Directed State Plan Personal Care – Under MO’s regular Medicaid program, this program allows family members to be hired as personal care providers and paid by the state.

5) Structured Family Caregiving – For persons with dementia / Alzheimer’s, this program provides for an adult foster living situation.

 

How to Apply for Missouri Medicaid

Missouri seniors can apply for MO HealthNet online at myDSS. Alternatively, an application can be found here. Seniors must also submit the Supplemental Form. For application assistance, the MO Department of Social Services Family Support Division can be reached at 1-855-373-4636. One’s local Family Support Office may also be useful in providing program information and help with applying for benefits. Click here and then scroll down to “Find an Office”.

MO HealthNet applicants should be confident that they meet all the eligibility criteria prior to submitting a completed application. If there is any uncertainty as to whether income and asset limits are met, or if one is over the limits, Medicaid planning can make the difference between approval and denial of benefits. The Medicaid application process can be confusing and should be taken seriously. For more information about Medicaid’s long-term care application process, click here.

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