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

Last updated: January 25, 2022

 

Nebraska Medicaid Definition

In Nebraska, Medicaid is administered by the Nebraska Department of Health & Human Services (DHHS) agency.

Medicaid is a jointly funded state and federal health care program for low-income individuals of all ages. While there are many different coverage groups, this page is focused strictly on Medicaid eligibility for elderly Nebraska residents who are 65 years of age and older. Specifically, long term care Medicaid is covered. In addition to nursing facility care and assisted living services, NE Medicaid pays for non-medical services and supports to help frail seniors live at home or the home of a loved one.

  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 Nebraska seniors may be eligible. These programs have varying financial and medical eligibility requirements, as well as 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; Anyone who is eligible will receive assistance. It is provided only in nursing homes.

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

3) Regular Medicaid / Aged Blind and Disabled – This is an entitlement program; Anyone who meets the eligibility requirements will receive services. Long-term care benefits, 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 Nebraska Medicaid 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 Nebraska. More.

2022 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 $1,133 / month* $4,000 Nursing Home $1,526 / month* $8,000 ($4,000 per spouse) Nursing Home $1,133 / month for applicant* $4,000 for applicant & $137,400 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $1,133 / month† $4,000 Nursing Home $1,526 / month† $8,000 ($4,000 per spouse) Nursing Home $1,133 / month for applicant† $4,000 for applicant & $137,400 for non-applicant Nursing Home
Regular Medicaid / Aged Blind and Disabled $1,133 / month $4,000 Help with ADLs $1,526 / month $6,000 Help with ADLs $1,526 / month $6,000 Help with ADLs
*All of a beneficiary’s monthly income, with the exception of a personal needs allowance of $60 / month, Medicare premiums, and possibly a spousal income allowance for a non-applicant spouse, must be paid to the nursing home.
†Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level.

 

What Defines “Income”

Any income that a Medicaid applicant receives is counted. 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. An exception exists for Covid-19 stimulus checks and Holocaust restitution payments, which do not count as income.

When just one spouse of a married couple applies for Institutional Medicaid or a 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, which is $2,178 / month (effective 7/1/21 – 6/30/22) is a spousal impoverishment provision. It is the minimum amount of monthly income a non-applicant spouse is said to require to avoid spousal impoverishment. If a non-applicant’s income falls under $2,178 / month, income can be transferred from their applicant spouse, bringing their monthly income up to $2,178.

In Nebraska, a non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $654 / month (effective 7/1/21 – 6/30/22). However, in 2022, a spousal income allowance cannot push a non-applicant’s income above $3,435 / month. This is the Maximum Monthly Maintenance Needs Allowance. Learn more about the spousal income allowance is calculated here.

Income is counted differently when only one spouse applies for Regular Medicaid / Aged Blind and Disabled; The income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. For more information on how Medicaid counts income, click here.

 

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 long-term care. This includes stocks, bonds, investments, IRAs, credit union, savings, and checking accounts, and real estate in which one does not reside. There are also many assets that are exempt (non-countable). Exemptions include personal belongings, such as clothing, household furnishings, an automobile, irrevocable burial trusts, and generally one’s primary home. For home exemption, the Medicaid applicant must live in the home or have intent to return, and in 2022, their home equity interest must not be 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 any other circumstances.

 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, Nebraska’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 permit the non-applicant spouse of an Institutional Medicaid or Medicaid Waiver applicant a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can retain 50% of the couples’ joint 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.

Nebraska has a 60-month Medicaid Look-Back Period that immediately precedes one’s Medicaid application date. During this period, Medicaid checks to ensure no assets were transferred under fair market value. This includes gifts and items sold for less than they are worth by the applicant and their spouse (if applicable). If the look-back period has been violated, is assumed it was to meet Medicaid’s asset limit and a penalty period of Medicaid ineligibility will be established.

 Non-Financial Eligibility Requirements – For Nebraska long-term care Medicaid, an applicant must have a functional need for such care. For Institutional Medicaid and Medicaid Waivers, a nursing home 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 a personal emergency response system, an inability to safely live at home without a medical alert system 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 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 – Nebraska has a Share of Cost Program for persons who have income over the Medicaid limit, but who also have high medical expenses. This program allows seniors to become income eligible by paying a “share of cost” or “spenddown” on medical expenses, such as 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”, which can be thought of as a deductible, is the difference between one’s income and the Medically Needy Income Limit (MNIL). In 2022, the MNIL in Nebraska is $392 / month for an individual, as well as a couple. As an example, a Medicaid applicant with $1,500 / month in income would have a “share of cost” of $1,109 / month ($1,500 – $392 = $1,109). Once an individual or couple has met their “share of cost”, they are eligible for Medicaid for the remainder of the month.

2) Asset Spend Down – Seniors who have assets over Medicaid’s limit can still qualify for Medicaid by “spending down” extra assets. This can be done by spending countable assets on non-countable assets. Examples include making home modifications (i.e., the addition of wheelchair ramps or stair lifts), prepaying funeral and burial expenses, and paying off debt. Remember, assets cannot be gifted or sold under fair market value, as doing so violates Medicaid’s look back rule. It is recommended one keep documentation of how assets were spent as proof the look back rule was not violated.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” or “over-asset” or both, 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 protect their home from Medicaid recovery. 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.

3) Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care services, and Medicare are combined into one program. Additional benefits, such and dental and eye care, may be available.

 

How to Apply for Nebraska Medicaid

Applications for Nebraska Medicaid can be completed online at ACCESSNebraska. Alternatively, persons can apply over the phone or submit a completed paper application to their local Department of Health and Human Services (DHHS) office. DHHS can be reached at 1-855-632-7633, or to locate one’s local Public Assistance Office, click here. Seniors can also contact their local Area Agency on Aging office for more information or for application assistance.

It is vital that Nebraska Medicaid applicants be certain that all eligibility requirements, which are covered in detail above, are met prior to applying for benefits. Seniors who do not meet the income and / or asset limit(s), or are unsure, should strongly consider Medicaid planning. The Medicaid application process can be complicated and lengthy. For general information about applying for long-term care Medicaid, click here.

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