If you need long-term care and cannot afford to pay for either the genuine care you need or any form of insurance or annuity protection, you will need to apply for coverage under the Medicaid program. This program provides managed care to people who are disabled or age 65 or over and have income and assets that fall below certain federal and state thresholds.
It is often challenging to qualify for Medicaid, but the following steps can help determine if you are eligible and improve your odds of obtaining coverage.
- In 2021, President Biden began unwinding the previous administration’s attempts to impose work requirements on Medicaid applicants.
- Applicants must meet specific federal and state income level thresholds to qualify for Medicaid.
- Experts recommend that potential applicants speak to both an elder care lawyer and a financial advisor about "spending down" their assets in order to qualify for Medicaid.
Learn About Medicaid Asset Limits and Eligibility Requirements
Although Medicaid is federally funded, it is administered at the state level, and each state has its own set of rules and regulations for this program. The income and asset levels allowed differ from one state to another, so be sure to find out where your balance sheet falls in relation to the threshold.
If you are single, you generally cannot have more than $2,000 worth of cash or other assets outside of your residence, vehicle, and other necessary items unless your state has a higher limit.
If you are married and your spouse is still able to live independently, they are allowed to retain 50% (or in some states 100%) of your joint assets up to a threshold of $130,380 as of January 2021. Your single or joint income usually cannot exceed 138% of the federal poverty level, although several states have thresholds above this amount.
In nearly all cases, you will also have to prove via medical documents that you are disabled. However, certain exceptions apply (such as women with breast or cervical cancer or anyone diagnosed with tuberculosis). You must also be either a U.S. citizen or have a green card and prove your residency within the state. (Another list of exceptions to these parameters apply, such as those who were victims of human trafficking or are classified by Medicaid as “medically needy.”)
Start the Spend-Down Process
If your assets or income exceed the thresholds for your state, you will need to reduce your estate. If you plan a minimum of five years in advance (or 30 months in California), you can gift your assets or belongings to your children or another responsible party you can count on to use them on your behalf.
You may also be able to create a spend-down trust in some cases, depending on the laws in your state. But this arrangement has restrictions and any funds remaining in the trust after death cannot be passed on to a relative.
Apply for Coverage
There are several ways you can begin applying for Medicaid. You can go to www.medicaid.gov, www.healthcare.gov, or the website for your state’s Medicaid agency. If you do not have online access, Medicaid has local eligibility offices in each state where you can file your application, or you can apply over the phone.
One of the most common reasons people are denied coverage is incomplete information on the application. Before you begin filling out an application, gather these documents to submit:
- Birth certificate or driver's license (to prove your age)
- Proof of citizenship
- Documentation of all assets and income
- Copies of your mortgage, lease, rent payment receipts, utility bills, or other documents that prove where you live
- Medical records documenting your disability
- Information about any other health insurance coverage you may have
Be sure to check with your particular state to see if they require different or additional documentation, along with the standard documents listed above.
Work Requirements and Medicaid in the Future
In April 2021, President Biden began unwinding the previous administration’s attempts to create and implement new eligibility requirements for adults without children or disabilities. These requirements would have allowed states to remove Medicaid coverage from childless adults who are not disabled, who do not have jobs, or are not involved in work-related or volunteer programs. Even states that received approval had not enforced work requirements as of April 2021, because federal courts invalidated the rules.
In an effort to encourage states to expand Medicaid, President Biden’s 2021 American Rescue Plan contains more matching of federal funds as an incentive. The U.S. Department of Health and Human Services has now revoked work requirements in the Medicaid programs of Arizona, Arkansas, Indiana, Michigan, New Hampshire, Ohio, South Carolina, Utah, and Wisconsin. Kentucky and Nebraska withdrew their applications for work requirements after initially receiving approval.
According to the Pew Charitable Trusts, at least 15 states either applied for or received permission to impose work requirements during the previous administration. The nonpartisan research and policy Center on Budget and Policy Priorities reported that in 2018, Arkansas removed more than 18,000 Medicaid beneficiaries off the rolls because they did not meet new eligibility requirements.
Get Some Expert Help
Before or during the Medicaid application process, you may want to consult with two experts who can help you increase your chances of getting coverage. The first expert is an attorney who specializes in elder law and thoroughly understands the Medicaid laws in your state. The other person is a financial advisor, who can assist you with creating a Medicaid trust or other spend down actions you need to take.
Medicaid Eligibility FAQs
Does every state offer expanded Medicaid?
Thirty-nine states and Washington, D.C., have accepted federal funding to expand Medicaid under the ACA. Missouri voters approved Medicaid expansion that was slated to take effect in mid-2021, but implementation has been suspended after GOP lawmakers refused to provide funding.
Can I qualify even if my state does not have expanded Medicaid?
In states that have not expanded Medicaid, eligibility levels are lower than in states that have expanded. Even if your state hasn't expanded Medicaid and it looks like your income is below the level to qualify for financial help with a Marketplace plan, you should fill out a Marketplace application.
Does the federal poverty level vary from one state to another?
The federal poverty level is higher in Alaska and Hawaii. HHS sets three different amounts each year: one for the continental United States, a higher level for Hawaii, and an even higher level for Alaska. But within the continental U.S., the federal poverty level does not vary.
The Bottom Line
Qualifying for Medicaid is not an easy process, and with state-by-state changes, it is not getting any easier to register. Get all of the help you can from a financial advisor and a qualified elder care attorney before you begin this process to maximize your chances of acceptance.
Also, be prepared to plan ahead and drastically reduce the size of your acceptable estate through a gifting or donation program to meet the thresholds for your state.
The information contained in this article is not tax or legal advice and is not a substitute for such advice. State and federal laws change frequently, and the information in this article may not reflect your own state’s laws or the most recent changes to the law. For current tax or legal advice, please consult with an accountant or an attorney.