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

Nevada Medicaid Long-Term Care Definition

Medicaid is a health care program for low-income individuals of all ages. While there are varying coverage groups, our focus is on long-term care Medicaid eligibility for elderly Nevada residents (aged 65 and older). In addition to nursing home care, Medicaid in NV pays for many services and supports that help frail seniors remain living at home, assisted living residences, and group residential homes. There are three categories of Medicaid long-term care programs for which Nevada seniors may be eligible.

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

2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; the number of participants is limited and wait lists may exist. Services are intended to delay the need for nursing home care and are provided at home, adult day care, and assisted living, or in group residential homes. More on Waivers.

3) Regular Medicaid / Medical Assistance to Aged, Blind and Disabled (MAABD) – An entitlement; anyone who is eligible will receive assistance. Various long-term care benefits, such as personal care assistance or adult day care, may be available.

While the Medicaid program is jointly funded by the state and federal government, it is administered by the state under federally set parameters. The Nevada Department of Health and Human Services is the administering agency.

Income & Asset Limits for Eligibility

The three categories of long-term care Medicaid programs have differing financial and medical eligibility requirements. Further complicating financial criteria is that it changes annually, varies with marital status, and Nevada offers multiple pathways towards eligibility.

The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from a Nevada Medicaid program. Alternatively, persons can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for NV Medicaid. More.

Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly all income that a Medicaid applicant receives is counted towards eligibility. This includes 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 NV, the VA Aid & Attendance and Housebound Allowance, which is above and beyond the Basic VA Pension, is not counted.

Treatment of Income for a Couple
When just one spouse of a married couple applies for Nursing Home Medicaid or a HCBS Medicaid Waiver, only the income of the applicant is counted towards Medicaid’s income limit. The non-applicant spouse, however, may be entitled to a Spousal Income Allowance from their applicant spouse. This is called a Monthly Maintenance Needs Allowance (MMNA) and is said to be the minimum amount of monthly income a non-applicant spouse is said to require to avoid spousal impoverishment. In 2025, the MMNA in Nevada is $3,948. If a non-applicant’s monthly income is under this amount, income can be transferred to them from their applicant spouse to bring their income up $3,948 / month. A non-applicant spouse whose own monthly income is $3,948 / month or more is not entitled to a MMNA / Spousal Income Allowance.

Income is counted differently when only one spouse of a married couple applies for Regular Medicaid; the income of both spouses is calculated towards the applicant’s income eligibility. Furthermore, there is no Minimum Monthly Maintenance Needs Allowance. More on how Medicaid counts income.

Asset Definition & Exceptions

Countable vs. Non-Countable Assets
Countable (non-exempt) assets are calculated 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 Nevada, 401Ks / IRAs are counted. There are also many assets that are non-countable (exempt). Exemptions include personal belongings (i.e., clothing), household furnishings, an automobile, irrevocable burial trusts, and generally one’s primary home.

Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned (regardless of the long-term care Medicaid program for which one or both spouses are applicants). There is, however, a Community Spouse Resource Allowance (CSRA) that protects a larger amount of a couple’s countable assets for the non-applicant spouse of a Nursing Home Medicaid or Medicaid Waiver applicant. In 2025, the CSRA allows the community spouse (the non-applicant spouse) to keep up to $157,920 of the couple’s assets. Note: There is no CSRA for Regular Medicaid.

Medicaid’s Look-Back Rule
Nevada 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 sold under fair market value. This includes asset transfers made by one’s spouse. This rule is meant to discourage persons from gifting assets to meet Medicaid’s asset limit. Persons who violate the Look-Back Rule are penalized with a Penalty Period of Medicaid ineligibility. Note: The Look-Back Rule does not apply to Regular Medicaid.

The IRS Gift Tax Exemption does not extend to Medicaid eligibility. In 2025, the Gift Tax Rule allows one to gift up to $19,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s Look-Back Period.

Nevada Medicaid Home Exemption Rules

For the home to be exempt, the Medicaid applicant or their spouse must live in it. If there is no spouse in the home, there is a home equity interest limit of $730,000 (in 2025). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of the home’s equity that is owned by the applicant. Furthermore, if neither the applicant nor their spouse live in the home, the applicant must have Intent to Return. Note: 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 (MERP). Following a long-term care Medicaid beneficiary’s death, Nevada’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 Medicaid long-term care. For Nursing Home Medicaid and HCBS Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Furthermore, there may be additional eligibility criteria specific to a particular benefit. For example, for a waiver to cover the cost of a personal emergency response system, it may be required that a beneficiary need it to safely live independently. For long-term care services via the Regular Medicaid program, a functional need with Activities of Daily Living is required, but a NFLOC is not necessarily required.

Qualifying When Over the Limits

For Nevada elderly residents (aged 65+) who do not meet the financial eligibility requirements above, there are other ways to qualify for Medicaid.

1) Qualified Income Trusts (QIT’s) – Also called Miller Trusts or Income Cap Trusts, QITs allow persons who are over the income limit to still qualify for Nursing Home Medicaid or a Medicaid Waiver. For Medicaid eligibility purposes, monthly income deposited into an irrevocable QIT no longer counts as income. “Irrevocable” means the terms of the trust cannot be changed or canceled. Essentially, “excess” income is put into the trust, in which a trustee is named, giving that individual legal control of the money. Trust funds can only be used for very specific purposes, such as the Medicaid recipient’s Personal Needs Allowance, a Spousal Needs Allowance, and long-term care services / medical expenses not covered by Medicaid. Following the Medicaid recipient’s death, any remaining funds must be paid to the state of Nevada.

2) Asset Spend Down – Persons who have assets over NV Medicaid’s limit can become asset-eligible by spending excess assets on non-countable ones. Examples include making home modifications (i.e., wheelchair ramps, roll-in showers, and stair lifts), vehicle modifications (i.e., 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. Remember that assets cannot be gifted or sold under fair market value within 60-months of applying for Nursing Home Medicaid or a Medicaid Waiver, as it violates Medicaid’s Look-Back Period. When “spending down”, it is best to keep documentation of how assets were spent as evidence this rule was not violated.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and/or “over-asset”, but they still cannot afford their cost of care. For these individuals, 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 to protect their home from Medicaid’s Estate Recovery Program. Connect with a Medicaid Planner.

Specific Nevada Medicaid Programs

In addition to paying for nursing home care, Nevada Medicaid offers the following programs relevant to the elderly that help them to live at home or in the community.

1) Frail Elderly (FE) Waiver– Provides home and community based services to promote independent living. Benefits may include adult day care, housecleaning, preparation of meals, respite care, and augmented personal care (care services and supports in assisted living or group residential homes).

2) 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, including certain family members, 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.

3) Adult Day Health Care (ADHC) – Daytime care, supervision, and meals are provided for frail seniors and adults with disabilities in adult day care centers. Assistance may include help with daily living activities, medication administration, and nursing services.

4) Money Follows the Person (MFP) – This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.

How to Apply for Nevada Medicaid

Seniors can apply for Medicaid in Nevada online at Access Nevada, complete and submit an “Application for Assistance- Medicaid, MAABD, SNAP”, or call their local Division of Welfare and Supportive Services office for a mailed application. One’s local office can provide information about Medicaid programs and assist with the application process. Alternatively, persons can call the Customer Service Voice Response Unit toll free at 1-800-992-0900. In Northern Nevada, seniors can call 775-684-7200, or in Southern Nevada, they can call 702-486-1646. The Aging and Disability Resource Centers in one’s area may also be helpful. The application process may vary based on the program for which one is applying.

Applying for NV Medicaid can be complicated, particularly since there are several programs relevant to aging seniors. It is imperative that one be certain all eligibility requirements be met prior to application. Not meeting the criteria can lead to a denial or delay of benefits. For those who are uncertain of their eligibility status, or know they are over the income and / or asset limits(s), Medicaid Planning is highly suggested. Applying for Medicaid entails more than submitting an application; supportive documentation must also be included. Familiarizing oneself with general information about the long-term care Medicaid application process can be helpful.