Missouri Medicaid Definition
Medicaid, which is called MO HealthNet in Missouri, is a wide-ranging, jointly funded state and federal health care program. Through MO HealthNet, many groups of low-income people, including pregnant women, families, and the blind, disabled, and elderly are able to receive medical and care assistance. That being said, this page is focused on Medicaid eligibility, specifically for senior Missouri residents who are 65 years of age and over, and specifically for long term care, whether that be at home, in a nursing home, or in assisted living.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Missouri seniors may be eligible. These programs have slightly different 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 – is an entitlement (anyone who is eligible will receive assistance) and is provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services – Limited number of participants and is provided at home, adult day care or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled / MO HealthNet for the Aged, Blind, and Disabled (MHABD) – is an entitlement (meeting the eligibility requirements ensures one will 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 MO HealthNet program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the criteria below does not mean one is ineligible or cannot become eligible for Medicaid in Missouri. More.
|2020 Missouri Medicaid (MO HealthNet) Long Term Care Eligibility for Seniors (as of July 1, 2020)|
|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*||$5,000||Nursing Home||All available income must be paid towards care*||$10,000||Nursing Home||All available income must be paid towards care*||$5,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$1,370 / month||$5,000||Help w/ 2 Activities of Daily Living||$2,740 / month||$10,000||Help w/ 2 Activities of Daily Living||$1,370 / month||$5,000 for applicant & $128,640 for non-applicant||Help w/ 2 Activities of Daily Living|
|Regular Medicaid / Aged Blind and Disabled||$904 / month**||$5,000||None||$1,222 / month**||$10,000||None||$1,222 / month**||$5,000||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 nursing home Medicaid 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. However, in the situation where only one spouse is an applicant for regular Medicaid, the income of both spouses is calculated together to determine the income eligibility of the applicant spouse. (If you want to know more about how income is counted for Medicaid eligibility purposes, click here).
Relevant to married couples with one spouse applying for home and community based services via a Medicaid waiver or nursing home Medicaid, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA). This is the minimum amount of monthly income to which the non-applicant spouse is entitled. As of July 2020, this equates to $2,155 / month (this figure is set to increase in July 2021). There is also a maximum monthly maintenance needs allowance for persons with high living costs, such as mortgage and utilities. As of January 2020, it is $3,216 / month (this figure will increase again in January 2021). This spousal allowance rule is meant to ensure non-applicant spouses have sufficient funds with which to live. To be very clear, an income allowance is not permitted for married couples with one spouse applying for regular Medicaid.
*As mentioned above, all available income must be paid towards the cost of nursing home care. However, there are a few exceptions. Program participants can keep $50 / month as a personal needs allowance, pay monthly premiums for medical insurance, and if they are married, transfer money to their non-applicant spouses as a spousal income allowance.
**The income limits above are only relevant for the aged and disabled. For those who are blind, the income limits are slightly higher. As of April 2020, the income limit for a single blind applicant is $1,064 / month, and for a blind married couple with both spouses as applicants, the monthly income limit is $1,437.
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 is the amount of the home’s value owned by the applicant). If a non-applicant spouse lives in the home, it is also exempt, regardless of where the applicant spouse lives or the applicant spouse’s equity interest in the home
For married couples, as of 2020, the community spouse (the non-applicant spouse of a nursing home Medicaid applicant or a Medicaid waiver applicant) can retain half of the couple’s joint assets, up to a maximum of $128,640, as the chart indicates above. That said, if the couple does not have assets greater than $25,728, the non-applicant spouse is entitled to 100% of the assets. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA) and is intended to prevent spousal impoverishment. The CSRA does not extend to non-applicant spouses of regular Medicaid applicant spouses.
It’s important to be aware that Missouri has a 5-year Medicaid Look-Back Period. This is a period of time in which Medicaid checks to ensure no assets were sold or given away under fair market value in order to meet Medicaid’s asset limit. 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 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 – In a nutshell, those who are aged, blind or disabled may still be eligible for Medicaid services even if they are over the Medicaid income limit if they have high medical bills. In Missouri, this program is called a Spend Down program, and the way this program works is one’s “excess income,” (their income over the Medicaid eligibility limit), is used to cover medical bills. Examples include 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 go towards meeting one’s spend down. (One’s spend down can be thought of as an insurance deductible). Missouri has a one-month “spend-down” period, so once an individual has paid their excess income down to the Medicaid eligibility limit for the period, one will qualify for the remainder of the month.
2) Qualified Income Trusts (QIT’s) – QIT’s, also referred to as Miller Trusts, are for nursing home Medicaid and HCBS Medicaid Waiver applicants who are over the income limit, but still cannot afford to cover the cost of their long-term care. This type of trust offers a way for individuals over the Medicaid income limit to still qualify for long-term care Medicaid, as money deposited into a QIT does not count towards Medicaid’s income limit. 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 the money. The money in the account can only be used for very specific purposes, such as contributing towards the cost of nursing home care, HCBS long term care, and medical expenses and items not covered by MOHealth Net, such as wheelchairs, accrued by the Medicaid enrollee. The trust must be irreversible, meaning once it has been established, it cannot be changed or canceled, and 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.
Unfortunately, the Medically Needy Pathway nor Qualified Income Trusts 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 options cannot assist one in reducing countable assets. However, one can “spend down” assets by spending excess assets on non-countable ones, such as 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.
3) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, yet 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 Missouri Medicaid Programs
Missouri Medicaid / MO HealthNet will pay for nursing home care for those residents who require that level of care. In addition, MO HealthNet offers several programs that help Missouri residents who require the level of care provided in a nursing home, but wish to remain living at home. These programs and other types of community-based care from the state Medicaid program are detailed below.
1. Aged and Disabled Waiver (ADW) – Provides adult day care, respite care, and meal services 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 caring for a loved one.
2. Supplemental Nursing Care (SNC) Assistance – This is a cash benefit intended to help persons in need to afford the cost of assisted living. 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. Independent Living Waiver (ILW) – As implied by the name, this program helps physically disabled beneficiaries to live independently by paying for personal care, medical equipment, and home modifications. Enrollment is limited.
5. 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.
How to Apply for Missouri Medicaid
Missouri seniors can apply for MO HealthNet online at myDSS. Alternatively, an application can be downloaded here. For assistance with the application process, call the MO Department of Social Services Family Support Division at 1-855-373-4636. Persons can also contact their local Family Support Office to request additional program information or for 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 (listed above on this page) 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.