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Medicaid Long Term-Care Eligibility

 

Long-Term Care Medicaid includes nursing facility care and Home and Community Based Services where medical providers come into the home to render the necessary services to keep a disabled individual from being institutionalized in a nursing facility or hospital.

 

Disability Eligibility:

 

Individuals under the age of 65 requiring long-term care services must meet the Social Security disability criteria either through Social Security Income (SSI) eligibility or Social Security Disability Income (SSDI) eligibility. Colorado also has a state contractor who can determine disability if an individual has not been determined disabled by the Social Security Administration.

 

Income Eligibility:

 

  • The income limit is $2,130 a month. For those individuals who are not hospitalized an income trust can be established if one's income exceeds $2,130 a month. There are limits for the income trust which are dependent on which county the applicants resides.

 

Only individual applicant income is considered in the eligibility determination. An applicant's spouse's income is not considered.

 

Resource Eligibility:

 

  • The individual resource limit is $2,000.
  • The couple resource limit is $4,000 if both members of a marital couple are applying for long-term care benefits and they are sharing the same room in a nursing facility or if both are going to receive Home and Community Based Services. 
  • The couple resource limit is $3,000 if both members of a marital couple are applying for long-term care benefits are living in separate rooms in a nursing facility.

 

The couple resource limit is $115,920 (2013 limit) if one member of the couple is applying for long-term care services and the other spouse is not applying for Medicaid and is not institutionalized.

 

Level of Care Eligibility

 

Case management agencies evaluate applicants of long-term care to determine if their medical condition qualifies them to receive long-term care services. This approval is necessary for eligibility.

 

Additional Eligibility Requirements:

 

  • 30 Consecutive Day Stay: Applicants of long-term care Medicaid must receive long-term care services for 30 consecutive days before eligibility can be approved.

     

  • Transfers without fair consideration: Applicants of long-term care Medicaid cannot transfer assets for less than fair market value within 5 years of the date of application. If any transfers were made the applicant may be ineligible for long-term care services for a period of time.

 

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