Medicaid is a federal and state financial medical assistance program. Medicaid provides a wide range of medical services to the aged and disabled, for those who apply and qualify. The federal government provides a significant portion of the financing for the Medicaid program. In order for North Carolina to receive federal funding, the state must comply with the applicable federal statutes and regulations.
There are three major components for Medicaid eligibility: medical, income, and resource eligibility. All three components of eligibility must be met before the state will approve a Medicaid application.
- Medical Eligibility – To medically qualify for the Medicaid program, a person must require a level of care that places him or her “at risk” of nursing home care. Your medical doctor initially determines the level of care you need. Your doctor’s opinion is then reviewed by EDS who determines the level of care required. One must remember that your level of care can change upon re-evaluation.
- Financial Eligibility – Medicaid applicants must meet both the relevant income and asset criteria. Different income and resource criteria apply depending on whether the applicant is married or single. It is important to know that a couple can own over &600,000 of countable property, plus an unlimited amount of non-countable assets and still qualify. Nursing Home eligibility is a Middle Class program. The eligibility criteria for single and married applicants are as follows:
- Single Income Eligibility Criteria – The single individual’s gross monthly income must fall below their cost for care.
- Married Income Eligibility Criteria – First, only the nursing home patient’s income is considered for eligibility; that income must fall below the cost of care. The Community Spouse can have unlimited income, but if that income is low, he or she is permitted to “take” a portion of the applicant’s income to obtain a minimum monthly income of $1,712.00 up to $2,739.00.
- Resource Eligibility – Medicaid applicants must meet both the relevant income and asset criteria. Different income and resource criteria apply depending on whether the applicant is married or single. It is important to know that a couple can own over $600,000 of countable property, plus an unlimited amount of non-countable assets and still qualify. Nursing Home eligibility is a Middle Class program. The eligibility criteria for single and married applicants are as follows:
- Single Resource Eligibility Criteria – The resource limit for a single individual is $2,000.00 in “countable” assets. Thus, to qualify, an individual must have no more than $2000.00 in countable assets. However, it is important to understand that an individual can own “excluded” or “non-countable” assets.
- Married Resource Eligibility Criteria – The resource limited for married couples depends largely on the countable assets owned by both spouses as of the time of the Medicaid applicant’s first period of continuous institutionalization of at least 30 days, and the current value of countable assets. If the current countable assets are less than $21,912.00, then the couple automatically qualifies; otherwise, a “Resource Assessment” will need to be completed to determine how much the applicant’s spouse is entitled to keep in countable assets. During the Resource Assessment, the state will total the countable assets and divide them in half. The resulting figure plus $2,000.00 is how much in countable assets the couple may own to receive Medicaid assistance. Note, the maximum countable assets the community spouse may keep is $109,560.00. The overage must be converted to non-countable assets. Once the marital assets have been “spent down” to the amount specified by Medicaid, the applicant then qualifies under the resource criteria for Medicaid. Note – different limits apply if both spouses are seeking benefits.
In addition to the applicable amount of countable assets, a single of married applicant may own “excluded” assets, and be eligible for Medicaid: the primary residence; an automobile; prepaid irrevocable burial plans; burial plots; household goods and personal effects; certain life insurance policies; specific types of bonds and annuities; and an array of other non-countable resources.