Income Limits for Medicaid-Funded Long-Term Care

When a person applies for Medicaid long-term care benefits, there are several questions that arise about income, and how that income is treated during the Medicaid application process. 

Are there income limits when applying for Medicaid long-term care benefits? 

When applying for Medicaid benefits that cover nursing facility care, monthly income is not normally a barrier to qualifying for benefits because the monthly cost of nursing home care usually exceeds the Medicaid applicant’s income. If you are in a nursing home, your income must usually be paid to the facility and Medicaid takes care of the rest of the nursing home bill. There are exceptions to the Medicaid requirement to pay income to the nursing home

In Pennsylvania, Medicaid also pays for in-home care for those who qualify. When applying for Medicaid funded home- and community-based services through the Community Health Choices waiver, formerly referred to as the Aging Waiver, there is an income limit that changes from year to year. The 2022 monthly income limit is gross income of $2,523. 

What if I want to apply for home- and community-based services and I am over the income limit?

It is possible in some cases to work with an elder law attorney to qualify for Medicaid funded home- and community-based services even when you are over what we will call the “standard income cap.” There are techniques to “spend-down to waiver” but they are complex for all parties: the applicant, elder law attorney, and County Assistance Office caseworkers. That said, staying out of a nursing home when possible is normally very important to our clients, so the complexity and work of spending-down to qualify for the waiver program for Medicaid-funded home care is sometimes worth it. 

How do I spend-down excess income to qualify for Medicaid-funded in-home long-term care?

Where income is over the income-cap by less than $500/month, the excess can in some cases be transferred to a pooled special needs trust. Where monthly income is over the limit by more than $500, there is another way to spend-down the excess income to qualify. Specifically, where virtually all income is paid towards medical expenses such as in-home care through an agency, Medicaid benefits can be approved, but this approach requires the maintenance of meticulous records and submission of verification of income spending to the County Assistance Office on a precise and tight deadline. 

This second approach only works if the documentation is submitted on time each month with perfect diligence. Failure to provide documentation of income spending or to meet the submission deadline can result in the discontinuance of benefits. Additionally, since just about all income is paid toward caregiving, there must be some other source of funding to pay for expenses besides caregivers, such as utilities, rent, insurance, and food. In many cases, there is no other source of funding necessary living expenses and the spend-down to waiver is not an option. 

It is hoped that it will become easier over time for those with income over $2,523/month to qualify for home-based care paid through Medicaid. Until that happens, many people with income just over the income cap will be forced by financial realities to enter a nursing home where Medicaid will pay for care, even for those with income over the $2,523/month cap. 

The path to follow for “spend-down to waiver” is complicated and challenging even for the lawyers who handle them routinely, but it is possible in some cases to qualify, even if you were told that you were over the income cap. Give our office a call (215-885-6785) and we can discuss your options and the Medicaid application process. 

Disclaimer: We recommend that you have ongoing legal advice from an elder law attorney before attempting to navigate the Medicaid application process. If you have questions or wish to secure our services, please contact Gerhard & Gerhard, P.C.

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