Oklahoma Medicaid Definition
In Oklahoma, Medicaid is called SoonerCare and is administered by the Oklahoma Department of Human Services (OKDHS).
Medicaid is a health care insurance program, jointly funded by the state and federal government, for low-income individuals of all ages. While there are many different eligibility groups, this page is focused specifically on Medicaid eligibility for senior Oklahoma residents (65 years of age and older). That said, the focal point will be on long term care, whether that be at home, in a nursing home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Oklahoma 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 Oklahoma offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – is an entitlement (anyone who is eligible will receive assistance) program. Assistance is provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – Limited number of participants due to enrollment caps. Therefore, wait lists may exist. Assistance is provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – is an entitlement (persons meeting eligibility automatically receive benefits) program. Assistance is provided at home or adult day care.
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 the criteria below does not mean one is not eligible or cannot become eligible for Medicaid in Oklahoma. More.
|2020 Oklahoma 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||$2,349 / month||$2,000||Nursing Home||$4,698 / month||$4,000||Nursing Home||$2,349 / month for applicant||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,349 / month||$2,000||Nursing Home||$4,698 / month||$4,000||Nursing Home||$2,349 / month for applicant||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$1,063 / month||$2,000||None||$1,437 / month||$3,000||None||$1,437 / month||$3,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To be clear, this income can come from any source, such as employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends.
When only one spouse of a married couple is applying for nursing home Medicaid or a HCBS Medicaid waiver, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. (This is not true for a married couple with one spouse applying for Regular Medicaid). In fact, a portion (or all) of the applicant spouse’s income can be transferred to the non-applicant spouse. This, in Medicaid terminology, is called a Minimum Monthly Maintenance Needs Allowance (MMMNA), and is the minimum amount of monthly income to which the non-applicant spouse is entitled. This spousal impoverishment rule is intended to ensure the non-applicant spouse has sufficient funds with which to live. As of 2020, up to $3,216 / month can be transferred to the non-applicant spouse from his/her applicant spouse. Learn more on how Medicaid counts income.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and second homes, such as vacation homes. However, for Medicaid eligibility, there are many assets that are not counted, as they are considered exempt. Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant or his or her spouse lives in the home and the home equity value is not greater than $585,000 (in 2019).
For married couples, as of 2020, the community spouse (the non-applicant spouse) of a nursing home Medicaid applicant or Medicaid waiver applicant can keep as much as 50% of the couple’s joint assets, up to $128,64. (This figure is shown in the chart above). If half of the assets are less than $25,728, the non-applicant spouse can keep 100% of the assets, up to $25,728. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA). This resource allowance does not extend to non-applicant spouses of those who are applying for regular Medicaid.
One should be aware that Oklahoma 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. It’s important to note, this even includes gifts or transfers a non-applicant spouse has made. Another important point to make is that the IRS gift tax exemption does not extend to Medicaid eligibility. Said differently, while the IRS allows US citizens to gift a specific amount of money tax free, this gifting is still a violation of Medicaid’s look back period. Unfortunately, violating the look-back period is cause for penalty in the form of Medicaid ineligibility for a period of time.
Qualifying When Over the Limits
For Oklahoma 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, are for Medicaid applicants who are over the income limit, but still cannot afford to pay for their long-term care. (For Oklahoma Medicaid purposes, a Miller Trust is often called a Medicaid Income Pension Trust.) This type of trust allows seniors who are 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 excess income (over the Medicaid limit) 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 the passing of the Medicaid participant, the remaining funds must be paid to the state of Oklahoma. In addition, the money in the account can only be used for very specific purposes, such as paying long term care services / medical expenses accrued by the Medicaid enrollee. As of 2020, the income cap for a QIT is $5,420 / month.
Unfortunately, Income Only Trusts do not assist one in qualifying for Medicaid if they are over the asset 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 their extra assets. However, one can “spend down” assets by spending excess assets on non-countable assets. 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.
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 Oklahoma Medicaid Programs
1) ADvantage Program Waiver – This Medicaid program allows program participants to direct their own care and even hire some family members to provide personal care assistance. A variety of other benefits are available, including adult day care, personal emergency response systems, home modifications, and respite care.
2) Personal Care Program – Part of Oklahoma’s state Medicaid plan, there is no waitlist 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.
How to Apply for Oklahoma Medicaid
To apply for SoonerCare in Oklahoma, elderly individuals need to apply through the Department of Human Services. To find your local county office, click here. Persons might also find their local Area Agency on Aging office helpful, as they should be able to answer Medicaid program questions and offer application assistance. Unfortunately, at this time, there is no option for seniors to apply for long-term care Medicaid online.
Prior to submitting a SoonerCare application, Oklahoma seniors need be certain that they meet all of the eligibility criteria, which are covered in detail above. 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. For general information about the application process for long-term care Medicaid, click here.