What is Medicaid?
What is Long-Term Care Medicaid?
Long-Term Care Medicaid is the Medicaid program that allows for the coverage of long-term care services through several avenues and over a continuum of settings. This includes:
- Nursing Facility/Institutional Care
- Home and Community Based Services (HCBS) Medicaid waivers
Eligibility Criteria for Long-Term Care Medicaid
General Eligibility Criteria
- U.S. Citizen or Qualified Non-Citizen
- Resident of Colorado
- Must be 65 years or older, disabled, or blind.
Income is any item an individual receives in cash or in-kind that can be used to meet their need for food or shelter. Examples of income include Social Security Retirement, pensions, wages, alimony, Social Security Disability Income (SSDI), Veteran’s benefits, Supplemental Security Income (SSI), and dividends.
- The 2023 income limit is $2,742.
- If over the monthly limit, an Income Trust is needed.
*Most income sources count towards the income limit, but there are income sources that do not count.
Resources are defined as cash and/or property that a person owns and has the right, authority, or power to convert to cash (if not already cash). Examples of resources include checking accounts, savings accounts, money market accounts, certificate of deposit, IRA’s, 401K’s, stocks, bonds, cash, property, vehicles, mineral and oil rights, life insurance, and pre-paid burial or cremation policies.
The 2023 Medicaid Resource Limits are:
- $2,000 – Individual
- $3,000 – Couple (not living in same nursing facility room)
- $4,000 – Couple (living in same nursing facility room)
- $148,620 – Community Spouse Allowance
*Some resources count towards the resource limit, but there are types of resources that do not count.
Functional / Level of Care / 30-day Institutionalization
- A level of care assessment is completed to determine if an applicant functionally needs a long-term care service. The assessment is performed on site by a caseworker from the county Single-Entry Point (SEP).
- A person must have medical conditions requiring supervision. They must have been admitted to a nursing home, a hospital, or a combination of both for at least 30 consecutive days. There is no institutionalization time requirement if applying for HCBS-Medicaid/assisted living.
Transfer of Assets
A transfer of assets occurs when an individual, or spouse of the individual, disposes of assets for less than fair market value within 5 years of the Medicaid application. Examples of transfer of assets include but are not limited to:
- Giving away property, money, cars, and boats.
- Uncompensated funds such as large checks or cash in which one cannot prove how the money was spent or closing an account with no paper trail of where the money was re-deposited.
- Waiving the right to an inheritance, not getting your fair share of a divorce, or not receiving your spousal share of an estate.
Period of Ineligibility
For individuals who have transferred assets within 5 years of the Medicaid application, a Period of Ineligibility (POI) is generated. The POI is the amount of time during which the individual will be ineligible for Long-Term Care Medicaid.
- The length of the POI depends on the amount of assets transferred.
- The POI will begin when the person would have been otherwise eligible for Long-Term Care Medicaid benefits.
- Medicaid will begin paying for long-term care benefits once the penalty period expires.