Oklahoma Medicaid Definition
In Oklahoma, Medicaid is called SoonerCare. It is administered by the Oklahoma Department of Human Services (OKDHS).
Medicaid is a health care insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, there are several different coverage groups. The focus of this page, however, is on Medicaid eligibility for senior Oklahoma residents (65 years of age and older). Specifically, long-term care is covered, whether that be at home, in a nursing home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several Medicaid long-term care programs for which Oklahoma seniors may be eligible. These programs have differing financial and medical eligibility requirements, as well as 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 – 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) – These are not entitlement programs; There are a limited number of participants due to enrollment caps. Therefore, wait 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 – This is an entitlement program; Anyone who is eligible will receive assistance. Various long-term care services, 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 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 ineligible or cannot become eligible for Medicaid in Oklahoma. More.
|2022 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||$2,523 / month*||$2,000||Nursing Home||$5,046 / month*||$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||$5,046 / month†||$4,000||Nursing Home||$2,523 / month for applicant†||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$1,133 / month||$2,000||Help with ADLs||$1,526 / month||$3,000||Help with ADLs||$1,526 / month||$3,000||Help with ADLs|
†Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level.
What Defines “Income”
Any income that a Medicaid applicant receives is counted. 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. Covid-19 stimulus checks and Holocaust restitution payments do not count as income, and therefore, have no impact on eligibility.
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 Medicaid eligibility. However, to prevent spousal impoverishment, the non-applicant spouse may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA). In 2022, the MMMNA in OK is $3,435 / month. If a non-applicant spouse has monthly income under this amount, income can be transferred from their applicant spouse to bring the non-applicant’s monthly income up to this level. A non-applicant spouse who already has a monthly income of $3,435 or more is not entitled to a MMMNA / 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. Learn more on how Medicaid counts income.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, IRAs, credit union, savings, and checking accounts, and second homes, such as vacation homes. There are also many assets that are not counted; They are exempt. Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and generally one’s primary home. For home exemption, the Medicaid applicant must live in the home or have intent to return, and in 2022, their home equity interest must be no more than $636,000. Equity interest is the amount of the home’s value of which the applicant outright owns. If a non-applicant spouse lives in the home, it is exempt regardless of the above criteria.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, the non-applicant spouse of a Medicaid 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 the chart indicates above. If the non-applicant’s half of the assets is under $27,480, 100% of the assets, up to $27,480 can be retained by the non-applicant.
Oklahoma has a Medicaid Look-Back Period, which is 60 months immediately preceding the date of one’s Medicaid application. During this time frame, Medicaid checks to ensure no assets were sold or given away under fair market value. This includes gifts or transfers a non-applicant spouse has made. Some persons incorrectly think the IRS gift tax exemption extends to Medicaid eligibility, but it does not. 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. Violating the look-back rule results in a penalty period of Medicaid ineligibility.
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) – 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, and upon the passing of the Medicaid participant, the remaining funds must be paid to the state of Oklahoma. In 2022, the income cap for a QIT is $5,725 / month.
2) Asset Spend Down – Persons who have assets over Medicaid’s limit can become asset eligible 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. 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 the look back rule was not violated.
3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” or “over-asset” or both, 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. Read more about Medicaid planning 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.
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.
How to Apply for Oklahoma Medicaid
Elderly individuals apply for SoonerCare in Oklahoma through the Department of Human Services. To find your local county office, click here. 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.
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.