Washington DC Medicaid Eligibility for Long Term Care: Income & Asset Limits

Last updated: June 09, 2022

 

Washington DC Medicaid Definition

Medicaid in Washington DC is administered by the Department of Health Care Finance (DHCF) agency.

Medicaid is a wide-ranging health insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, coverage is provided for varying groups of Washington DC residents. While this includes pregnant women, parents and caretaker relatives, adults with no dependent children, disabled individuals, and seniors, the focus of this page is strictly on Medicaid eligibility for Washington DC elders, aged 65 and over. Specifically, long term care is covered, whether that be at home, an assisted living facility, or a nursing 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 Medicaid long-term care programs for which Washington DC seniors may be eligible. These programs have differing financial and medical (functional) eligibility requirements, as well as benefits. Further complicating eligibility are the facts that the requirements vary with marital status and that Washington DC offers multiple pathways towards Medicaid eligibility.

1) Institutional / Nursing Home Medicaid – This is an entitlement program; Anyone who meets the eligibility requirements will receive assistance. Benefits are provided only in nursing home facilities.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – These are not entitlement programs; There are a limited number of participant enrollment slots and wait lists may exist. Intended to delay the need for nursing home admissions, benefits are provided at home, adult day care, or in assisted living. More on Waivers.

3) Regular Medicaid / Aged, Blind and Disabled (ABD) – This is an entitlement program; As long as eligibility requirements are met, one will receive assistance. Limited 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 might be immediately eligible for long term care from a Washington DC 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 Medicaid in the District of Columbia. More.

2022 Washington DC 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* $4,000 Nursing Home $5,046 / month ($2,523 / month per spouse)* $6,000 Nursing Home $2,523 / month for applicant* $4,000 for applicant & $137,400 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $2,523 / month† $4,000 Nursing Home $5,046 / month ($2,523 / month per spouse)† $6,000 Nursing Home $2,523 / month for applicant† $4,000 for applicant & $137,400 for non-applicant Nursing Home
Regular Medicaid / Aged Blind and Disabled $1,132 / month $4,000 Help with ADLs $1,525 / month $6,000 Help with ADLs $1,525 / month $6,000 Help with ADLs
*All of a beneficiary’s monthly income, with the exception of a personal needs allowance of $70 / month, Medicare premiums, and potentially a spousal income allowance for a non-applicant spouse, must go towards nursing home costs.
†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. Examples include employment wages, alimony payments, railroad retirement, Veteran’s benefits, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends. Holocaust restitution payments and Covid-19 stimulus checks do not count as income, and therefore, do not impact Medicaid eligibility.

When only one spouse of a married couple applies for Institutional 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 the income eligibility of their spouse. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA). This income allowance, also called a Community Maintenance Needs Allowance (CMNA) in Washington DC, is a spousal impoverishment provision. It is said to be the minimum amount of monthly income the non-applicant spouse requires to avoid poverty. In DC, the MMMNA is $2,288.75 (effective 7/1/22 – 6/30/23). If a non-applicant’s monthly income falls under $2,288.75, income can be transferred from their applicant spouse, bringing their income up to this level.

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. For more information on how Medicaid counts income, click here.

 

What Defines “Assets”

Countable assets (also called resources) include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. There are also many assets that are not counted; They are exempt from the eligibility limit. Exemptions include personal belongings, such as clothing, household furnishings, a vehicle, a burial plot for the applicant and spouse, and life insurance, given the face value is not greater than $1,500. One’s primary home is also exempt if the Medicaid applicant is married and their spouse lives in the home. If unmarried, the home is exempt if the applicant lives in it or has intent to return, and in 2022, their home equity interest is not more than $955,000. Equity interest is the amount of the home’s value owned by the applicant.

 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, Washington DC’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.

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 an Institutional Medicaid or Medicaid 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’ assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s half of the assets falls under $27,480, 100% of the assets, up to $27,480 can be kept by the non-applicant.

It is vital that one does not give away assets or sell them for less than fair market value within 60 months (5 years) of long-term care Medicaid application. This is because Washington DC has a Medicaid Look-Back Period in which the Medicaid agency scrutinizes all past asset transfers. This includes transfers made by a non-applicant spouse. If assets have been gifted or sold under fair market value during this period, the Medicaid agency assume it was done to meet Medicaid’s asset limit. A penalization period in the form of Medicaid ineligibility is calculated for persons who violate the look-back period.

 Non-Financial Eligibility Requirements – For Washington DC long-term care Medicaid eligibility, an applicant must have a functional need for such care. For Institutional Medicaid and Medicaid Waivers, a nursing home level of care (NHLOC) is required. Furthermore, some program benefits, such as home modifications, may have further eligibility, such as an inability to safely live at home without modifying the home. For long-term care services via the Regular Medicaid program, a functional need with the activities of daily living is required, but a NHLOC is not necessarily required.

 

Qualifying When Over the Limits

For Washington DC 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) Medically Needy Pathway – Washington DC has a Medically Needy Spend Down Program that allows those who would otherwise be over the income limit to still qualify for Medicaid if they have high medical expenses. In simple terms, one “spends down” their income on private health insurance, prescription medications, unpaid medical bills, and medical expenses that Medicaid does not cover. The medically needy income limits (MNILs), effective 2/1/22 – 1/31/23, are $724.77 / month for an individual and $762.92 / month for a couple. The “spend down” amount can be thought of as a deductible. It is the difference between one’s monthly income and the MNIL and is calculated for a 6 month period. Once one has met their “spend down”, they will be Medicaid eligible for the remainder of the period. The medically needy asset limit is $4,000 for an individual and $6,000 for a couple. Learn more about the medically needy pathway.

2) Asset Spend Down – Persons who have assets over Medicaid’s eligibility limit can still become asset eligible by “spending down” excess assets. This can be done by spending countable assets on non-countable ones, such as home modifications (i.e., addition of wheelchair ramps or stair lifts), 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 or connect with a Medicaid planner.

 

Specific Washington DC Medicaid Programs

Like all states, Medicaid in Washington DC pays for nursing home care for state residents who are medically and financially eligible for such care. DC Medicaid also offers programs for seniors who require nursing home level care or have slightly lesser care requirements and do not wish to reside in a nursing home. These programs provide care at home or “in the community”.

1) Adult Day Health Care & Personal Care – Part of the state Medicaid plan, adult day health care and personal care assistance is available as nursing home diversion services. Personal care assistance, which provides aid with activities of daily living, such as bathing, grooming, dressing, eating, and mobility, is available both in-home and in adult day health care. Additional benefits are provided in adult day health care and include supervision, meals, and therapeutic activities.

2) Elderly and Persons with Disabilities (EPD) Medicaid Waiver – This Waiver provides benefits promoting independent living at home or in assisted living for seniors and disabled individuals. An option, Services My Way, allows program participants to hire the individual of their choosing, including adult children, to provide personal care services. Other benefits include adult day health, personal emergency response systems, home modifications, respite care, and homemaker services.

 

How to Apply for Washington DC Medicaid

To apply for Medicaid in the District of Columbia, seniors need to submit a “Combined Application for Benefits” either by mail to the Department of Human Services, Economic Security Administration, Case Record Management Unit, P.O. Box 91560, Washington, DC 20090 or by fax to 202-671-4400. Alternatively, seniors can return the completed application to their local Economic Security Administration (ESA) Service Center. Find yours here. Persons might find the Aging and Disability Resource Center helpful with the application process. Currently, elderly applicants do not have the option of applying for Medicaid benefits online.

Prior to applying for Medicaid in Washington DC, senior applicants should be certain that they meet all eligibility requirements (as discussed above) for the program for which they are applying. Being over the income and / or asset limit(s), or being uncertain if eligibility criteria are met, can result in a denial of benefits. In these cases, persons should seriously consider Medicaid planning for the best chance of acceptance into a Medicaid program. For additional information about applying for long-term care Medicaid, click here.

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