Nevada Medicaid Definition
In Nevada, Medicaid is administered by the Nevada Department of Health and Human Services.
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 Nevada 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 Nevada 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 Nevada offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – This is an entitlement (anyone who is eligible will receive assistance) program. It is provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – Waivers limit the number of participants. Therefore, wait lists may exist. Services are provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Medical Assistance to Aged, Blind and Disabled (MAABD) – This is an entitlement (anyone who is eligible will receive assistance) program. 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 Nevada 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 for Nevada Medicaid. More.
|2019 Nevada 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||$2,313 / month||$2,000||Nursing Home||$4,626 / month (Each spouse is allowed up to $2,313 / month)||$4,000 (Each spouse is allowed up to $2,000)||Nursing Home||$2,313 / month for applicant||$2,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,313 / month||$2,000||Nursing Home||$4,626 / month (Each spouse is allowed up to $2,313 / month)||$4,000 (Each spouse is allowed up to $2,000)||Nursing Home||$2,313 / month for applicant||$2,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$771 / month||$2,000||None||$1,157/ month||$3,000||None||$771 / month||$2,000||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, 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 affect the applicant spouse’s eligibility. For more information in regards to how Medicaid counts income, click here.
There is a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which a non-applicant spouse is entitled. As of July 1, 2018, this figure falls between $2057.50 / month and $3,160.50 / month. (The lower figure will change again 7/1/19, while the higher figure will change 1/1/20). This community spouse maintenance allowance allows the Medicaid applicant to transfer income to his/her non-applicant spouse to ensure he or she has sufficient funds with which to live. This also effectively lowers the amount the applicant spouse has to pay towards their cost of care.
What Defines “Assets”
Countable (non-exempt) assets, also sometimes called liquid 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 non-exempt assets include stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility purposes, 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 live in the home and the home is valued under $585,000 (in 2019).
For married couples, there is a Community Spouse Resource Allowance (CSRA). As of 2019, the community spouse (the non-applicant spouse) can retain up to one half of the couples’ joint assets, up to a maximum of $126,420, as shown in the chart above. If one half of the couple’s joint assets are $25,284 or less, the non-applicant spouse can retain 100% of the assets.
When considering assets, one should be aware that Nevada 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 has 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 Nevada 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) Qualified Income Trusts (QIT’s) – QIT’s, also referred to as Miller Trusts or Income Cap Trusts, are for Medicaid applicants who are over the income limit, but still cannot afford to pay for 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 simple terms, one’s income is directly deposited into a trust, in which a trustee is named, giving that individual legal control of the money. The account must be irreversible, meaning once it has been established, it cannot be changed or canceled, and upon death of the Medicaid participant, any remaining funds must be paid to the state of Nevada. In addition, the money in the account can only be used for very specific purposes, such as paying a Medicaid participant’s personal needs allowance, a community spousal allowance, and long term care services / medical expenses accrued by the Medicaid enrollee.
Unfortunately, Income Cap Trusts are not helpful if one has assets over the Medicaid eligibility limit. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above option cannot assist one in reducing and meeting the asset limit. However, one can “spend down” assets by spending excess assets on non-countable assets, such as home modifications (wheelchair ramps, roll-in showers, and stair lifts), vehicle modifications (wheelchair lifts, adaptive control devices, and floor modifications to allow one to drive from a wheelchair), prepaying funeral and burial expenses, and paying off debt.
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 Nevada Medicaid Programs
1) HCB Frail Elderly Waiver– This home and community based waiver for frail seniors, abbreviated HCBW-FE, is a nursing home diversion program. Benefits to help promote independent living include adult day care, attendant care, housecleaning, preparation of meals, and respite care.
2) HCBW for Persons with Physical Disabilities (HCBW-PD) – Also called the Physical Disability Waiver, program participants are able to receive supportive services in their home or in an assisted living facility. Personal emergency response systems, home modifications, personal care assistance, and durable medical equipment are all program benefits.
3) Personal Care Services (PCS) Program – Intended for those who are disabled or have a chronic health condition, program participants can hire and manage their own personal care aide to assist with Activities of Daily Living (ADLs) and Independent Activities of Daily Living (IADLs). Examples of assistance include bathing, mobility, eating, housekeeping, and meal preparation. Via this program, participants have the option of hiring, training, and managing the person who will be providing them with care assistance. This includes certain family members.