Tip – To qualify for Medicaid you must meet certain income, asset and
health requirements.
Medicaid is a federal program administered by the states—a good example of American Federalism—that helps pay for care in an assisted living facility for people who don’t have the resources to pay for their care. Unlike Medicare, which you qualify for by turning 65, to qualify for Medicaid you must meet certain income, asset, and health requirements. In addition, Medicaid is a loan which must be paid back out of the estate of the person who received Medicaid. This is known as Estate Recovery and is a tip for another day.
Let’s look at the financial eligibility requirements for Medicaid.
To qualify for Medicaid coverage in an assisted living facility, you must meet both
income and asset limits:
Income Limits
- Individual monthly income limit: Generally, around $2,742 (300% of SSI for 2024)
- Income above this limit may still qualify through a Miller Trust
- Social Security, pensions, IRA distributions, and most other income sources count
Asset Limits
- Individual asset limit: $2,000 in Idaho
- Married couples may protect additional assets for the non-applicant spouse
- Exempt assets include:
- Primary residence (if spouse or dependent lives there)
- One vehicle
- Personal belongings and household items
- Burial plots and prepaid funeral arrangements
- Life insurance with face value under $1,500
There are also medical eligibility requirements. To meet those requirements, you must demonstrate the need for assisted living level care.
Medical Eligibility Requirements
• Require assistance with multiple Activities of Daily Living (ADLs)
• Need regular supervision due to cognitive impairment
• Have documented medical conditions requiring ongoing care
• Must be assessed by state Medicaid authorities
Application Process
Here are the steps you take to complete the application process
- Gather documentation:
- Birth certificate and ID
- Proof of income (tax returns, Social Security statements)
- Bank statements and investment accounts
- Property deeds and vehicle titles
- Medical records and physician statements
- Insurance policies
- Birth certificate and ID
- Complete Medicaid application through the Department of Health and Welfare
- Submit to medical assessment by state evaluator
- Facility must be Medicaid-certified
Important Considerations
Depending on your situation, applying for Medicaid can be a lengthy, complex and sometimes frustrating process. If you are considering applying for Medicaid, remember to apply early as soon as you have met the above requirements. If you have transferred assets to someone without compensation, there is a 5 year look back period that may affect your eligibility. Finally, if you have questions or need assistance, consider talking with an Elder Law Attorney.
View our “Senior’s Guide to a Well-Planned Future” on our website! Packer Elder Care Law – with you for life!
Tom Packer is an Elder Law Attorney serving all Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.
December 2024