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

Oklahoma Medicaid Long-Term Care Definition

Medicaid is a health care insurance program for low-income individuals of all ages. While there are many different coverage groups, the focus here is on long-term care Medicaid eligibility for senior Oklahoma residents (65 years of age and older). In addition to care services in nursing homes and assisted living facilities, services and supports are available to help the elderly live in their homes. There are three categories of Medicaid long-term care programs for which Oklahoma 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; there are a limited number of participants due to enrollment caps. Therefore, waiting lists may exist. Intended to delay the need for nursing home admissions, assistance is provided at home, adult day care, or in assisted living. More about Waivers.

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

In Oklahoma, Medicaid is called SoonerCare. While the program is jointly funded by the state and the federal government, it is administered by the state under federally set parameters. The Oklahoma Department of Human Services (OKDHS) is the administering agency.

Income & Asset Limits for Eligibility

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

The table below provides a quick reference to allow seniors to determine if they could be immediately eligible for long-term care from an Oklahoma Medicaid program. Alternatively, persons may take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the criteria below does not mean one cannot become eligible for Medicaid in Oklahoma. More.

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 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 OK, the VA Aid & Attendance benefit, which is above and beyond the Basic VA Pension, does not count as income.

Treatment of Income for a Couple
When only one spouse of a married couple applies for Nursing Home 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 their spouse’s income eligibility. The non-applicant spouse, however, may be entitled to a Monthly Maintenance Needs Allowance (MMNA) from their applicant spouse to prevent them from becoming impoverished.

In 2024, the MMNA in OK is $3,854. If a non-applicant spouse has monthly income under this amount, income can be transferred to them from their applicant spouse to bring their monthly income up to this level. A non-applicant spouse who already has a monthly income of $3,854 or more is not entitled to a MMNA / Spousal Income Allowance.

Income is counted differently when only one spouse applies for Regular Medicaid / Aged Blind and Disabled; the income of both the applicant spouse and non-applicant spouse is calculated towards the applicant’s income eligibility. Furthermore, there is no Monthly Maintenance Needs Allowance for a non-applicant spouse. Learn more on how Medicaid counts income.

Asset Definition & Exceptions

Countable vs. Non-Countable Assets
The value of countable assets are added together and counted towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), and second homes, such as vacation homes. In Oklahoma, IRAs are also counted. There are also many assets that are not counted; they are exempt. Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial contracts up to $10,000, 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 spouse or both are applicants. However, the non-applicant spouse of a Medicaid nursing home or Waiver applicant is permitted a Community Spouse Resource Allowance (CSRA). In 2024, the community spouse (the non-applicant spouse) can retain 50% of the couple’s combined assets, up to a maximum of $154,140. If the non-applicant’s share of the assets is under $30,828, 100% of the assets, up to $30,828 can be retained by the non-applicant.

Medicaid’s Look-Back Rule
Oklahoma has a Medicaid Look-Back Period, which is 60 months immediately preceding the date of one’s Nursing Home Medicaid or Medicaid Waiver application. During the “look back”, Medicaid checks to ensure no assets were sold or given away under fair market value. This includes gifts or transfers made by a non-applicant spouse. Some persons incorrectly think the IRS Gift Tax Exemption extends to Medicaid eligibility. While the IRS allows US citizens to gift a specific amount without filing a Gift Tax Return, this gifting is still a violation of Medicaid’s Look-Back Rule. Violating this rule results in a Penalty Period of Medicaid ineligibility.

There is no Look-Back Period for Regular Medicaid.

Oklahoma 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, Oklahoma’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 Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Furthermore, for some program benefits, such as home modifications, additional eligibility criteria might need to be met. For example, an inability to safely and independently live at home without modifications 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 NFLOC is not necessarily required.

Qualifying When Over the Limits

For Oklahoma 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) Qualified Income Trusts (QIT’s) – Also called Miller Trusts, or Medicaid Income Pension Trusts in OK, these trusts allow Nursing Home Medicaid and Medicaid Waiver applicants who are over the income limit to still become income-eligible. For eligibility purposes, money deposited into a QIT does not count towards Medicaid’s income limit. In simple terms, one’s excess income (over the Medicaid limit) is directly deposited into a trust, in which a trustee is named. The trustee has legal control of trust funds, which can only be used for very specific purposes, such as paying long-term care services / medical expenses accrued by the Medicaid enrollee. Furthermore, the trust must be irreversible, meaning once it has been established, it cannot be changed or canceled. Upon the passing of the Medicaid participant, the remaining funds must be paid to the state of Oklahoma. Effective 7/1/24, the income cap for a QIT is $7,445 / month.

2) Asset Spend Down – Persons who have assets over Medicaid’s limit can become asset-eligible by spending excess assets on non-countable ones. Examples include paying for home modifications (wheelchair ramps, roll-in showers, pedestal sinks, 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, 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.

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 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 to protect their home from Medicaid’s Estate Recovery Program. Connect with a Medicaid Planner.

Specific Oklahoma Medicaid Programs

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

1) ADvantage Waiver Program – Allows program participants to self-direct their own personal care services through Consumer Directed Personal Assistance Services and Supports. This option allows them to hire select family members to serve as their caregiver. A variety of other benefits are available, including adult day care, assisted living services, personal emergency response systems, home modifications, and respite care.

2) State Plan Personal Care (SPPC) Program – Part of Oklahoma’s Regular state Medicaid plan, there is no waiting list to receive personal care assistance. This program allows for self-direction, meaning the program participant is able to hire, train, and manage the personal care assistant of their choosing.

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 care and eye care, may be available.

4) Money Follows the Person – Also called the Living Choice Program in Oklahoma. This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.

How to Apply for Oklahoma Medicaid

Elderly individuals apply for SoonerCare in Oklahoma through the Department of Human Services. Find your local county office. Alternatively, persons can call the Director’s Helpline at 877-751-2972 or 405-521-2779 or apply online at OKDHSLive!. One’s local Area Agency on Aging office might be helpful in answering Medicaid program questions and offering application assistance. The application process may vary based on the program for which one is applying.

Prior to submitting a SoonerCare application, Oklahoma seniors need be certain that they meet all of the eligibility criteria. Persons who have excess income and / or assets, should strongly consider Medicaid planning. In addition, the application process can be lengthy and challenging, as documentation must be included with the application. Familiarizing oneself with general information about the application process for long-term care Medicaid can be helpful.