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

Last updated: January 25, 2024

 

Nebraska Medicaid Long-Term Care Definition

Medicaid is a health care program for low-income individuals of all ages. While there are many different coverage groups, this page is focused on long-term care Medicaid eligibility for elderly Nebraska residents who are 65 years of age and older. In addition to nursing facility care and assisted living services, NE Medicaid pays for non-medical services and supports to help frail seniors remain living at home or that of a loved one. There are three categories of Medicaid long-term care programs for which Nebraska seniors may be eligible.

1) Institutional / Nursing Home Medicaid – An entitlement; anyone who is eligible will receive assistance. It is provided only in nursing homes.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; the number of program participants is limited and waiting 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 – An entitlement; 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.

In Nebraska, Medicaid is called the Nebraska Medical Assistance Program (NMAP). While it is jointly funded by the state and federal government, it is administered by the state under federally set parameters. The Nebraska Department of Health & Human Services (DHHS) is the administering agency.

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

 

Income & Asset Limits for Eligibility

Each of the three categories of Medicaid long-term care programs have varying financial and medical eligibility requirements. Further complicating financial eligibility is that the criteria change annually, vary with marital status, and Nebraska offers multiple pathways towards eligibility.

 Simplified Eligibility Criteria: Single Nursing Home Applicant
Nebraska seniors must have limited income and assets, and a medical need to qualify for Medicaid long-term care. In 2024, a single Nursing Home Medicaid applicant must meet the following criteria: 1) Income under $1,255 / month 2) Assets under $4,000 3) Require a Nursing Home Level of 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 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.

2024 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 $1,255 / month* $4,000 Nursing Home $1,255 / month per spouse* $8,000 ($4,000 per spouse) Nursing Home $1,255 / month for applicant* $4,000 for applicant & $154,140 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $1,255 / month† $4,000 Nursing Home $1,255 / month per spouse† $8,000 ($4,000 per spouse) Nursing Home $1,255 / month for applicant† $4,000 for applicant & $154,140 for non-applicant Nursing Home
Regular Medicaid / Aged Blind and Disabled $1,255 / month $4,000 Help with ADLs $1,703 / month $6,000 Help with ADLs $1,703 / month $6,000 Help with ADLs
*All of a beneficiary’s monthly income, with the exception of a Personal Needs Allowance of $75 / month, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must be paid to the nursing home. This is called a Patient Liability.
†Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level.

 

Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly any income from any source that a Medicaid applicant receives is counted towards Medicaid’s income limit. This includes cash gifts, employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in NE, the VA Aid & Attendance Allowance, which is above and beyond the Basic VA Pension, does not count as income.

Treatment of Income for a Couple
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) / Spousal Income Allowance from their applicant spouse. The MMMNA, which is $2,465 / month (eff. 7/1/23 – 6/30/24), 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 $2,465 / month, income can be transferred to them from their applicant spouse, bringing their monthly income up to $2,465.

In Nebraska, a non-applicant spouse can further increase their Spousal Income Allowance if their housing and utility costs exceed a “shelter standard” of $740 / month (eff. 7/1/23 – 6/30/24). However, in 2024, a Spousal Income Allowance cannot push a non-applicant’s total income above $3,854 / month. This is the Maximum Monthly Maintenance Needs Allowance. More on how this allowance is calculated.

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. Furthermore, there is no Spousal Income Allowance for a non-applicant spouse. More on how Medicaid counts income.

 

Asset Definition & Exceptions

Countable vs. Non-Countable Assets
The value of countable (non-exempt) assets are added together and count towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. In Nebraska, IRAs are counted. There are also many assets that are exempt (non-countable). Exemptions include personal belongings, such as clothing, household furnishings, an automobile, irrevocable burial trusts up to $6,346 (eff. 9/1/23), and generally one’s primary home.

Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. However, Spousal Impoverishment Rules permit the non-applicant spouse of an Institutional Medicaid or Medicaid Waiver applicant a Community Spouse Resource Allowance (CSRA). In 2024, the community spouse (the non-applicant spouse) can retain 50% of the couple’s assets, up to a maximum of $154,140. If the non-applicant’s portion of the assets falls under $30,828, 100% of the assets, up to $30,828 can be retained by the non-applicant. There is no CSRA for a non-applicant spouse of a Regular Medicaid applicant.

Medicaid’s Look-Back Rule
Nebraska has a 60-month Medicaid Look-Back Period that immediately precedes one’s Nursing Home Medicaid or Medicaid Waiver application date. During the “look back”, Medicaid checks to ensure no assets were gifted or transferred under fair market value by the applicant and / or their spouse (if applicable). If the Look-Back Period has been violated, it is assumed it was to meet Medicaid’s asset limit and a Penalty Period of Medicaid ineligibility will be established. The Look-Back Rule does not apply to Regular Medicaid applicants and their spouses.

The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, this rule allows one to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s Look-Back Period.

 

Nebraska Medicaid Home Exemption Rules

For home exemption, the Medicaid applicant or their spouse must live in their home. If there is no spouse in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of home equity owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. For Regular Medicaid, there is no home equity interest limit. Other exemptions exist.

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.

 

Medical / Functional Need Requirements

An applicant must have a medical need for long-term care Medicaid. For Institutional Medicaid and Medicaid Waivers, a Nursing Home Level of Care (NHLOC) 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 (ADLs) is required, but a NHLOC is not necessarily required.

 

Qualifying When Over the Limits

For Nebraska elderly residents (aged 65 and over), who do not meet the financial eligibility requirements above, there are other ways to qualify for long-term care 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 2024, 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 income-eligible for Medicaid for the remainder of the month. The Medically Needy Asset Limit is $4,000 for an individual and $6,000 for a couple.

2) Asset Spend Down – Seniors who have assets over Medicaid’s limit can still become asset-eligible by “spending down” extra assets on non-countable ones. 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 this rule was not violated.

 Our Medicaid Spend Down Calculator can assist persons in determining if they might have a spend down, and if so, provide an estimate of the amount.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, but they still cannot afford their cost of long-term 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’s Estate Recovery Program. Connect with a Medicaid Planner.

 

Specific Nebraska Medicaid Programs

In addition to paying for nursing home care, Nebraska Medicaid offers the following programs relevant to the elderly that helps them to remain living at home or in the community.

1) Nebraska Aged & Disabled (A&D) Waiver – Provides supportive services for elderly and disabled individuals in their homes and in assisted living facilities to prevent unnecessary nursing home admissions. Available benefits include adult day care, home modifications, personal emergency response systems, meal delivery, and more.

2) Nebraska’s State Plan 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 as dental and eye care, may be available.

 

How to Apply for Nebraska Medicaid

Applications for Nebraska Medicaid can be completed online at ACCESSNebraska or in person at one’s local DHHS office. One can also call the Department of Health and Human Services (DHHS) at 855-632-7633 to apply via phone or request a paper application. One’s local Area Agency on Aging office might be helpful in providing information and / or application assistance. The application process may vary based on the program for which one is applying.

It is vital that Nebraska Medicaid applicants be certain that all eligibility requirements 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. Familiarizing oneself with general information about the application process for long-term care Medicaid can be helpful.

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