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

Last updated: December 15, 2021

 

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 on Medicaid eligibility for elderly Nevada residents who are 65 years of age and older. Specifically, long term care Medicaid is covered. In addition to nursing home care and assisted living services, Nevada Medicaid pays for many non-medical support services that help frail seniors remain living at home.

  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 Nevada 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 Nevada offers multiple pathways towards eligibility.

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

2) Medicaid Waivers / Home and Community Based Services (HCBS) – This is not an entitlement program; Waivers limit the number of participants and wait lists may exist. Services are intended to delay the need for nursing home care and are provided at home, adult day care, or in assisted living. More about Waivers here.

3) Regular Medicaid / Medical Assistance to Aged, Blind and Disabled (MAABD) – This is an entitlement program; Anyone who is eligible will receive assistance. Various 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 Nevada Medicaid program. Alternatively, persons can take the Medicaid Eligibility TestIMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for NV Medicaid. More.

2022 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 $2,523 / month* $2,000 Nursing Home $5,046 / month ($2,523 / month per spouse)* $4,000 ($2,000 per spouse) Nursing Home $2,523 / month for applicant* $2,000 for applicant & $137,400 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $2,523 / month $2,000 Nursing Home or At Risk of Nursing Home Placement within 30 Days $5,046 / month ($2,523 / month per spouse) $4,000 ($2,000 per spouse) Nursing Home or At Risk of Nursing Home Placement within 30 Days $2,523 / month for applicant $2,000 for applicant & $137,400 for non-applicant Nursing Home or At Risk of Nursing Home Placement within 30 Days
Regular Medicaid / Aged Blind and Disabled $841 / month $2,000 Help with ADLs $1,261 / month $3,000 Help with ADLs $1,261 / month $3,000 Help with ADLs
* With the exception of a personal needs allowance of approximately $35.00 / month, Medicare premiums, and a non-applicant spousal income allowance (if applicable), all of one’s income must go towards the cost of nursing home care.

 

What Defines “Income”

Any income that a Medicaid applicant receives is counted towards eligibility. 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. Holocaust restitution payments and Covid-19 stimulus checks are not counted as income and have no impact on Medicaid eligibility.

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. This means the income of the non-applicant spouse is disregarded and does not affect the applicant spouse’s eligibility. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse. The MMMNA is the minimum amount of income a non-applicant spouse is said to require to avoid spousal impoverishment. From 7/1/21 – 6/30/22, the MMMNA is $2,177.50. If a non-applicant’s income is under $2,177.50 / month, income can be transferred from their applicant spouse to bring their income up to this level.

In Nevada, a non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $653.25 / month (effective 7/1/21 – 6/30/22). However, in 2022, in no case can a spousal income allowance put a non-applicant’s monthly income over $3,435.This is the Maximum Monthly Maintenance Needs Allowance. Learn more about how the spousal income allowance is calculated.

In addition to providing spousal support, the monthly maintenance needs allowance effectively lowers the amount applicant spouses have to pay towards their cost of care.

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. More on how Medicaid counts income

 

What Defines “Assets”

Countable (non-exempt) assets, also called liquid assets, include cash and most anything that can easily be converted to cash to pay for 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.

For Medicaid eligibility purposes, there are also many assets that are exempt (non-countable). Exemptions include personal belongings, such as clothing, household furnishings, an automobile, and irrevocable burial trusts. One’s primary home is also exempt if the Medicaid applicant lives in it or has intent to return and their home equity interest is under $636,000 (in 2022). Equity interest is the amount of the home’s value owned by the applicant. If a spouse lives in the home, it is exempt regardless of where the applicant lives or their home equity interest.

 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, the Nevada 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 an applicant. This means that assets in the non-applicant’s name are counted towards the applicant spouse’s asset eligibility. However, the non-applicant spouse of a nursing home or Waiver applicant is permitted 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 shown in the chart above. If the non-applicant’s share falls below $27,480, 100% of the assets, up to $27,480 can be retained by the non-applicant spouse.

Nevada has a 60-month Medicaid Look-Back Period that immediately precedes one’s Medicaid application date. During this time frame, Medicaid checks to ensure no assets were sold or transferred under fair market value. This includes gifts, as well as asset transfers one’s spouse has made. Unfortunately, some persons mistakenly think the IRS gift tax exemption extends to Medicaid and unknowingly violate Medicaid’s look back rule. Persons who violate the look-back period are penalized with a penalty period of Medicaid ineligibility.

 Non-Financial Eligibility Requirements – For Nevada Medicaid-funded long-term care, an applicant’s functional need is considered. For nursing home Medicaid and HCBS Medicaid Waivers, a nursing facility level of care (NFLOC) is required. Furthermore, some program benefits may have additional eligibility criteria specific to the particular benefit. For example, for a Medicaid 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 the activities of daily living is required, but a NFLOC is not necessarily required.

 

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) – 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. In simple terms, “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. Examples include the Medicaid recipient’s personal needs allowance, a community spousal income allowance, and long term care services / medical expenses accrued by the Medicaid enrollee. Following the death of the Medicaid recipient, 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 eligible by spending excess assets on non-countable assets. Examples include 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. Remember that assets cannot be gifted or sold under fair market value, as it violates Medicaid’s look back rule. When “spending down”, it is best to keep documentation of how assets were spent as evidence the look back period was not violated.

3) 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 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 programRead 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 as HCBW-FE, is a nursing home diversion program. Benefits to help promote independent living include adult day care, housecleaning, preparation of meals, respite care, and augmented personal care (care services and supports in assisted living).

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 an assisted living facility. Personal emergency response systems, home modifications, personal care assistance, and durable medical equipment are available 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, 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.

 

How to Apply for Nevada Medicaid

Seniors wishing to apply for Medicaid in Nevada can apply online at Access Nevada, download an “Application for Assistance- Medicaid, MAABD, SNAP” here, or call their local Division of Welfare and Supportive Services office for a mailed application. One’s local office can also provide more information about Medicaid programs and assist with the application process. For office locations and contact information, click here. Alternatively, persons can call the Customer Service Voice Response Unit at 1-800-992-0900. Seniors in Northern Nevada can also call 775-684-7200, and seniors in Southern Nevada can call 702-486-1646. In addition, the Aging and Disability Resource Centers in one’s area may be helpful.

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, as discussed above, are 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 just submitting an application. For instance, supportive documentation must also be included with the application. For more information about applying for long-term care Medicaid, click here.

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