Overview of MO’s Supplemental Nursing Care Program
Missouri’s Supplemental Nursing Care (SNC) Program provides monthly cash assistance to aged and disabled adults living in licensed assisted living facilities (ALFs) and residential care facilities (RCFs). Intended to help cover the cost of living in these facilities, the amount of financial assistance provided varies based on the setting in which one lives. Persons residing in assisted living facilities may receive nearly double the cash assistance of those residing in residential care facilities. Program participants are also provided with a minimal monthly personal needs allowance and their medical needs are covered by Missouri Medicaid.
SNC is an entitlement program. This means the state does not limit the number of persons who can receive program assistance. However, there may be a facility-based waitlist if no beds are available at a specific residential care facility or assisted living facility.
The Missouri Supplemental Nursing Care Program is a Missouri Medicaid program. Medicaid in Missouri is Called MO HealthNet. The Medicaid program for the elderly and disabled is called MO HealthNet for the Aged, Blind, and Disabled (MHABD).
Benefits of the Supplemental Nursing Care Program
The SNC Program provides financial assistance up to $156 / month for persons residing in residential care facilities and up to $292 / month for those in assisted living facilities, as well as a $50 / month personal needs allowance. Payments are made to the program participant, not the facility in which they reside. Program participants are also eligible for medical care, such as hospitalization, lab work, x-rays, and physician appointments, through Medicaid / MO HealthNet. These figures have not yet been updated for 2022.
Eligibility Requirements for the Supplemental Nursing Care Program
SNC is for Missouri residents who are 21+ years old and live in a licensed residential care facility or assisted living facility. Additional eligibility criteria are as follows:
Financial Criteria: Income, Assets & Home Ownership
There is no set income limit. The only requirement is that an applicant’s monthly income be less than the monthly cost of the assisted living facility or residential care facility in which one resides. If the applicant has a non-applicant spouse, only the applicant’s income is considered. In other words, the non-applicant spouse’s income is disregarded.
In 2022, the asset limit is $5,035 for a single applicant. For married couples, regardless if one or both spouses are applicants, the asset limit is $10,070.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
While there is a 60-month look back rule in which Medicaid checks past asset transfers of those applying for nursing home Medicaid or home and community based services via a Medicaid waiver, it is not relevant for the Supplemental Nursing Care Program. In other words, the look back period is not applicable.
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that MO Medicaid will take their home. Fortunately, for eligibility purposes, Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has “intent” to return to the home and his / her home equity interest is no greater than $636,000 in 2022. Home equity interest is the current value of the home minus any outstanding mortgage.
– A spouse lives in the home.
– The applicant has a minor child (under 21 years old) who lives in the home.
– The applicant has an adult child (21+) who is blind or disabled (permanently and totally) who lives in the home.
To learn more about the potential of Medicaid taking the home, click here.
Medical Criteria: Functional Need
Many long-term care Medicaid programs require a nursing facility level of care (NFLOC), but applicants residing in assisted living facilities and residential care facilities need only require assistance with their activities of daily living (ADLs). ADLs include activities such as bathing, dressing, eating, toileting, and mobility. An Initial Assessment – Social and Medical form is used to make this assessment. Relevant to many persons with Alzheimer’s disease or a related dementia, cognitive and behavioral issues, such as lack of orientation and wandering, are also considered. A diagnosis of dementia in and of itself does not mean one will meet the functional need.
Qualifying When Over the Limits
Having income and / or assets over MO HealthNet’s / Medicaid’s limit(s) does not mean an applicant cannot still qualify for Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
While MO HealthNet has a Spenddown Program that permits Medicaid applicants to spend “excess” income on medical expenses in order to meet Medicaid’s income limit, SNC prohibits persons from qualifying via this avenue.
When persons have assets over the limits, trusts are an option. Irrevocable Funeral Trusts are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Another option is to “spend down” extra assets on assets that are exempt from Medicaid’s asset limit. Examples include building on to one’s home, making home and safety modifications, purchasing home furnishings, and buying personal items, such as clothing. There are many other options when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of MO HealthNet benefits. Professional Medicaid planners are educated in the planning strategies available in Missouri to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, while Medicaid’s 60-month look back rule does not apply to the Supplemental Nursing Care Program, it does apply to nursing home Medicaid and other long-term care Medicaid programs. If one might apply for one of these program in the future, it is vital that the look back rule not be violated. Medicaid planning strategies should ideally only be implemented with careful planning and well in advance of the need for long-term care. However, there are some workarounds, and Medicaid planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid planner.
How to Apply for MO HealthNet Supplemental Nursing Care Program
Before You Apply
Prior to submitting an application for SNC, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid eligibility test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid eligibility test.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, previous bank statements, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.
To apply for the Supplemental Nursing Care Program, applicants must be eligible for MO HealthNet. Persons can apply online at myDSS, over the phone by calling the Family Support Division (FSD) at 1-855-373-4636, or at one’s local family support office / resource center. Contact information for local offices can be found here. When filling out the application, applicants should check the box indicating they live in a nursing home or a similar facility.
Persons already enrolled in MO HealthNet should fill out the “Addendum to MO HealthNet Application: Request for Optional Cash Benefits”. This form (form number IM-1MAC) can be found here by typing IM-1MAC into the search bar. When filling out the application, persons should check the Supplemental Nursing Care box.
For additional information about the Supplemental Nursing Care Program, click here. Persons can also call FSD at 1-855-373-4636 or the Nursing Home Unit in one’s area for information and / or assistance. Contact information by Nursing Home Unit can be found here.
The Family Support Division (FSD) within the Missouri Department of Health and Senior Services (DHSS) administers the MO Supplemental Nursing Care Program.
Approval Process & Timing
The Medicaid / MO HealthNet application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed even further. In most cases, it takes between 45 and 90 days for the Medicaid agency to review and approve or deny one’s application. Based on law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). However, despite the law, applications are sometimes delayed even further.