Nebraska Medicaid Definition
In Nebraska, Medicaid is administered by the Nebraska Department of Health & Human Services (DHHS) agency.
Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. While there are many different eligibility groups, this page is focused strictly on Medicaid eligibility for elderly Nebraska residents who are 65 years of age and older. This page will specifically cover long term care Medicaid, whether that is in one’s home, a nursing home, or an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Nebraska 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 criteria vary with marital status and that Nebraska offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – This is an entitlement program, meaning anyone who is eligible will receive assistance. It is provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – Waivers limit the number of program participants. Therefore, wait lists may exist. Services are provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – This is an entitlement program, which means as long as one meets the eligibility requirements, services can be received. It is provided at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they are immediately eligible for long term care from an Nebraska Medicaid program. Alternatively, take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible. More.
|2018 Nebraska 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||$1,012 / month||$4,000||Nursing Home||$1,372 / month||$6,000||Nursing Home||$1,012 / month for applicant||$4,000 for applicant & $123,600 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$1,012 / month||$4,000||Nursing Home||$1,372 / month||$6,000||Nursing Home||$1,012 / month for applicant||$4,000 for applicant & $123,600 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$1,012 / month||$4,000||Nursing Home||$1,372 / month||$6,000||Nursing Home||$1,012 / month for applicant||$4,000||Nursing Home|
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 cash gifts, employment wages, Veteran’s benefits, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. That said, when just one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded and does not impact the eligibility of the applicant spouse. For more information on how Medicaid counts income, click here.
For the non-applicant spouse, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which he or she is entitled. As of 2018, this figure falls between $2,058 / month (this figure changes 7/1 of each year) and $3,090 / month (this figure changes 1/1 of each year). This monthly maintenance needs allowance is also called a spousal allowance. This rule allows the Medicaid applicant to transfer income to the non-applicant spouse to ensure he or she has sufficient funds with which to live, while also effectively lowering the amount the applicant spouse must contribute to their cost of care.
What Defines “Assets”
Countable (non-exempt) assets include cash and most anything that can easily be converted to cash to be used to pay for the cost of long-term care. Other countable assets include stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are also many assets that are considered exempt (non-countable). Exemptions include personal belongings, such as clothing, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the home is valued under $572,000 (in 2018).
For married couples, as of 2018, the community spouse (the non-applicant spouse) can retain half of the couple’s joint assets, up to a maximum of $123,600, as shown on the chart above. That said, if a couple has $24,720 or less in resources, the non-applicant spouse can retain 100% of the assets. In Medicaid terminology, this is called the Community Spouse Resource Allowance (CSRA).
When considering assets, one should be aware that Nebraska has a Medicaid Look-Back Period, which is a period of 60 months 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. Please note, this also includes gifts, as well as asset transfers one’s spouse may have made. If one is found to be in violation of the look-back period, a penalty period will be established and one will be ineligible for Medicaid for the duration of the penalty period.
Qualifying When Over the Limits
For Nebraska 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 Nebraska, there is a medically needy pathway, also called a Share of Cost program, which is specifically intended for those that have income over the Medicaid limit. One’s “share of cost” may also be referred to as a “spend down”, as one must “spend down” their excess income on medical expenses to become Medicaid eligible. (Medical expenses may include past due medical bills, Medicare premiums, home health services, private health insurance premiums, and medical expenses that Medicaid won’t cover.) One’s “share of cost” is the difference between one’s income and the Medically Needy Income Limit (MNIL).
As of 2018, the MNIL in Nebraska is the same for a single individual, as well as a married couple, and is set at $392 / month. For instance, say a Medicaid applicant has $600 / month in income. Their “share of cost”, which can also be thought of as similar to a deductible, is $208 / month. Once an individual or married couple has met their “share of cost”, they are eligible for Medicaid for the remainder of the spenddown period, which is one month in Nebraska. Please note, the income limit for the medically needy program is different from the program limits in the chart above.
The Medically Needy Pathway, unfortunately, 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 non-countable assets, such as home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt. As mentioned previously, when spending down assets, it’s important that one does not give away assets or sell them under market value. This is because in Nebraska, Medicaid has a “Look-Back” period of 60 months, and if one is found to be in violation, a period of Medicaid ineligibility will result.
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 Nebraska Medicaid Programs
1) Nebraska Aged & Disabled Waiver – To prevent unnecessary nursing home placements of elderly and disabled individuals, supportive services are provided in one’s home or in an assisted living facility. Available benefits include adult day care, home modifications, personal emergency response systems, meal delivery, and more.
2) Nebraska Personal Assistance Services (PAS) – Intended for those who are disabled or have a chronic medical condition, personal assistance services are provided in one’s home. Program participants are able to self direct their own care, including hiring select family members.