Medicaid Eligibility for Persons Age 65+ and
Individuals with Disabilities: 2009 State
Profiles
Julie Stone
Specialist in Health Care Financing
June 28, 2011
Congressional Research Service
7-5700
www.crs.gov
R41899
CRS Report for Congress
P
repared for Members and Committees of Congress
Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Summary
Medicaid is a means-tested, state-operated program providing health and long-term services and
supports (LTSS) to certain people who are unable to afford private insurance or pay out-of-pocket
for services. Under federal law, Medicaid has approximately 50 distinct eligibility groups; some
are mandatory, meaning that states participating in Medicaid must cover them, while others are
optional. People aged 65 and over and certain persons with disabilities are among the population
groups who may qualify. Eligibility groups are differentiated, in part, by their income and asset
thresholds. These financial thresholds are set by states within federal guidelines. The groups and
thresholds that states cover determine who has access to Medicaid in that state and who does not.
At the request of states, Congress is currently debating whether and how to allow states to cut
back on certain optional eligible populations. Congress demonstrated a similar interest in
containing Medicaid eligibility, and therefore spending, around the time of passage of the Deficit
Reduction Act of 2005 (DRA, P.L. 109-173). DRA amended federal law to create more
limitations on coverage for people who might have transferred assets to meet Medicaid’s means
testing requirements. Although this interest in containing Medicaid eligibility is not new,
Congress recently made changes to federal law to allow states additional options to expand
coverage. Under the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148), for
example, states were provided new flexibility to extend coverage to certain people aged 65 and
over and younger persons with disabilities with LTSS needs, among other populations.
Despite this activity, recent information to help Congress and other stakeholders evaluate how
legislation would affect Medicaid eligibility for aged and disabled individuals is limited. Among
the information that would be potentially helpful are profiles of states’ eligibility rules. In 2009,
CRS partnered with AARP’s policy research group to conduct a survey of the 50 states and the
District of Columbia’s Medicaid eligibility rules for the major aged and disabled groups,
including eligibility rules for accessing certain LTSS. This report presents the results of the
survey by describing the major eligibility groups and other rules states used to allow people aged
65 and older and younger persons with disabilities to qualify for Medicaid in 2009. It also
includes profiles of each state’s eligibility rules.
The report begins with background on the general rules for determining eligibility in Medicaid for
aged and disabled individuals. It then provides an explanation of the major eligibility groups
about which states were surveyed and the income and resources thresholds associated with each
of these groups. Next, the report provides a general explanation of the types of Medicaid services
that individuals might be eligible to obtain, by eligibility group. Finally, profiles of each state and
the District of Columbia are provided, including a description of the major groups covered and
their associated financial thresholds. These state profiles include information on the types of
Medicaid benefits that are available to beneficiaries by eligibility group.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Contents
Introduction ................................................................................................................................ 1
Overview of Medicaid Eligibility for Aged and Disabled............................................................. 2
Overview of Survey .................................................................................................................... 4
Major Eligibility Groups .......................................................................................................4
Spousal Impoverishment Rules ............................................................................................. 7
Post-Eligibility Treatment of Income by LTC Setting ............................................................ 8
Benefits by Eligibility Group ...................................................................................................... 8
Traditional Benefits............................................................................................................... 8
Benefits for Medically Needy................................................................................................ 9
Benefits for Individuals Qualifying through Institutional Rules ............................................. 9
Home and Community-Based Services (HCBS) Waivers....................................................... 9
Analysis of Selected Survey Findings........................................................................................ 10
State Profiles............................................................................................................................. 19
Alabama ............................................................................................................................. 20
Alaska................................................................................................................................. 21
Arizona ............................................................................................................................... 22
Arkansas............................................................................................................................. 23
California............................................................................................................................ 25
Colorado............................................................................................................................. 26
Connecticut......................................................................................................................... 27
Delaware ............................................................................................................................ 28
District of Columbia............................................................................................................ 29
Florida ................................................................................................................................ 30
Georgia ............................................................................................................................... 31
Hawaii ................................................................................................................................ 32
Idaho .................................................................................................................................. 33
Illinois ................................................................................................................................ 34
Indiana................................................................................................................................ 35
Iowa ................................................................................................................................... 36
Kansas ................................................................................................................................ 37
Kentucky ............................................................................................................................ 38
Louisiana ............................................................................................................................ 39
Maine ................................................................................................................................. 40
Maryland ............................................................................................................................ 41
Massachusetts ..................................................................................................................... 42
Michigan ............................................................................................................................ 43
Minnesota ........................................................................................................................... 44
Mississippi.......................................................................................................................... 45
Missouri.............................................................................................................................. 46
Montana.............................................................................................................................. 47
Nebraska............................................................................................................................. 48
Nevada ............................................................................................................................... 49
New Hampshire .................................................................................................................. 50
New Jersey ......................................................................................................................... 51
New Mexico ....................................................................................................................... 52
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
New York............................................................................................................................ 53
North Carolina .................................................................................................................... 54
North Dakota ...................................................................................................................... 55
Ohio ................................................................................................................................... 56
Oklahoma ........................................................................................................................... 57
Oregon................................................................................................................................ 58
Pennsylvania....................................................................................................................... 59
Rhode Island....................................................................................................................... 60
South Carolina .................................................................................................................... 61
South Dakota ...................................................................................................................... 62
Tennessee ........................................................................................................................... 63
Texas .................................................................................................................................. 64
Utah.................................................................................................................................... 65
Vermont .............................................................................................................................. 66
Virginia............................................................................................................................... 67
Washington ......................................................................................................................... 68
West Virginia ...................................................................................................................... 69
Wisconsin ........................................................................................................................... 70
Wyoming ............................................................................................................................ 71
Tables
Table 1. Medicaid Enrollment, by State and Basis of Eligibility for Aged and Disabled,
FY2008.................................................................................................................................. 11
Table 2. Upper Income Threshold for Non-Working Aged and Disabled Medicaid
Applicants, 2009 .................................................................................................................... 13
Table 3. Upper Income Threshold for Applicants Meeting the State’s Level-of-Care
Criteria for Institutional LTSS ................................................................................................ 15
Table 4. Monthly Maintenance of Need Allowance (MMNA) for Enrollees in Home and
Community-Based Waiver Services........................................................................................ 17
Table 5. Eligibility Pathways for Medicaid and Long-Term Care in Alabama, 2009 ................... 20
Table 6. Eligibility Pathways for Medicaid and Long-Term Care in Alaska, 2009 ...................... 21
Table 7. Eligibility Pathways for Medicaid and Long-Term Care in Arizona, 2009..................... 22
Table 8. Eligibility Pathways for Medicaid and Long-Term Care in Arkansas, 2009................... 23
Table 9. Eligibility Pathways for Medicaid and Long-Term Care in California, 2009 ................. 25
Table 10. Eligibility Pathways for Medicaid and Long-Term Care in Colorado, 2009................. 26
Table 11. Eligibility Pathways for Medicaid and Long-Term Care in Connecticut, 2009 ............ 27
Table 12. Eligibility Pathways for Medicaid and Long-Term Care in Delaware, 2009 ................ 28
Table 13. Eligibility Pathways for Medicaid and Long-Term Care in the District of
Columbia, 2009...................................................................................................................... 29
Table 14. Eligibility Pathways for Medicaid and Long-Term Care in Florida, 2009.................... 30
Table 15. Eligibility Pathways for Medicaid and Long-Term Care in Georgia, 2009................... 31
Table 16. Eligibility Pathways for Medicaid and Long-Term Care in Hawaii, 2009.................... 32
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Table 17. Eligibility Pathways for Medicaid and Long-Term Care in Idaho, 2009 ...................... 33
Table 18. Eligibility Pathways for Medicaid and Long-Term Care in Illinois, 2009.................... 34
Table 19. Eligibility Pathways for Medicaid and Long-Term Care in Indiana, 2009 ................... 35
Table 20. Eligibility Pathways for Medicaid and Long-Term Care in Iowa, 2009 ....................... 36
Table 21. Eligibility Pathways for Medicaid and Long-Term Care in Kansas, 2009.................... 37
Table 22. Eligibility Pathways for Medicaid and Long-Term Care in Kentucky, 2009 ................ 38
Table 23. Eligibility Pathways for Medicaid and Long-Term Care in Louisiana, 2009................ 39
Table 24. Eligibility Pathways for Medicaid and Long-Term Care in Maine, 2009 ..................... 40
Table 25. Eligibility Pathways for Medicaid and Long-Term Care in Maryland, 2009................ 41
Table 26. Eligibility Pathways for Medicaid and Long-Term Care in Massachusetts, 2009......... 42
Table 27. Eligibility Pathways for Medicaid and Long-Term Care in Michigan, 2009 ................ 43
Table 28. Eligibility Pathways for Medicaid and Long-Term Care in Minnesota, 2009............... 44
Table 29. Eligibility Pathways for Medicaid and Long-Term Care in Mississippi, 2009 ............. 45
Table 30. Eligibility Pathways for Medicaid and Long-Term Care in Missouri, 2009 ................. 46
Table 31. Eligibility Pathways for Medicaid and Long-Term Care in Montana, 2009 ................. 47
Table 32. Eligibility Pathways for Medicaid and Long-Term Care in Nebraska, 2009 ................ 48
Table 33. Eligibility Pathways for Medicaid and Long-Term Care in Nevada, 2009 ................... 49
Table 34. Eligibility Pathways for Medicaid and Long-Term Care in New Hampshire,
2009 ...................................................................................................................................... 50
Table 35. Eligibility Pathways for Medicaid and Long-Term Care in New Jersey, 2009 ............. 51
Table 36. Eligibility Pathways for Medicaid and Long-Term Care in New Mexico, 2009........... 52
Table 37. Eligibility Pathways for Medicaid and Long-Term Care in New York, 2009 ............... 53
Table 38. Eligibility Pathways for Medicaid and Long-Term Care in North Carolina, 2009........ 54
Table 39. Eligibility Pathways for Medicaid and Long-Term Care in North Dakota, 2009.......... 55
Table 40. Eligibility Pathways for Medicaid and Long-Term Care in Ohio, 2009 ....................... 56
Table 41. Eligibility Pathways for Medicaid and Long-Term Care in Oklahoma, 2009............... 57
Table 42. Eligibility Pathways for Medicaid and Long-Term Care in Oregon, 2009 ................... 58
Table 43. Eligibility Pathways for Medicaid and Long-Term Care in Pennsylvania, 2009 .......... 59
Table 44. Eligibility Pathways for Medicaid and Long-Term Care in Rhode Island, 2009........... 60
Table 45. Eligibility Pathways for Medicaid and Long-Term Care in South Carolina, 2009........ 61
Table 46. Eligibility Pathways for Medicaid and Long-Term Care in South Dakota, 2009.......... 62
Table 47. Eligibility Pathways for Medicaid and Long-Term Care in Tennessee, 2009 ............... 63
Table 48. Eligibility Pathways for Medicaid and Long-Term Care in Texas, 2009...................... 64
Table 49. Eligibility Pathways for Medicaid and Long-Term Care in Utah, 2009 ....................... 65
Table 50. Eligibility Pathways for Medicaid and Long-Term Care in Vermont, 2009.................. 66
Table 51. Eligibility Pathways for Medicaid and Long-Term Care in Virginia, 2009 .................. 67
Table 52. Eligibility Pathways for Medicaid and Long-Term Care in Washington, 2009............. 68
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Table 53. Eligibility Pathways for Medicaid and Long-Term Care in West Virginia, 2009.......... 69
Table 54. Eligibility Pathways for Medicaid and Long-Term Care in Wisconsin, 2009............... 70
Table 55. Eligibility Pathways for Medicaid and Long-Term Care in Wyoming, 2009................ 71
Appendixes
Appendix A. Eligibility Groups Excluded from the Survey........................................................ 72
Appendix B. Medicaid’s Resources Rules for Aged and Disabled Eligibility Pathways .............. 73
Contacts
Author Contact Information ...................................................................................................... 74
Acknowledgments .................................................................................................................... 74
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Introduction
Medicaid is a means-tested health insurance program funded by both the federal and state
governments. In 2009, the program covered 67.8 million low-income individuals in the United
States.1 People qualify for Medicaid if they meet the program’s categorical thresholds and have
income and assets equal to or below state-specified thresholds. Under federal law, Medicaid has
approximately 50 distinct eligibility groups; some are mandatory, meaning that states
participating in Medicaid must cover them, while others are optional. Eligibility groups are
differentiated, in part, by their income and asset thresholds. These financial thresholds are set by
states within federal guidelines. The groups and thresholds that states adopt determine who has
access to coverage under Medicaid in that state and who does not.
Eligibility groups, and income and asset thresholds, vary considerably among states. For instance,
individuals in similar circumstances of need for acute, post-acute, or long-term services and
supports (LTSS) may be automatically eligible for coverage in one state, be required to assume a
certain portion of their medical expenses before they can obtain coverage in a second state, and
not be eligible at all in a third state.
At the request of states, Congress is currently debating whether and how to allow states to cut
back on optional eligible populations.2 Congress demonstrated a similar interest in containing
Medicaid eligibility, and therefore spending, around the time of passage of the Deficit Reduction
Act of 2005 (DRA, P.L. 109-173). DRA amended federal law to create more limitations on
coverage for people who might have transferred assets to meet Medicaid’s means testing
requirements.3 Although this interest in containing Medicaid eligibility is not new, Congress also
recently made changes to federal law to allow states additional options to expand coverage.
Under the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148), for example, states
were provided new flexibility to extend coverage to certain people aged 65 and over and younger
persons with disabilities with long-term services and supports (LTSS) needs, 4 among other
populations.
Current information to help Congress and other stakeholders evaluate how legislation would
affect Medicaid eligibility for aged and disabled individuals is limited. Among the information
that would be potentially helpful are profiles of states’ eligibility rules. The last time such
comprehensive state profiles were available was in 2003, when the results of a 50-state survey on
eligibility, conducted by CRS and the American Public Human Services Association (APHSA),
were made available on the APHSA website.5
1 Congressional Budget Office, “Spending and Enrollment Detail for CBO’s March 2009 Baseline: Medicaid,”
Washington, DC. At https://www.cbo.gov/budget/factsheets/2009b/medicaid.pdf. This figure is the total number of
individuals enrolled in Medicaid at any point during the fiscal year and include enrollment in the territories.
2 For more information, see CRS Report R41835, Medicaid and CHIP Maintenance of Effort (MOE): Requirements
and Responses, by Evelyne P. Baumrucker.
3 For more information, see CRS Report RL33593, Medicaid Coverage for Long-Term Care: Eligibility, Asset
Transfers, and Estate Recovery, by Julie Stone.
4 For more information, see CRS Report R41210, Medicaid and the State Children’s Health Insurance Program
(CHIP) Provisions in PPACA: Summary and Timeline, coordinated by Julie Stone.
5 This information is no longer available on the APHSA website.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
In 2009, CRS partnered with AARP’s research policy group to conduct a survey of each state and
the District of Columbia’s Medicaid eligibility rules for the major aged and disabled groups,
including eligibility rules for accessing certain LTSS. The survey was web-based, but numerous
follow-up calls to clarify unclear, confusing, or blank survey responses were made. Except
Alabama, all states and the District of Columbia responded. To complete Alabama’s survey,
information on the state’s website and waiver application was used. Additional information about
states’ Medicaid Buy-In programs was obtained from Mathematica Policy Research, Inc.6 When
needed, state section 1915(c) waiver applications were used to verify eligible populations.7
This report presents the survey results for all the major eligibility groups and other rules states use
to allow people aged 65 and older and younger persons with disabilities to qualify for Medicaid.
All information is based on 2009 rules and data and therefore does not include any changes made
to eligibility by PPACA. An explanation of the eligibility groups not included in this survey is
provided in Appendix A.
The report begins with background on the general rules for determining eligibility in Medicaid for
aged and disabled individuals. It then provides an explanation of the major eligibility groups
about which states were surveyed and the income and resources thresholds associated with each
of these groups. Next, the report provides a general explanation of the types of Medicaid services
that individuals might be eligible to obtain, by eligibility group. Finally, profiles of each state and
the District of Columbia are provided, including a description of the major groups covered and
their associated financial thresholds. These state profiles include information on the types of
Medicaid benefits that are available to beneficiaries by eligibility group.
Overview of Medicaid Eligibility for Aged
and Disabled
Medicaid is a means-tested, state-operated program providing health and LTSS to certain people
who are unable to afford private insurance or pay out-of-pocket for services. To qualify for
Medicaid, an individual must meet both categorical and financial eligibility requirements.
Categorical eligibility requirements relate to the age or other characteristics of an individual.
People aged 65 and over and certain persons with disabilities are among the categories of
individuals who may qualify.8
6 Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and
Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final
Report, Washington, DC, December 23, 2010.
7 To grant states additional flexibility to offer a broad range of home and community-based LTSS as an alternative to
institutional care, Congress authorized the use of the HCBS waiver program under section 1915(c) of the Social
Security Act in 1981. To date, most states have chosen to make these waivers available to targeted populations (other
states have used section 1115 waivers for similar purposes). Section 1915(c) gives states the option to extend a broad
range of home and community-based services to selected populations of individuals with the level-of-need that would
otherwise be offered in Medicaid-covered institutions, such as a nursing home, ICF/MR, or a hospital. For HCBS
waivers to be approved, states also must meet other requirements, such as a cost-effectiveness test, under which
average Medicaid expenditures for waiver participants do not exceed costs that would have been incurred if these
individuals resided in institutions.
8 Some aged and disabled recipients apply to Medicaid as children after being born with disabling conditions; others
apply as working-age adults with inherited or acquired disabling conditions, and still others enroll much later as aging
retirees who have lost the ability to care for themselves.
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The program’s financial eligibility requirements place limits on the amount of income and
resources or assets individuals may possess and still be eligible for Medicaid. These thresholds, or
standards, specify the maximum amount of countable income and resources a person may have to
qualify; income and resources above these amounts generally make an individual ineligible for
coverage. The specific income and asset limitations that apply to each eligibility group are set
through a combination of federal parameters and state definitions.9
In addition to categorical and financial requirements, individuals in need of LTSS may be
required to meet level-of-care eligibility criteria that demonstrate difficulty performing activities
necessary for self-care and independent living.10 Many Medicaid beneficiaries with disabilities
and individuals aged 65 and older have complex health conditions that require specialized care.11
Many have multiple chronic conditions, physical disabilities, and/or cognitive impairments. A
number of beneficiaries have limitations in activities of daily living (ADLs), such as bathing,
dressing, feeding, and toileting; and/or instrumental activities of daily living (IADLs), such as
managing money, shopping, getting around outside the house, and taking medications.
Traditionally, Medicaid eligibility rules for aged and disabled individuals have been linked to the
federal cash welfare program, Supplemental Security Income (SSI).12 To qualify for SSI, a person
must satisfy the program criteria for age or disability and meet SSI’s income and resources
requirements. For adults, disability is defined as the inability to engage in substantial gainful
activity (SGA) by reason of a medically determinable physical or mental impairment expected to
result in death or last at least 12 months. In general, the worker must be unable to do any kind of
work that exists in the national economy, taking into account age, education, and work
experience. A child under the age of 18 may qualify as disabled if he or she has an impairment
that results in “marked and severe” functional limitations.13 Individuals receiving SSI
automatically qualify for Medicaid in all but 11 209(b) states that may use financial and disability
criteria that are more restrictive that SSI.
Other non-SSI pathways for aged and disabled individuals are generally required to use SSI’s
rules for counting income and assets, as well as SSI’s definition of disability. 14 Examples include
the more restrictive SSI-related pathways used by 209(b) states, the 100% of federal poverty level
(FPL) pathway, medically needy pathways for people with high medical expenses, and buy-in
pathways for working disabled individuals. However, section 1902(r)(2) of the Social Security
Act grants states flexibility to modify the financial (but not disability) criteria for these pathways.
This provision allows states to use more liberal thresholds for computing income and resources
than are specified under SSI. Some states use section 1902(r)(2) to ignore or disregard certain
types or amounts of income and assets, thereby extending Medicaid to individuals with income
and/or assets too high to otherwise qualify under the specified rules for that eligibility pathway.
Additional information about Medicaid’s countable resource rules is provided in Appendix B.
9 The federal government mandates states to meet certain minimum eligibility standards and gives states flexibility to
establish additional criteria that are more generous and, in some limited instances, more restrictive.
10 The survey did not ask about level-of-care criteria, which can vary state.
11 See Tables 3B, 4B, and 5B, Medicaid and CHIP Payment and Access Commission (MACPAC), Report to Congress:
The Evolution of Managed Care in Medicaid, Washington, DC, June 2011.
12For more information about SSI program rules, see CRS Report 94-486, Supplemental Security Income (SSI), by
Umar Moulta-Ali.
13 See CRS Report 94-486, Supplemental Security Income (SSI), by Umar Moulta-Ali.
14 In this report, the terms pathway and eligibility group are used interchangeably.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
To understand which aged and disabled individuals in each state are eligible for Medicaid, the
survey solicited information on the major eligibility groups they cover and what the states’
income and resource thresholds are for each of those groups. In addition, it requested information
on spousal impoverishment and post-eligibility treatment of income for beneficiaries receiving
LTSS in a nursing home or HCBS waiver.
Overview of Survey
The following is an explanation of these major eligibility groups and other rules, including
background on the federal rules for setting income thresholds. The state profiles, presented later
in this report, provide more detailed information on the groups each state has selected as well as
the income and resources thresholds by group.
Additional survey questions asked states to report on their use of section 1902(r)(2) to deviate
from SSI program rules (usually used by states for counting income and resources) for the income
and resources counting. These results are not included in the state profiles below.
Major Eligibility Groups
States were surveyed about their income and asset rules for the one mandatory pathway relevant
to this population. This pathway is based on the program rules for the Supplemental Security
Income (SSI) program. It is described below in two parts: SSI-related and SSI-related: 209(b).
1. SSI-related: Federal law requires states to provide Medicaid coverage to
recipients of SSI and relies on SSI eligibility rules, established at the national
level, as the basis for Medicaid eligibility for aged and disabled individuals who
are not receiving SSI. To qualify for SSI, a person must satisfy the program
criteria for age or disability and meet SSI’s income and resources requirements.
In addition, applicants must meet certain citizen and residency requirements.
2. SSI-related: 209(b): Under section 209(b) of the Social Security Amendments of
1972 (P.L. 92-603), states may elect to use eligibility criteria, including income
and resources thresholds that are more restrictive than SSI but no more restrictive
than those in effect on January 1, 1972. Unlike non-209(b) states, receipt of SSI
does not guarantee eligibility for Medicaid in a 209(b) state. These 11 209(b)
states may require persons to meet a lower income threshold than SSI’s or may
use more restrictive policies for defining countable income. They may also have
lower limits for the amount of resources a person may have. Each of the 209(b)
states has at least one eligibility standard (income, resources, or definition of
disability) that is more restrictive than SSI thresholds. States that use more
restrictive eligibility rules under section 209(b) must also allow applicants to
deduct medical expenses from countable income when determining eligibility.
This process is sometimes referred to as the “209(b) spend-down.”15
15 An example of 209(b) spend-down is as follows: if an applicant has a monthly income of $700 (not including any
SSI or certain other cash payments) and the states’ maximum allowable income standard for spend-down eligibility is
$600, the applicant would qualify for Medicaid after incurring $100 in medical expenses in that month. As discussed
below, the spend-down process is also used in establishing eligibility for the medically needy.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Other optional pathways for aged and disabled applicants use the SSI program’s definition of
disability for eligibility purposes.
3. Income up to 100% of the Federal Poverty Level (FPL, 100% FPL): The
enactment of the Omnibus Budget Reconciliation Act of 1986 (OBRA 86)
offered states an option for covering persons whose income exceeds SSI or
209(b) levels. This option allows states to cover aged or disabled individuals with
incomes up to 100% of the FPL ($903 for an individual and $1,214 for a couple
per month in 2009) as long as they meet the SSI definition for aged or disabled.
States use the same resources rules for this eligibility pathway as they use for the
SSI groups.
4. Medicaid Buy-In (Buy-In): Many individuals with disabilities who work have
historically been ineligible for Medicaid because their incomes were too high.
Congress established special rules to help guarantee health insurance for certain
working individuals with disabilities for whom employer-sponsored health
insurance is not available. Two statutory authorities have established what is
known as the Medicaid Buy-In groups. These authorities have created three
distinct Buy-In options.
a. The first option was established by the Balanced Budget Act of 1997 (BBA 97, P.L.
105-33). BBA 97 allows states to extend Medicaid coverage to working individuals
with disabilities whose family’s net income, after exclusions following the SSI
income counting methodology, does not exceed 250% of FPL.16 Under BBA 97,
states are also permitted to establish cost-sharing whereby a person with a disability
who is working purchases or “buys into” Medicaid coverage through the payment of
premiums and/or co-payments.
b. The second option, referred to as the Basic Eligibility group, was established by the
Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA, P.L. 106-
170). For this Basic group, TWWIIA provisions allow states to expand Medicaid
coverage to working individuals with disabilities between the ages of 16 and 64.
Under this option, states may establish state-defined income and resource levels that
are not limited by the 250% of FPL under BBA 97’s option one authority. Further,
this option establishes limitations on the amounts of premiums and other cost-sharing
that beneficiaries could pay.
c. The third Buy-In option, referred to as the Medical Improvement Group, is available
only to those states that cover the Basic Eligibility group. Under this option, also
established under TWWIIA, states may continue to cover people who still have a
significant impairment. Individuals must be employed and earning at least the federal
minimum wage and must be working at least 40 hours per month. The state may
establish a different definition of employment subject to the approval of the Secretary
of the Department of Health and Human Services (HHS).
The medically needy optional pathway is intended for applicants with high medical expenses
relative to their income and who meet SSI’s definition of aged or disabled.
16 States may also disregard additional income and resources under section 1902(r)(2) of the Social Security Act. There
is no limit on the amount of additional income and resources that may be disregarded under section 1902(r)(2).
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
5. Medically Needy (MN): Under this eligibility group, aged or disabled
individuals qualify when their medical expenses (on such things as nursing home
[NH] care, prescription drugs, etc.) deplete, or “spend down,” their income and
assets to specified Medicaid thresholds. For example, if an individual has
monthly income of $1,000 and the state’s income threshold is $480, then the
applicant would be required to incur $520 in out-of-pocket medical expenses
before he or she would be eligible for Medicaid. States use a specific time period
for calculating a person’s medical expenses, often referred to as a “budget
period,” generally ranging from one to six months.17 States may also use spend
down groups to extend Medicaid coverage to persons who are members of one of
the broad categories of Medicaid covered groups (i.e., are aged or have a
disability) but do not meet the applicable income requirements and, in some
instances, resources requirements for other eligibility pathways.
The Special Income Rule is intended for applicants with higher income and who require a level of
care offered in an institution.
6. Special Income Rule, Miller Trust: States also have an option to extend
coverage of certain institutional services, as well as other traditional benefits, to
individuals who are in nursing facilities or other institutions. States can establish
a special income rule, known as “the 300% rule,” to allow these persons to
qualify for Medicaid coverage of their NH care and other institutional long-term
services and supports. To be eligible, persons must (1) require care provided by a
NH or other medical institution for no less than 30 consecutive days, (2) meet the
resources threshold determined by the state, and (3) have income that does not
exceed a specified level—no greater than 300% of the maximum SSI payment
applicable to a person living at home ($2,022 per month in 2009).
Medicaid law requires those states that use only the special income rule, and not
the medically needy pathway, to allow applicants to place income in excess of the
special income level in a special Miller Trust, and receive Medicaid coverage for
their care. States that use the combination of the special income rule with a Miller
Trust effectively allow individuals to qualify for institutional care and Medicaid’s
traditional benefits with higher income. Following the individual’s death, the
state becomes the beneficiary of amounts in this trust.
The Katie Beckett and hospice only coverage pathways are also optional groups about which
states were surveyed.
7. Katie Beckett: To address the barriers to home and community-based care for
certain children with disabilities,18 Medicaid law allows states to extend
17 The calculation becomes the basis for determining the amount of a person’s spend-down requirement. Generally a
shorter time period is more beneficial to the applicant. For example, if the state has a one-month spend-down
calculation period, the individual would be required to incur $520 in medical expenses in a month, after which services
would be covered by Medicaid. On the other hand, if the state had a six-month calculation period, the individual would
have to incur a projected amount of $3,120 ($520 times six) in medical expenses before Medicaid would begin
coverage. The length of the spend-down period does not significantly affect total out-of-pocket expenditures for
persons with predictable and recurring medical expenses, such as persons with chronic illnesses or disabling conditions.
However, individuals faced with acute nonrecurring problems generally benefit more from a shorter calculation period.
18 Generally, Medicaid rules require that the income and resources of the parents of a child with a disability (under age
21) be automatically considered available for medical care expenses; they are “deemed” to the child. These deeming
(continued...)
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Medicaid coverage to certain disabled children under 18 who are living at home
and who would be eligible for Medicaid if in a hospital, nursing facility, or an
intermediate care facility for the mentally retarded (ICF/MR). Under the Katie
Beckett option, the state must determine that (1) the child requires the level of
care provided in an institution, (2) it is appropriate to provide care outside the
facility, and (3) the cost of care at home is no more than institutional care. States
electing this option are required to cover all disabled children who meet these
criteria on a statewide basis.
8. Hospice Only Coverage: Medicaid law allows states to cover, as an eligibility
group, individuals who are terminally ill and elect to receive hospice care only,19
provided that they would be eligible for Medicaid if they were in a medical
institution.20
Spousal Impoverishment Rules
States were also surveyed about their spousal impoverishment rules. These rules are intended to
prevent the impoverishment of a spouse whose husband or wife seeks Medicaid coverage for
institutional LTSS or home and community-based services (HCBS) waivers. These rules address
the treatment of income and assets of married couples, allowing the community spouse to retain
higher amounts of income and assets (on top of non-countable assets such as a house, car, etc.)
than allowed under general Medicaid rules.
Regarding income, federal law exempts all of a community spouse’s income (e.g., pension or
Social Security) in his or her name from being considered available to the other spouse for
purposes of Medicaid eligibility. For community spouses with limited income, federal law allows
institutionalized spouses to transfer income to the community spouse up to a state-determined
maximum level. Federal law specifies that this limit may be no greater than $2,739 per month,
and no less than $1,821 per month in 2009 (same amounts for 2010, the most recent year
available). Regarding assets, federal law allows states to select the amount of assets a community
spouse may be allowed to retain. It specified that this limit could not exceed $109,560 in 2009
(same amount for 2010, the most recent year available) and could be no less than $21,912 in total
countable assets in 2009 (same amount for 2010, the most recent year available).21
(...continued)
rules have presented eligibility barriers for children with disabilities who could be provided needed care in their homes.
If the same child is institutionalized, however, after the first month away from home, the child no longer is considered
to be a member of the parent’s household and only the child’s financial resources are considered available for care. The
child then is able to qualify for Medicaid.
19 Social Security Act §1902(a)(10)(A)(ii)(VII); State Medicaid Manual, Pub. 45, §3580 et seq.
20 Hospice generally covers palliative medical care, that is, relief from pain, and supportive social and counseling
services for terminally ill beneficiaries and their families. Services are provided primarily in the patient’s home, but
may also be provided in institutional settings, such as NHs.
21 For purposes of determining how many assets the community spouse may retain, all assets of the couple are
combined, counted, and split in half, regardless of which of the two spouses possesses ownership. If the community
spouse’s assets are less than the state standard, then the Medicaid beneficiary must transfer his or her share of the assets
to the community spouse until the community-spouse’s share reaches the standard. All other non-exempt assets must be
depleted before the applicant can qualify for Medicaid.
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Post-Eligibility Treatment of Income by LTC Setting
Finally, the survey solicited information from states about the amounts they allow beneficiaries
receiving certain LTC services to retain for personal needs allowances and monthly maintenance
needs allowances (MMNA). Once eligible for Medicaid, persons qualifying through certain
eligibility groups are required to apply their income above specified amounts toward the cost of
their care. The amounts they may retain vary by setting. For example, Medicaid beneficiaries in a
NH may retain a personal needs allowance. Persons receiving services in home and community-
based settings may retain an MMNA, which is higher than a personal needs allowance because it
is intended to pay for the living expenses of a person living in the community. These amounts
vary by states. All income amounts above these levels, including what may be available in a
Miller Trust, must be applied toward the cost of their care.
Benefits by Eligibility Group
Not all Medicaid benefits that a state offers in its program are available to all Medicaid
beneficiaries. The benefits a Medicaid beneficiary is eligible for depend, in part, upon the
eligibility group through which the individual enters Medicaid. The following provides a brief
description of the types of benefits that are available to beneficiaries based on eligibility group.
The state profiles that follow show which type of benefits are available to which group of
beneficiaries.
Traditional Benefits
Once enrolled in Medicaid, individuals who entered the program through SSI-related, 100% FPL,
Buy-In, and special income rule groups are entitled to what are often referred to as “traditional
Medicaid benefits.” 22 Traditional Medicaid benefits include a broad, and often comprehensive,
range of mandatory and optional benefits. Examples of benefits that are mandatory for these aged
and disabled individuals include inpatient hospital services (excluding services for mental
disease); services provided by federally qualified health centers; laboratory and x-ray services;
physician services; and home health care for those entitled to NH care. Nursing home services for
individuals age 21 and over are also a mandatory benefit for categorically needy eligibility
groups.
The optional benefits available under Medicaid vary across states. Examples of optional benefits
that states cover are prescribed drugs (covered by all states); routine dental care; physician-
directed clinic services; services provided by other licensed practitioners (e.g., optometrists,
podiatrists, psychologists); inpatient psychiatric care for the elderly and for individuals under age
21; nursing facility services for individuals under age 21; and consumer-directed personal care
attendant services beginning in 2011.
In addition, the breadth of coverage for a given mandatory or optional benefit can and does vary
from state to state. For example, states may place different limits on the amount of inpatient
22 Beginning in 2006, as an alterative to traditional benefits, states were given the option to provide what are called
“benchmark” benefit packages to certain Medicaid subpopulations. These plans can also be limited to substate areas.
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hospital services a beneficiary can receive in a year (e.g., up to 15 inpatient days per year in one
state versus unlimited inpatient days in another state).
Benefits for Medically Needy
Special benefit rules apply to optional medically needy populations. States may offer a more
restrictive benefit package than is provided to “aged” and “disabled” populations under the
traditional benefits rules, but at a minimum, must offer (1) prenatal, delivery, and postpartum
services for pregnant women; (2) ambulatory services as defined in the state Medicaid plan for
individuals under 18 and those entitled to institutional services; and (3) home health services for
individuals entitled to nursing facility care.23 Among the optional benefits states may select for
medically needy eligibles is nursing home care. As part of this survey, states were asked whether
they extended nursing home care to this population. Twenty-nine of the 33 states with medically
needy pathways extended nursing home care to this population.
Benefits for Individuals Qualifying through Institutional Rules
Medicaid covers institutional services for people who meet the state’s level-of-care criteria. These
services include care in a nursing home, ICF/MR, and institution for mental disease (IMD),
among others. Nursing home care includes room and board, skilled nursing care, rehabilitation,
and other health and supportive services. ICF/MR services include room and board and a wide
range of specialized therapeutic services to assist persons in functioning at optimal levels.24 IMDs
provide diagnosis and treatment or care of persons with mental diseases, including medical
attention, nursing care, and related services.
States use a number of pathways to allow individuals to qualify for institutional care under
Medicaid. First, states must allow individuals who qualify for Medicaid through the mandatory
SSI-related pathways to access those institutional services covered under the state’s traditional
benefits package if the individuals meet the state’s medically necessary criteria for that benefit.
States electing to cover individuals through the 100% FPL and/or the Buy-In groups must make
traditional benefits, including certain institutional care services, available to people who meet the
state’s medically necessary criteria. States also have an option to extend coverage of certain
institutional services, as well as other traditional benefits, to individuals who qualify for Medicaid
through the Special Income Rule, and this pathway’s accompanying Miller Trusts.
Home and Community-Based Services (HCBS) Waivers
States have the option of providing a narrow or comprehensive package of LTSS to a limited
number of persons in home and community-based settings if they would otherwise require
institutional care paid for by Medicaid. States make these packages of LTSS available to certain
persons with disabilities using HCBS waivers, generally authorized under section 1915(c) of the
23 Broader requirements apply if a state has chosen to provide coverage for medically needy persons in institutions for
mental disease and intermediate care facilities for the mentally retarded.
24 “Active treatment” is defined by regulation as aggressive, consistent implementation of a program of specialized and
generic training, treatment, health and related services directed toward acquisition of behaviors necessary for the client
to function with as much self-determination and independence as possible, and the prevention or deceleration of
regression or loss of optional functional status.
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Social Security Act. Some states also use section 1115 waiver authority to design LTSS packages
in the community following similar rules as under section 1915(c).
To qualify, a person generally must be a member of one of the following target groups who would
otherwise be eligible for institutional care: the aged, persons with disabilities, persons with
mental retardation or developmental disabilities, or persons with mental illness. States must apply
for separate waivers to serve each of these different groups.
Services that states may choose to cover under HCBS waivers include case management;
homemaker; home health aide; personal care; adult day health; habilitation; respite care; day
treatment or other partial hospitalization services; psychosocial rehabilitation and clinic services
for individuals with chronic mental illness; and other services requested by the state and approved
by Secretary.
HCBS waiver services must meet both financial and level-of-care eligibility requirements set by
state and federal law. Under HCBS waivers, states may limit coverage to those persons receiving
SSI or allow persons to qualify under other groups, such as the SSI-related, 100% of FPL, Buy-
In, or medically needy pathways. States also have the option of setting financial eligibility limits
for income as high as 300% of SSI benefit level. Those states that use the 300% rule may also
allow eligibles to establish a Miller Trust if those states do not also have medically needy
programs. States also have the option of applying spousal impoverishment protections for couples
when only one of the spouses requires Medicaid coverage of long-term care expenses.
Our survey questioned states about which aged and disabled eligibility groups they allow to be
potentially eligible for their largest HCBS waiver and whether spousal impoverishment rules
were used for eligibility determinations. States’ answers are provided in the profiles below. When
insufficient information was obtained from the survey, CRS reviewed the state’s waiver
applications to discover which eligibility groups allow for access to HCBS waivers in that state.
Analysis of Selected Survey Findings
The survey looked at states’ criteria for access to Medicaid for people aged 65 and over and
certain people with disabilities. Questions concerning the income and asset thresholds associated
with each eligibility pathway available in each state were among the many issues surveyed. In
general, states’ responses helped to measure the level of generosity or restrictiveness of a states’
eligibility rules. States with higher income thresholds, for example, allow people with higher
income levels to access Medicaid, while states with lower thresholds are more restrictive.
Although information on income thresholds is useful for comparative purposes, it does not tell the
entire picture. To more accurately measure a state’s generosity or restrictiveness for eligibility
purposes, the wealth status of the state, the size of its population, and its demands on Medicaid
enrollment should be considered. For example, a poorer state may have lower income thresholds
than a richer state but have higher enrollment. Simultaneously, a richer state may have higher
thresholds and have comparable, or even lower, enrollment numbers. Although an analysis of this
complexity is not included in this report, Table 1 shows state-by-state enrollment numbers for the
aged and disabled. The survey was conducted in calendar year (CY) 2009; the most recent
enrollment data available are for FY2008.
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Table 1. Medicaid Enrollment, by State and Basis of Eligibility for Aged and Disabled,
FY2008
(thousands)
State Aged Disabled Total
Alabama 103 221 324
Alaska 7
16
23
Arizona 84 142 226
Arkansas 70 132 202
California 793 1,154 1,947
Colorado 55 85 140
Connecticut 66
68
134
Delaware 13 23 36
District of
10 38 48
Columbia
Florida 369 560 929
Georgia 138 286 424
Hawai 22 26
316
Idaho 16
37
53
Illinois
169 345 514
Indiana 84
158
242
Iowa 42
74
116
Kansas 36 68
104
Kentucky 72 244 316
Louisiana 110 204 314
Maine 57 59
116
Maryland 59 143 202
Massachusetts 160
502
662
Michigan 136 313 449
Minnesota 93 117 210
Mississippi 77 171 248
Missouri 92 185 277
Montana 10 20 30
Nebraska 24 36 60
Nevada 24 40 64
New Hampshire
15
24
39
New Jersey
113
199
312
New Mexico
27
69
96
New York
454
746
1,200
North Carolina
182
295
477
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State Aged Disabled Total
North Dakota
9
11
20
Ohio 188
362
550
Oklahoma 65 109 174
Oregon 51 86 137
Pennsylvania
234
537
771
Rhode Island
21
44
65
South Carolina
77
151
228
South Dakota
10
19
29
Tennessee 98 357 455
Texas 431 569
1,000
Utah 14
38
52
Vermont 18 24 42
Virginia 99 166 265
Washington 90
184
274
West Virginia
38
114
152
Wisconsin 136
152
288
Wyoming 6 10 16
Total 5,369a 9,733a 15,100
Source: Medicaid and CHIP Payment and Access Commission (MACPAC), Report to Congress on Medicaid and
CHIP, Washington, DC, March 2011, Table 2.
Notes: Numbers reflect individuals ever enrolled during the year, even if for a single month. FY2008 unavailable
for Hawai ; FY2007 shown instead.
a. Components do not sum to totals due to a smal number of enrol ees with unknown status.
Below, the aged and disabled are divided into two groups: (1) applicants who are non-working
regardless of whether they require LTSS and (2) applicants with higher income who apply to
Medicaid for LTSS and require the level-of-care offered in an institution.25 The following analysis
looks at the highest income thresholds available in each state for both groups. Decisions states
make about these thresholds often reflect the amount of state revenue they want to dedicate
toward Medicaid for aged and disabled populations in general and LTSS in particular.
Table 2 summarizes the highest level of income, in 2009, that non-working elderly or disabled
applicants could have and qualify for Medicaid by state. Specifically, it includes the upper income
threshold, as a percent of the federal poverty level, for the SSI-related, 100% FPL, and medically
needy pathways. (Table 2 does not describe the upper threshold for applicants applying to
Medicaid because they require LTSS. These pathways are described in Table 3.)
25 For an analysis of income thresholds for working disabled, among other issues, see the body of work available at
Mathematica Policy Research, at http://www.mathematica-mpr.com/publications/SearchList2.aspx?jumpsrch=yes&
txtSearch=buy-in.
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Thirty-one states (30 used medically needy rules and 1 used spend-down rules) had no limit on
the amount of income an aged or disabled individual (or individual with high medical expenses)
could have to qualify for Medicaid. In these states, applicants could access Medicaid with higher
income levels than in other states. Benefit packages for those who qualify for Medicaid through
the SSI-related and 100% FPL pathways are generally more comprehensive than the benefit
packages offered to medically needy individuals.
Among the 21 states with income caps for the non-working elderly and disabled applicants, 4
states (Arizona, Massachusetts, Utah, and Vermont) allowed applicants to qualify with income up
to 100% FPL while the remaining states set thresholds at lower levels.
Table 2. Upper Income Threshold for Non-Working Aged and Disabled Medicaid
Applicants, 2009
State
Upper Income Threshold
Alabama 75%
FPL
Alaska 61%
FPL
Arizona 100%
FPL
Arkansas
80% FPL or no limit under medical y needy
California
100% FPL or no limit under medical y needy
Colorado 75%
FPL
Connecticut
93% FPL or no limit under medical y needy
Delaware 75%
FPL
District of Columbia
100% FPL or no limit under medical y needy
Florida
88% FPL or no limit under medically needy
Georgia
75% FPL or no limit under medical y needy
Hawai
100% FPL (Aged) and 97% (Disabled) or no limit under
medical y needy
Idaho 75%
FPL
Illinois
100% FPL or no limit under medically needy
Indiana
75% FPL or no limit under medical y needy
Iowa
75% FPL or no limit under medically needy
Kansas
75% FPL or no limit under medical y needy
Kentucky
75% FPL or no limit under medical y needy
Louisiana
75% FPL or no limit under medical y needy
Maine
100% FPL or no limit under medical y needy
Maryland
75% FPL or no limit under medical y needy
Massachusetts
100% FPL (Aged) or 133% FPL (blind or disabled)
Michigan
100% FPL or no limit under medical y needy
Minnesota
95% FPL or no limit under medical y needy
Mississippi 75%
FPL
Missouri 85%
FPL
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State
Upper Income Threshold
Montana 75%
FPL
Nebraska
100% FPL or no limit under medical y needy
Nevada 75%
FPL
New Hampshire
76% FPL or no limit under medically needy
New Jersey
100% FPL or no limit under medical y needy
New Mexico
75% FPL
New York
75% FPL or no limit under medically needy
North Carolina
100% FPL or no limit under medical y needy
North Dakota
75% FPL or no limit under medical y needy
Ohio
65% FPL or no limit under medically needy
Oklahoma
100% FPL or no limit under 209(b) spend down
Oregon
75% FPL
Pennsylvania
100% FPL or no limit under medical y needy
Rhode Island
100% FPL or no limit under medical y needy
South Carolina
100% FPL
South Dakota
75% FPL
Tennessee 75%
FPL
Texas 75%
FPL
Utah 100%
FPL
Vermont
100% FPL or no limit under medical y needy
Virginia
80% FPL or no limit under medically needy
Washington
75% FPL or no limit under medically needy
West Virginia
75% FPL
Wisconsin
100% FPL or no limit under medical y needy
Wyoming 75%
FPL
Source: CRS Analysis of CRS/AARP State Survey, 2009.
Notes: Table excludes eligibility for LTSS through the Special Income Rule and the Medicaid Buy-In pathway.
Table shows the maximum threshold for individuals. In 2009, the federal poverty level (100% FPL) in the lower
48 states and the District of Columbia was $10,830 for an individual; in Hawaii, it was $12,460; and in Alaska, it
was $13,330. See Federal Poverty Guidelines for 2009 at http://aspe.hhs.gov/poverty/09poverty.shtml. Under the
medically needy pathway, aged or disabled individuals qualify when their medical expenses (on such things as
nursing home [NH] care, prescription drugs, etc.) deplete, or “spend down,” their income and assets to specified
Medicaid thresholds.
Table 3 summarizes the upper income threshold for applicants applying to Medicaid because they
require LTSS and meet the state’s criteria for institutional care. LTSS in Table 3 is divided into
two service types: nursing homes and states’ largest HCBS waivers. By showing the upper
income thresholds for both service types, one can begin to evaluate the extent to which parity
exists between these services. However, to fully evaluate parity, additional information is needed
about the number of waiver slots a state offers compared to demand as well as the amount of
income an individual is allowed to retain to pay for living expenses in a home and community-
based setting (i.e., MMNA). The latter of these measures is presented in Table 4.
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Although states have many rules for determining eligibility, 45 states had no maximum income
limit for accessing nursing home care in their state (see Table 3). In addition, 39 states had no
income limit for accessing their states’ largest HCBS waiver program. In general, a state’s use of
either the medically needy pathway or miller trust, in conjunction with the special income rule,
results in no upper income limit. This shows that at least six states (Connecticut, Louisiana,
Massachusetts, Michigan, New Jersey, and Washington) allow applicants with higher income to
access nursing home care, while limiting access to HCBS waiver services to individuals with
lower income levels. Parity between nursing home and HCBS waivers was not as great in these
states as in others.
Table 3. Upper Income Threshold for Applicants Meeting the State’s Level-of-Care
Criteria for Institutional LTSS
Upper Income Threshold for
Upper Income Threshold for
State
Nursing Home Care
State’s Largest HCBS Waiver
Alabama
No upper limit
No upper limit
Alaska
No upper limit
No upper limit
Arizona
644% FPL in urban areas, 572% FPL in
644% FPL in urban areas, 572% FPL in
rural areas
rural areas
Arkansas
No upper limit
No upper limit
California
No upper limit
No upper limit
Colorado
Limit of the regional private pay rate
Limit of the regional private pay rate
of nursing home
of nursing home
Connecticut
No upper limit
224% FPL
Delaware
No upper limit
No upper limit
District of Columbia
No upper limit
No upper limit
Florida
No upper limit
No upper limit
Georgia
No upper limit
No upper limit
Hawai
No upper limit
No upper limit
Idaho
No upper limit
No upper limit
Illinois
No upper limit
No upper limit
Indiana
No upper limit
No upper limit
Iowa
No upper limit
No upper limit
Kansas
No upper limit
No upper limit
Kentucky
No upper limit
No upper limit
Louisiana
No upper limit
224% FPL
Maine
No upper limit
No upper limit
Maryland
No upper limit
No upper limit
Massachusetts
No upper limit
224% FPL
Michigan
No upper limit
100% FPL
Minnesota
No upper limit
No upper limit
Mississippi
No upper limit
No upper limit
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Upper Income Threshold for
Upper Income Threshold for
State
Nursing Home Care
State’s Largest HCBS Waiver
Missouri
85% FPL
85% FPL
Montana
No upper limit
No upper limit
Nebraska
No upper limit
No upper limit
Nevada
No upper limit
No upper limit
New Hampshire
No upper limit
No upper limit
New Jersey
No upper limit
224% FPL
New Mexico
No upper limit
No upper limit
New York
No upper limit
No upper limit
North Carolina
No upper limit
No upper limit
North Dakota
No upper limit
No upper limit
Ohio
No upper limit
No upper limit
Oklahoma
332% FPL
332% FPL
Oregon
720% FPL
720% FPL
Pennsylvania
No upper limit
No upper limit
Rhode Island
No upper limit
No upper limit
South Carolina
No upper limit
No upper limit
South Dakota
No upper limit
No upper limit
Tennessee
No upper limit
No upper limit
Texas
No upper limit
No upper limit
Utah
No upper limit
No upper limit
Vermont
No upper limit
No upper limit
Virginia
No upper limit
No upper limit
Washington
No upper limit
224% FPL
West Virginia
224% FPL
224% FPL
Wisconsin
No upper limit
No upper limit
Wyoming
No upper limit
No upper limit
Source: CRS Analysis of CRS/AARP State Survey, 2009.
Notes: Table shows the maximum threshold for individuals. In 2009, the federal poverty level (100% FPL) in the
lower 48 states and the District of Columbia was $10,830 for an individual; in Hawaii, it was $12,460; and in
Alaska, it was $13,330. See Federal Poverty Guidelines for 2009 at http://aspe.hhs.gov/poverty/09poverty.shtml.
States with no upper income limit either use the medical y needy pathway, in which medical expenses (on such
things as nursing home [NH] care, prescription drugs, etc.) deplete, or “spend down,” income and assets to
specified Medicaid thresholds, or the special income rule with a Mil er Trust, for eligibility purposes.
Table 4 shows each state’s monthly maintenance of need allowance (MMNA). The MMNA is the
maximum amount of income an individual enrolled in the state’s HCBS wavier program may
retain for living expenses; amounts above the MMNA are applied toward the cost of the
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
beneficiary’s care. Waiver enrollees use these funds to pay for living expenses, including housing,
food, transportation, clothing, personal care products, among others.26
Higher MMNAs allow Medicaid beneficiaries more income to live in their homes or community
setting while accessing Medicaid. Lower MMNAs leave individuals less income to reside in
home and community-based settings, increasing the likelihood that individuals will seek
institutional care to meet their LTSS and housing needs. Fifteen states have MMNAs of less than
$1,000 for all or some beneficiaries, while the remainder of states have MMNAs of higher than
$1,000. Although the information provided in Table 4 is useful for comparative purposes, it is not
adjusted for differences in the cost of living across states.
Table 4. Monthly Maintenance of Need Allowance (MMNA) for Enrollees in Home
and Community-Based Waiver Services
State Maintenance
Needs
Allowance
Alabama $1,658
Alaska
$1,656, or unlimited with a Miller Trust
Arizona
$2,022, or $5,808 with a Miller Trust
Arkansas
$2,022, or unlimited with a Miller Trusta
California
$600 for an individual, $934 for a couplea
Colorado
$2,022, or unlimited with a Miller Trusta
Connecticut $1,806
Delaware
$1,685, or unlimited with a Miller Trust
District of Columbia
$2,022
Florida
$674, or unlimited with a Miller Trusta
Georgia
$674, or unlimited with a Miller Trust
Hawaii
At Home = $1,038, At Care Facility = $674a
Idaho
$1,011 (w/mortgage or rent),
$674 (w/no mortgage or rent), or unlimited with a Miller
Trusta
Illinois $674a
Indiana
$2,022, or unlimited with a Miller Trust
Iowa
$2,022, or unlimited with a Miller Trust
Kansas $727a
Kentucky
$694, or unlimited with a Miller Trust
Louisiana $2,022
Maine $1,129
Maryland $2,022
Massachusetts $2,022a
26 Room and board, food, and some personal care products, among others, are provided to nursing home beneficiaries
by Medicaid.
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State Maintenance
Needs
Allowance
Michigan $2,022a
Minnesota $935
Mississippi
$2,022, or unlimited with a Miller Trust
Missouri $2,022a
Montana
$674 (Categorically Needy), $625 (Medically Needy)
Nebraska $903a
Nevada
$2,022, or unlimited with a Miller Trusta
New Hampshire
$2,022
New Jersey
$674 for residents in Assisted Living Facilities,
$2,022 for al othersa
New Mexico
$2,022, or unlimited with a Miller Trusta
New York
$787
North Carolina
$903
North Dakota
$750
Ohio $1,314
Oklahoma
$1,011, or $3,000 with a Miller Trust
Oregon
$1,822, or $6,494 with a Miller Trust
Pennsylvania
$2,022
Rhode Island
$923
South Carolina
Not available
South Dakota
$694, or unlimited with a Miller Trusta
Tennessee
$1,348, or unlimited with a Miller Trust
Texas
$2,022, or unlimited with a Miller Trust
Utah $903
Vermont $991
Virginia $2,022
Washington $903
West Virginia
$2,022b
Wisconsin $2,022
Wyoming
$2,022, or unlimited with a Miller Trusta
Source: CRS Analysis of CRS/AARP State Survey, 2009.
a. Information collected per telephone, e-mail, or contact with the state’s Medicaid office.
b. Information collected from the state’s section 1915(c) waiver application.
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State Profiles
The following tables and subsequent state profiles show the eligibility groups and other rules
states selected for calendar year 2009.
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Alabama
Table 5. Eligibility Pathways for Medicaid and Long-Term Care in Alabama, 2009
Monthly Income Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple) (Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Special Income Rule, $2,022 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Miller Trust
Source: State website, http://www.medicaid.alabama.gov/CONTENT/3.0_apply/
3.2_Qualifying_for_Medicaid.aspx, and waiver application.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The state makes the special income rule pathway
available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.
Institutional LTC
The SSI-related and special income rule pathways are available to individuals to qualify for
institutional LTC. Under spousal impoverishment, the community spouse may retain up to $1,822
in income and between $25,000 and $109,560 in assets. The personal needs allowance for an
individual in an LTC facility is $30 monthly, with an additional $90 monthly supplement for
veterans or widows of a veteran.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related and special income
pathways. The state does not apply spousal impoverishment rules to HCBS waiver applicants.
Waiver recipients may retain up to $1,658 in an MMNA.
Other
The Katie Beckett pathway is not available. The hospice only pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Alaska
Table 6. Eligibility Pathways for Medicaid and Long-Term Care in Alaska, 2009
Monthly Income Total Resources
Limit
Limit
Traditional
Institutional
HCBS
Eligibility Pathway
(Individual/Couple) (Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $2,819
(includes
$10,000 / $15,000
Yes
Yes
Yes
spousal income)a
Special Income Rule,
$1,656 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Miller Trust
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
a. Unearned income must be at or below $1,156 per month.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the
state’s Buy-In pathway. The state makes the special income rule pathway available to individuals
who have lived in an institution for at least 30 days. The state makes the special income rule
pathway available up to 246% of SSI. Amounts that can be deposited in a Miller Trust are
unlimited.
Institutional LTC
The SSI-related, Buy-In, and special income rule pathways are available to individuals to qualify
for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up
to $2,739 in income and $109,560 in assets. The personal needs allowance for an individual in an
LTC facility is $75 monthly or $90 monthly for veterans in LTC facilities.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, Buy-In, and special
income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants.
Waiver recipients may retain up to $1,656 in an MMNA.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
Congressional Research Service
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Arizona
Table 7. Eligibility Pathways for Medicaid and Long-Term Care in Arizona, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
No
Buy-In $2,257
(excluding
No Resource Limit
Yes
Yes
No
spousal income)
Special Income
$2,022, $5,808 cap
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
in urban areas,
$5,158 cap in rural
areas
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state’s
Buy-In pathway. The state makes the special income rule pathway available up to 300% of SSI.
Amounts that can be deposited in a Miller Trust may not exceed $5,808 in urban areas and $5,158
in rural areas.
Institutional LTC
The SSI-related, 100% FPL, Buy-In, and special income rule pathways are available to
individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community
spouse may retain up to $1,822 in income and between $21,912 and $109,560 in assets. The
personal needs allowance for an individual in an LTC facility is $101 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, and special income
pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver
recipients may retain up to $2,022 in an MMNA or higher with a Miller Trust.
Other
The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Arkansas
Table 8. Eligibility Pathways for Medicaid and Long-Term Care in Arkansas, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
No
100% FPL
$722 / $971
$2,000 / $3,000
Yes
Yes
No
Buy-In
$2,257 (excludes
$4,000 / $6,000
Yes
Yes
No
spousal income)a
Medical y Needy
$108 / $217
$2,000 / $3,000
MN benefits onlyb No
(NH
No
(MN)
care)c
Special Income Rule,
$2,022 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Miller Trust
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
a. Net personal income (earned plus unearned, after SSI income exclusions); unearned income must be less
than SSI threshold plus $20.
b. The type, amount and scope of benefits offered to the medical y needy population may be less than under
traditional benefit packages.
c. The state does not extend nursing home care to eligible medically needy individuals. Our survey did not ask
whether states extend other institutional services to these individuals.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 80% of the FPL. Individuals with disabilities may qualify under the state’s
Buy-In pathway. Under the medically needy pathway, certain individuals with high medical
expenses can spend down their income on medical expenses over a three month budget period to
the state’s medically needy threshold. The state makes the special income rule pathway available
up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.
Institutional LTC
The SSI-related, 100% FPL, Buy-In, and special income rule pathways are available to
individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community
spouse may retain between $1,822 and $2,739 in income and $21,912 and $109,560 in assets. The
personal needs allowance for an individual in an LTC facility is $40 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the special income pathway. The state
applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain
up to $2,022 in a monthly maintenance needs allowance (MMNA), or an unlimited amount with a
Miller Trust.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Other Pathways
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
Congressional Research Service
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
California
Table 9. Eligibility Pathways for Medicaid and Long-Term Care in California, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $2,257
(includes
$2,000 / $3,000
Yes
Yes
No
spousal income) a
Medical y Needy
$600 / $934
$2,000 / $3,000
MN benefits onlyb Yes
(NH
Yes
(MN)
care)c
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
a. Excludes disability-related income including SSDI benefits.
b. The type, amount and scope of benefits offered to the medical y needy population may be less than under
traditional benefit packages.
c. The state extends nursing home care to eligible medically needy individuals. Our survey did not ask whether
states extend other institutional services to these individuals.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state’s
Buy-In pathway. Under the medically needy pathway, certain individuals with high medical
expenses can spend down their income on medical expenses over a one month budget period to
the state’s medically needy threshold.
Institutional LTC
The SSI-related, 100% FPL, medically needy, and Buy-In pathways are available to individuals to
qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may
retain up to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an
individual in an LTC facility is $35 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, and
medically needy pathways. The state applies spousal impoverishment rules to HCBS waiver
applicants. Individual waiver recipients may retain up to $600 in an MMNA. Couples that are
both waiver recipients may retain up to $934 in an MMNA.
Other Pathways
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Colorado
Table 10. Eligibility Pathways for Medicaid and Long-Term Care in Colorado, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Special Income
$2,022, regional
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
private pay rate cap
Source: CRS/AARP State Survey, 2009.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The state makes the special income rule pathway
available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are capped by
region.
Institutional LTC
The SSI-related and special income rule pathways are available to individuals to qualify for
institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to
$2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in
an LTC facility is $30 monthly for SSI recipients and higher for certain others with non-service
connected disabilities.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related and special income
pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver
recipients may retain up to $2,022 in an MMNA or higher with a Miller Trust.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is available.
Congressional Research Service
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Connecticut
Table 11. Eligibility Pathways for Medicaid and Long-Term Care in Connecticut, 2009
Monthly Income
Total Resources
Limit
Limit
Traditional
Institutional
HCBS
Eligibility Pathway (Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related: 209(b)
$842 / $1,286
$2,000 / $3,000
Yes
Yes
Yes
Buy-In
$75,000 per year
$10,000 / $15,000
Yes
Yes
No
(excludes spousal
income)
Medical y Needy
$611 / $778
$1,600 / $2,400
MN benefits only
Yes (NH
No
(MN)
care)
Special Income Rule
$2,022
$2,000 / $3,000
Yes
Yes
Yes
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
Connecticut is a 209(b) state and applies more restrictive rules to the counting of income and
resources than are applied under the federal government’s SSI thresholds. Individuals with
disabilities may qualify under the state’s Buy-In pathway. Under the medically needy pathway,
certain individuals with high medical expenses can spend down their income on medical expenses
over a six month budget period to the state’s medically needy threshold. The state makes the
special income rule pathway available up to 300% of SSI.
Institutional LTC
The SSI-related 209(b), Buy-In, medically needy, and special income rule pathways are available
to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the
community spouse may retain between $1,821 and $2,739 in income and between $21,912 and
$109,560 in assets. The personal needs allowance for an individual in an LTC facility is $69
monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related: 209(b) and special
income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants.
Waiver recipients may retain up to $1,806 in an MMNA.
Other Pathways
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Delaware
Table 12. Eligibility Pathways for Medicaid and Long-Term Care in Delaware, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
No
Special Income
$1,685 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
Source: CRS/AARP State Survey, 2009.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The state makes the special income rule pathway
available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.
Institutional LTC
The SSI-related and special income rule pathways are available to individuals to qualify for
institutional LTC. Under spousal impoverishment rules, the community spouse may retain
between $1,821 and $2,739 in income and between $25,000 and $109,560 in assets. The personal
needs allowance for an individual in an LTC facility is $44 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the special income pathway. The state
applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain
up to $1,685 in an MMNA or higher with a Miller Trust.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
District of Columbia
Table 13. Eligibility Pathways for Medicaid and Long-Term Care in the District of
Columbia, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
Yes
Medical y Needy
$577 / $607
$4,000 / $6,000
MN benefits only
Yes (NH
Yes
(MN)
care)
Special Income
$2,022
$2,000 / $3,000
Yes
Yes
Yes
Rule
Source: CRS/AARP State Survey, 2009.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 100% of the FPL. Under the medically needy pathway, certain individuals
with high medical expenses can spend down their income on medical expenses to the state’s
medically needy threshold from a selected budget period between one and six months. The state
makes the special income rule pathway available up to 300% of SSI.
Institutional LTC
The SSI-related, 100% FPL, medically needy, and special income rule pathways are available to
individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community
spouse may retain up to $2,739 in income and between $21,912 and $109,560 in assets. The
personal needs allowance for an individual in an LTC facility is $70 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, medically
needy, and special income pathways. The state applies spousal impoverishment rules to HCBS
waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.
Other
The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.
Congressional Research Service
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Florida
Table 14. Eligibility Pathways for Medicaid and Long-Term Care in Florida, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
100% FPL
$794 / $1,068
$2,000 / $3,000
Yes
Yes
Yes
Medical y Needy
$180 / $241
$5,000 / $6,000
MN benefits only
No
No
(MN)
Special Income
$2,022 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
Source: CRS/AARP State Survey, 2009.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 88% of the FPL. Under the medically needy pathway, certain individuals with
high medical expenses can spend down their income on medical expenses over a one month
budget period to the state’s medically needy threshold. The state makes the special income rule
pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are
unlimited.
Institutional LTC
The SSI-related, 100% FPL, and special income rule pathways are available to individuals to
qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may
retain up to $1,822 in income and up to $109,560 in assets. The personal needs allowance for an
individual in an LTC facility is $35 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL and
special income pathways. The state applies spousal impoverishment rules to HCBS waiver
applicants. Waiver recipients may retain an unlimited amount for an MMNA.
Other Pathways
The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.
Congressional Research Service
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Georgia
Table 15. Eligibility Pathways for Medicaid and Long-Term Care in Georgia, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Medical y Needy
$317 / $375
$2,000 / $3,000
MN benefits only
No (NH
No
(MN)
care)
Special Income
$2,022 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
Source: CRS/AARP State Survey, 2009.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Under the medically needy pathway, certain
individuals with high medical expenses can spend down their income on medical expenses over a
one month budget period to the state’s medically needy threshold. The state makes the special
income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller
Trust are unlimited.
Institutional LTC
The SSI-related and special income rule pathways are available to individuals to qualify for
institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to
$2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in
an LTC facility is $50 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related and special income
pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver
recipients may retain up to $674 in an MMNA or higher with a Miller Trust.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is available.
Congressional Research Service
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Hawaii
Table 16. Eligibility Pathways for Medicaid and Long-Term Care in Hawaii, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related: 209(b)
$1,039 / $1,397
$2,000 / $3,000
Yes
Yes
Yes
(Aged) $674 /
$1,011 (Disabled)
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
Yes
Medical y Needy
$469 / $632
$2,000 / $3,000
MN benefits only Yes (NH
Yes
(MN)
care)
Source: CRS/AARP State Survey, 2009.
Traditional Benefits
Hawaii is a 209(b) state and applies more restrictive rules to the counting of income and resources
than are applied under the federal government’s SSI thresholds. The 100% FPL pathway is
available to individuals with incomes up to 100% of the FPL. Under the medically needy
pathway, certain individuals with high medical expenses can spend down their income on medical
expenses over a one month budget period to the state’s medically needy threshold.
Institutional LTC
The SSI-related: 209(b), 100% FPL, and medically needy pathways are available to individuals to
qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may
retain up to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an
individual in an LTC facility is $50 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related: 209(b), 100% FPL
and medically needy pathways. The state applies spousal impoverishment rules to HCBS waiver
applicants. Waiver recipients may retain up to $674 in an MMNA if they live in a residential care
facility. All other waiver recipients may retain up to $1,038 in an MMNA.
Other
The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.
Congressional Research Service
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Idaho
Table 17. Eligibility Pathways for Medicaid and Long-Term Care in Idaho, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Buy-In
Less than or equal
$10,000 (includes
Yes Yes
Yes
to $4,513a
spousal resources)
Special Income
$2,022 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
a. Excludes retirement accounts, life insurance; earned income >15% of total earned and unearned.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the
state’s Buy-In pathway. The state makes the special income rule pathway available up to 300% of
SSI. Amounts that can be deposited in a Miller Trust are unlimited.
Institutional LTC
The SSI-related and special income rule pathways are available to individuals to qualify for
institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to
$1,821 in income and between $21,912 and $109,560 in assets. The personal needs allowance for
an individual in an LTC facility is $40 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, Buy-In, and special
income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants.
Waiver recipients with a mortgage or rent may retain up to $1,011 in an MMNA. Waiver
recipients with no mortgage or rent may retain up to $674 in an MMNA.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is available.
Congressional Research Service
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Illinois
Table 18. Eligibility Pathways for Medicaid and Long-Term Care in Illinois, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related: 209(b)
$903 / $1,214
$2,000 / $3,000
Yes
Yes
Yes
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
Yes
Buy-In
$1,806 (includes
$10,000 (includes
Yes Yes
No
spousal income)a
spousal resources)b
Medical y Needy
$903 / $1,214
$2,000 / $3,000
MN benefits only
Yes
Yes
(MN)
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
a. Increased to $3,160 in February 2009.
b. Increased to $25,000 and exempts retirement and medical savings accounts.
Traditional Benefits
Illinois is a 209(b) state and applies more restrictive rules to the counting of income and resources
and the definition of disability than are applied under the federal government’s SSI thresholds.
The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL.
Individuals with disabilities may qualify under the state’s Buy-In pathway. Under the medically
needy pathway, certain individuals with high medical expenses can spend down their income on
medical expenses over a one month budget period to the state’s medically needy threshold.
Institutional LTC
The SSI-related: 209(b), 100% FPL, Buy-In, and medically needy pathways are available to
individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community
spouse may retain up to $2,739 in income and up to $109,560 in assets. The personal needs
allowance for an individual in an LTC facility is $30 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related: 209(b), 100% FPL
applicants. Waiver recipients may retain up to $674 in an MMNA.
Other
The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Indiana
Table 19. Eligibility Pathways for Medicaid and Long-Term Care in Indiana, 2009
Monthly Income
Total Resources
Limit
Limit
Traditional
Institutional
HCBS
Eligibility Pathway (Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related: 209(b)
$674 / $1,011
$2,000 / $3,000
Yes
Yes
No
Buy-In $3,160
(excludes
$2,000 (excludes
Yes Yes
Yes
spousal income)
spousal resources)
Medical y Needy
$674 / $1,011
$2,000 / $3,000
MN benefits only Yes (NH
Yes
(MN)
care)
Special Income Rule,
$2,022 (no cap)
$2,000 / $3,000
Yes
No
Yes
Miller Trust
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
Indiana is a 209(b) state and applies more restrictive rules to the counting of income and
resources than are applied under the federal government’s SSI thresholds. Individuals with
disabilities may qualify under the state’s Buy-In pathway. Under the medically needy pathway,
certain individuals with high medical expenses can spend down their income on medical expenses
over a one month budget period to the state’s medically needy threshold. The state makes the
special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a
Miller Trust are unlimited.
Institutional LTC
The SSI-related: 209(b), Buy-In, and medically needy pathways are available to individuals to
qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may
retain up to $2,739 in income and between $21,912 and $109,560 in assets. The personal needs
allowance for an individual in an LTC facility is $52 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the Buy-In, medically needy, and
special income pathways. The state applies spousal impoverishment rules to HCBS waiver
applicants. Waiver recipients may retain up to $2,022 in an MMNA.
Other
The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Iowa
Table 20. Eligibility Pathways for Medicaid and Long-Term Care in Iowa, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $2,257
(includes
$12,000 / $13,000
Yes
Yes
No
spousal income)
Medical y Needy
$483
$10,000
MN benefits only
No (NH
No
(MN)
care)
Special Income
$2,022 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the
state’s Buy-In pathway. Under the medically needy pathway, certain individuals with high
medical expenses can spend down their income on medical expenses over a two month budget
period to the state’s medically needy threshold. The state makes the special income rule pathway
available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.
Institutional LTC
The SSI-related, Buy-In, and special income rule pathways are available to individuals to qualify
for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up
to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual
in an LTC facility is $50 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related and special income
pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver
recipients may retain up to $2,022 in an MMNA.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Kansas
Table 21. Eligibility Pathways for Medicaid and Long-Term Care in Kansas, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $2,709
(includes
$15,000 (includes
Yes Yes
No
spousal income)
spousal resources)
Medical y Needy
$475
$2,000 / $3,000
MN benefits only
Yes (NH
Yes
(MN)
care)
Special Income
$2,022
$2,000 / $3,000
Yes
Yes
Yes
Rule
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the
state’s Buy-In pathway. Under the medically needy pathway, certain individuals with high
medical expenses can spend down their income on medical expenses over a six month budget
period to the state’s medically needy threshold. The state makes the special income rule pathway
available up to 300% of SSI.
Institutional LTC
The SSI-related, Buy-In, medically needy, and special income rule pathways are available to
individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community
spouse may retain between $1,821 and $2,739 in income and between $21,912 and $109,560 in
assets. The personal needs allowance for an individual in an LTC facility is $62 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, medically needy, and
special income pathways. The state applies spousal impoverishment rules to HCBS waiver
applicants. Waiver recipients may retain up to $727 in an MMNA.
Other
The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Kentucky
Table 22. Eligibility Pathways for Medicaid and Long-Term Care in Kentucky, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
No
Medical y Needy
$217 / $267
$2,000 / $4,000
MN benefits only
Yes (NH
No
(MN)
care)
Special Income
$2,022 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
Source: CRS/AARP State Survey, 2009.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Under the medically needy pathway, certain
individuals with high medical expenses can spend down their income on medical expenses to the
state’s medically needy threshold from a selected budget period between one and three months.
The state makes the special income rule pathway available up to 300% of SSI. Amounts that can
be deposited in a Miller Trust are unlimited.
Institutional LTC
The SSI-related, medically needy, and special income rule pathways are available to individuals
to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may
retain between $1,822 and $2,739 in income and between $21,912 and $109,560 in assets. The
personal needs allowance for an individual in an LTC facility is $40 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the special income pathway. The state
applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain
up to $694 in an MMNA.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Louisiana
Table 23. Eligibility Pathways for Medicaid and Long-Term Care in Louisiana, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
100% FPL
$677 / $911
$2,000 / $3,000
Yes
Yes
Yes
Buy-In
$2,257 (excludes
$25,000 (excludes
Yes Yes
No
spousal income)
spousal resources)
Medical y Needy
$100 / $192
$2,000 / $3,000
MN benefits only
Yes (NH
No
(MN)
care)
Special Income
$2,022
$2,000 / $3,000
Yes
Yes
Yes
Rule
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 75% of the FPL. Individuals with disabilities may qualify under the state’s
Buy-In pathway. Under the medically needy pathway, certain individuals with high medical
expenses can spend down their income on medical expenses over a three month budget period to
the state’s medically needy threshold. The state makes the special income rule pathway available
up to 300% of SSI.
Institutional LTC
The SSI-related, 100% FPL, Buy-In, medically needy, and special income rule pathways are
available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the
community spouse may retain up to $2,739 in income and up to $109,560 in assets. The personal
needs allowance for an individual in an LTC facility is $38 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL and
special income pathways. The state applies spousal impoverishment rules to HCBS waiver
applicants. Waiver recipients may retain up to $2,022 in an MMNA.
Other Pathways
The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Maine
Table 24. Eligibility Pathways for Medicaid and Long-Term Care in Maine, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
Yes
Buy-In
$2,257 (on total
$12,000 (includes
Yes Yes
Yes
income)a
spousal resources)
Medical y Needy
$903 / $1,214
$2,000 / $3,000
MN benefits only
Yes (NH
Yes
(MN)
care)
Special Income
$2,022
$2,000 / $3,000
Yes
Yes
Yes
Rule
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
a. Up to $903 on unearned income (includes spousal income).
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% pathway is available to individuals with
incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state’s Buy-In
pathway. Under the medically needy pathway, certain individuals with high medical expenses can
spend down their income on medical expenses over a six month budget period to the state’s
medically needy threshold. The state makes the special income rule pathway available up to
300% of SSI.
Institutional LTC
The SSI-related, 100% FPL, Buy-In, medically needy, and special income rule pathways are
available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the
community spouse may retain up to $1,822 in income and up to $109,560 in assets. The personal
needs allowance for an individual in an LTC facility is $40 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, Buy-In,
and special income pathways. The state applies spousal impoverishment rules to HCBS waiver
applicants. Waiver recipients may retain up to $1,129 in an MMNA.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
Congressional Research Service
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Maryland
Table 25. Eligibility Pathways for Medicaid and Long-Term Care in Maryland, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $2,709
(includes
$10,000 (includes
Yes Yes
Yes
spousal income)
spousal resources)
Medical y Needy
$350 / $392
$2,500 / $3,000
MN benefits only Yes (NH
Yes
(MN)
care)
Special Income Rule $2,022
$2,000 / $3,000
Yes
Yes
Yes
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the
state’s Buy-In pathway. Under the medically needy pathway, certain individuals with high
medical expenses can spend down their income on medical expenses over a six month budget
period to the state’s medically needy threshold. The state makes the special income rule pathway
available up to 300% of SSI.
Institutional LTC
The SSI-related, Buy-In, medically needy, and special income rule pathways are available to
individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community
spouse may retain between $1,821 and $2,739 in income and between $21,912 and $109,560 in
assets. The personal needs allowance for an individual in an LTC facility is $71 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related Buy-In, medically
needy, and special income pathways. The state applies spousal impoverishment rules to HCBS
waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.
Other
The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.
Congressional Research Service
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Massachusetts
Table 26. Eligibility Pathways for Medicaid and Long-Term Care in Massachusetts,
2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
Yes
Buy-In
No Income Limit
No Resource Limit
Yes
Yes
No
Medical y Needy
$522/ $650
$2,000 / $3,000
MN benefits only
Yes (NH
No
(MN)
care)
Special Income
$2,022
$2,000 / $3,000
Yes
No
Yes
Rule
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Notes: 100% of FPL Pathway disregards 33% of income above 100% of the FPL if the beneficiary is blind or
disabled.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state’s
Buy-In pathway. Under the medically needy pathway, certain individuals with high medical
expenses can spend down their income on medical expenses over a six month budget period to
the state’s medically needy threshold. The state makes the special income rule pathway available
up to 300% of SSI.
Institutional LTC
The SSI-related, 100% FPL, Buy-In, and medically needy pathways are available to individuals
to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may
retain up to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an
individual in an LTC facility is $73 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL and
special income pathways. The state does not apply spousal impoverishment rules to HCBS waiver
applicants. Waiver recipients may retain up to $2,022 in an MMNA.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
Congressional Research Service
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Michigan
Table 27. Eligibility Pathways for Medicaid and Long-Term Care in Michigan, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
No
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $903a $75,000
(excludes
Yes Yes
Yes
spousal resources)
Medical y Needy
$903 / $1,215
$2,000 / $3,000
MN benefits only
Yes (NH
No
(MN)
care)
Special Income
$2,022
$2,000 / $3,000
Yes
Yes
No
Rule
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
a. Pre-enrollment: Total countable income (earned and unearned) cannot exceed $903 using SSI methodology.
During enrol ment: No limit on earned income, but unearned income cannot exceed $903. (Excludes
spousal income)
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state’s
Buy-In pathway. Under the medically needy pathway, certain individuals with high medical
expenses can spend down their income on medical expenses over a one month budget period to
the state’s medically needy threshold. The state makes the special income rule pathway available
up to 300% of SSI.
Institutional LTC
The SSI-related, 100% FPL, Buy-In, medically needy, and special income rule pathways are
available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the
community spouse may retain up to $2,739 in income and between $21,912 and $109,560 in
assets. The personal needs allowance for an individual in an LTC facility is $60 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the 100% FPL and Buy-In pathways.
The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients
may retain up to $2,022 in an MMNA.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is available.
Congressional Research Service
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Minnesota
Table 28. Eligibility Pathways for Medicaid and Long-Term Care in Minnesota, 2009
Monthly Income
Total Resources
Limit
Limit
Traditional
Institutional
HCBS
Eligibility Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related: 209(b)
$482 / $602
$2,000 / $3,000
Yes
Yes
No
100% FPL
$858/ $1,153
$2,000 / $3,000
Yes
Yes
Yes
Buy-In
No maximum.
$20,000 (excludes
Yes Yes
No
Lower limit of $65
spousal resources)
of unearned
income (excludes
spousal income)
Medical y Needy
$467 / $583
$3,000 / $6,000
MN benefits only
Yes (NH
Yes
(MN)
care)
Special Income Rule
$2,022
$2,000 / $3,000
Yes
Yes
Aged
only
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
Minnesota is a 209(b) state and applies more restrictive rules to the counting of income and
resources than are applied under the federal government’s SSI thresholds. The 100% FPL
pathway is available to individuals with incomes up to 100% of the FPL. Individuals with
disabilities may qualify under the state’s Buy-In pathway. Under the medically needy pathway,
certain individuals with high medical expenses can spend down their income on medical expenses
over a six month budget period to the state’s medically needy threshold. The state makes the
special income rule pathway available up to 300% of SSI.
Institutional LTC
The SSI-related: 209(b), 100% FPL, Buy-In, medically needy, and special income rule pathways
are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules,
the community spouse may retain between $1,823 and $2,739 in income and between $31,094
and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $89
monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the 100% FPL, medically needy, and
special income pathways. The state applies spousal impoverishment rules to HCBS waiver
applicants. Waiver recipients may retain up to $935 in an MMNA.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Mississippi
Table 29. Eligibility Pathways for Medicaid and Long-Term Care in Mississippi, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Special Income
$2,022 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
Source: CRS/AARP State Survey, 2009.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The state makes the special income rule pathway
available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.
Institutional LTC
The SSI-related and special income rule pathways are available to individuals to qualify for
institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to
$2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in
an LTC facility is $44 monthly. This amount can increase if the beneficiary participates in a work
therapy program.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related and special income
pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver
recipients may retain up to $2,022 in an MMNA.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
Congressional Research Service
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Missouri
Table 30. Eligibility Pathways for Medicaid and Long-Term Care in Missouri, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related: 209(b)
$768 / $1,033a
$2,000 / $3,000b Yes
Yes
Yes
100% FPL
$767 / $1,032
$2,000 / $3,000
Yes
Yes
No
Source: CRS/AARP State Survey, 2009.
Note: State-reported survey data shows an inconsistency about whether Missouri offers the Special Income
Rule pathway.
a. For the blind and/or, disabled, the income threshold is $903 for an individual and $1,215 for a couple.
b. For the blind and/or disabled, the resource amount for a couple is $4,000.
Traditional Benefits
Missouri is a 209(b) state and applies more restrictive rules to the definition of disability than are
applied under the federal government’s SSI thresholds. The 100% FPL pathway is available to
individuals with incomes up to 85% of the FPL.
Institutional LTC
The SSI-related: 209(b) and 100% FPL pathways are available to individuals to qualify for
institutional LTC. Under spousal impoverishment rules, the community spouse may retain
between $1,822 and $2,739 in income and between $21,912 and $109,560 in assets. The personal
needs allowance for an individual in an LTC facility is $30 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related: 209(b) pathway. The
state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may
retain up to $2,022 in an MMNA.
Other Pathways
The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.
Congressional Research Service
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Montana
Table 31. Eligibility Pathways for Medicaid and Long-Term Care in Montana, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Medical y Needy
$625
$2,000 / $3,000
MN benefits only
Yes (NH
Yes
(MN)
care)
Source: CRS/AARP State Survey, 2009.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Under the medically needy pathway, certain
individuals with high medical expenses can spend down their income on medical expenses over a
one month budget period to the state’s medically needy threshold.
Institutional LTC
The SSI-related and medically needy pathways are available to individuals to qualify for
institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to
$1,821 in income and between $21,912 and $109,560 in assets. The personal needs allowance for
an individual in an LTC facility is $50 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related and medically needy
pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Medically
needy waiver recipients may retain up to $625 in an MMNA; other waiver recipients may retain
$674.
Other Pathways
The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Nebraska
Table 32. Eligibility Pathways for Medicaid and Long-Term Care in Nebraska, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
Yes
Buy-In
$903
$4,000 / $6,000
Yes
Yes
No
Medical y Needy
$903 / $1,215
$4,000 / $6,000
MN benefits only
Yes (NH
Yes
(MN)
care)
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state’s
Buy-In pathway. Under the medically needy pathway, certain individuals with high medical
expenses can spend down their income on medical expenses over a one month budget period to
the state’s medically needy threshold.
Institutional LTC
The SSI-related, 100% FPL, Buy-In, and medically needy pathways are available to individuals
to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may
retain up to $2,739 in income and between $21,912 and $109,560 in assets. The personal needs
allowance for an individual in an LTC facility is $50 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, and
medically needy pathways. The state applies spousal impoverishment rules to HCBS waiver
applicants. Waiver recipients may retain up to $903 in an MMNA.
Other Pathways
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Nevada
Table 33. Eligibility Pathways for Medicaid and Long-Term Care in Nevada, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $2,257
(earned
$15,000 (excludes
Yes Yes
No
income)a
spousal resources)
Special Income
$2,022 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
a. Unearned income is capped at $699.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the
state’s Buy-In pathway. The state makes the special income rule pathway available up to 300% of
SSI. Amounts that can be deposited in a Miller Trust are unlimited.
Institutional LTC
The SSI-related, Buy-In, and special income pathways are available to individuals to qualify for
institutional LTC. Under spousal impoverishment, the community spouse may retain between
$1,821 and $2,739 in income and between $21,912 and $109,560 in assets. The personal needs
allowance for an individual in an LTC facility is $35 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI related and special income
pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver
recipients may retain up to $2,022 in an MMNA.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
New Hampshire
Table 34. Eligibility Pathways for Medicaid and Long-Term Care in New Hampshire,
2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related: 209(b)
$688 / $1,012
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $4,063
(earned
$24,991 / $37,487
Yes
Yes
Yes
income, includes
spousal income)
Medical y Needy
$591 / $675
$2,500 / $4,000
MN benefits only
Yes (NH
Yes
(MN)
care)
Special Income Rule $2,022
$2,000 / $3,000
Yes
Yes
Yes
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
New Hampshire is a 209(b) state and applies more restrictive rules to the definition of disability
than are applied under the federal government’s SSI thresholds. Individuals with disabilities may
qualify under the state’s Buy-In pathway. Under the medically needy pathway, certain individuals
with high medical expenses can spend down their income on medical expenses over a one month
or six month budget period to the state’s medically needy threshold. The state makes the special
income rule pathway available up to 300% of SSI.
Institutional LTC
The SSI-related: 209(b), Buy-In, medically needy, and special income rule pathways are available
to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the
community spouse may retain up to $1,822 in income and between $21,912 and $109,560 in
assets. The personal needs allowance for an individual in an LTC facility is $56 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related: 209(b), Buy-In,
medically needy, and special income pathways. The state does not apply spousal impoverishment
rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.
Other Pathways
The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
New Jersey
Table 35. Eligibility Pathways for Medicaid and Long-Term Care in New Jersey, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
No
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
No
Buy-In $2,257
earned
$20,000 (excludes
Yes Yes
No
income, $903
spousal resources)
unearned incomea
Medical y Needy
$367 / $434
$4,000 / $6,000
MN benefits only
Yes (NH
No
(MN)
care)
Special Income
$2,022
$2,000 / $3,000
Yes
Yes
Yes
Rule
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
a. Unearned income threshold disregards SSDI benefits received under individual’s account (SSN, not
survivor’s SSN).
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state’s
Buy-In pathway. Under the medically needy pathway, certain individuals with high medical
expenses can spend down their income on medical expenses over a six month budget period to
the state’s medically needy threshold. The state makes the special income rule pathway available
up to 300% of SSI.
Institutional LTC
The SSI-related, 100% FPL, Buy-In, medically needy, and special income rule pathways are
available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the
community spouse may retain up to $2,739 in income and between $21,912 and $109,560 in
assets. The personal needs allowance for an individual in an LTC facility is $35 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the special income pathway. The state
applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients in an
alternative living facility may retain up to $674 in an MMNA. All other waiver recipients may
retain up to $2,022 in an MMNA.
Other
The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
New Mexico
Table 36. Eligibility Pathways for Medicaid and Long-Term Care in New Mexico, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $2,257
earned
$10,000 (excludes
Yes Yes
No
income,a $1,226
spousal resources)
unearned income
(includes spousal
income)
Special Income
$2,022 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
a. To be eligible for Medicaid Buy-In in New Mexico beneficiaries must earn at least $970 over three months.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Working individuals with disabilities may also
qualify for Medicaid state plan services through the state’s Buy-In pathway. The state makes the
special income rule pathway available to individuals who have been in an institution for at least
30 days. The state makes the special income rule pathway available up to 300% of SSI. Amounts
that can be deposited in a Miller Trust are unlimited.
Institutional LTC
The SSI-related, Buy-In, and special income rule pathways are available to individuals to qualify
for institutional LTC. Under spousal impoverishment, the community spouse may retain up to
$1,822 in income and up to $109,560 in assets. The personal needs allowance for an individual in
an LTC facility is $63 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related and special income
pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver
recipients may retain up to $2,022 in an MMNA.
Other
The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
New York
Table 37. Eligibility Pathways for Medicaid and Long-Term Care in New York, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Buy-In
$2,257
$13,800 / $20,100
Yes
Yes
Yes
Medical y Needy
$767 / $1,117
$13,800 / $20,100
MN benefits only
Yes (NH
Yes
(MN)
care)
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010. Additional information
was obtained from, http://www.health.state.ny.us/health_care/medicaid/program/buy_in/index.htmState Plan.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the
state’s Buy-In pathway. Under the medically needy pathway, certain individuals with high
medical expenses can spend down their income on medical expenses over a six month budget
period to the state’s medically needy threshold.
Institutional LTC
The SSI-related, Buy-In, and medically needy pathways are available to individuals to qualify for
institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to
$2,739 in income and between $74,820 and $109,560 in assets. The personal needs allowance for
an individual in an LTC facility is $50 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, Buy-In, and special
income pathways. The state does not apply spousal impoverishment rules to HCBS waiver
applicants. Waiver recipients may retain up to $787 in an MMNA.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
North Carolina
Table 38. Eligibility Pathways for Medicaid and Long-Term Care in North Carolina,
2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
Yes
Buy-In
$3,612 (excludes
$20,880 (includes
Yes Yes
No
spousal income)a
spousal resources)
Medical y Needy
$242 / $317
$2,000 / $3,000
MN benefits only
Yes (NH
Yes
(MN)
care)
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
a. Phased implementation open to individuals with monthly incomes up to $1,354 in December 2009.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state’s
Buy-In pathway. Under the medically needy pathway, certain individuals with high medical
expenses can spend down their income on medical expenses over a six month budget period to
the state’s medically needy threshold.
Institutional LTC
The SSI-related, 100% FPL, Buy-In, and medically needy pathways are available to individuals
to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may
retain up to $1,822 in income and between $21,912 and $109,560 in assets. The personal needs
allowance for an individual in an LTC facility is $30 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, and
medically needy pathways. The state applies spousal impoverishment rules to HCBS waiver
applicants. Waiver recipients may retain up to $903 in an MMNA.
Other Pathways
The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
North Dakota
Table 39. Eligibility Pathways for Medicaid and Long-Term Care in North Dakota,
2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related: 209(b)
$750 / $1,008
$2,000 / $3,000
Yes
Yes
Yes
Buy-In
$2,031 (excludes
$13,000 (includes
Yes Yes
Yes
spousal income)
family income)
Medical y Needy
$750 / $1,008
$3,000 / $6,000
MN benefits
Yes (NH
Yes
(MN)
care)
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
North Dakota is a 209(b) state and applies more restrictive rules to the counting of income and
resources than are applied under the federal government’s SSI thresholds. Individuals with
disabilities may qualify under the state’s Buy-In pathway. Under the medically needy pathway,
certain individuals with high medical expenses can spend down their income on medical expenses
over a one month budget period to the state’s medically needy threshold.
Institutional LTC
The SSI-related: 209(b), Buy-In, and medically needy pathways are available to individuals to
qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may
retain up to $2,267 in income and between $21,912 and $109,560 in assets. The personal needs
allowance for an individual in an LTC facility is $50 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related: 209(b), Buy-In, and
medically needy pathways. The state applies spousal impoverishment rules to HCBS waiver
applicants. Waiver recipients may retain up to $750 in an MMNA.
Other Pathways
The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Ohio
Table 40. Eligibility Pathways for Medicaid and Long-Term Care in Ohio, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related: 209(b)
$589 / $1,011
$1,011 / $2,250
Yes
Yes
Yes
Buy-In $2,257
(excludes
$10,580 (includes
Yes Yes
Yes
spousal income)a
spousal resources)
Medical y Needy
$589 / $1,011
$1,011 / $2,250
MN benefits only
Yes (NH
Yes
(MN)
care)
Special Income Rule
$2,022
$1,011 / $2,250
Yes
Yes
Yes
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
a. Persons with a severe work disability are given an unearned income disregard of up to $20,000 per year.
Traditional Benefits
Ohio is a 209(b) state and applies more restrictive rules to the counting of income and resources
than are applied under the federal government’s SSI thresholds. Individuals with disabilities may
qualify under the state’s Buy-In pathway. Under the medically needy pathway, certain individuals
with high medical expenses can spend down their income on medical expenses over a one month
budget period to the state’s medically needy threshold. The state makes the special income rule
pathway available up to 300% of SSI.
Institutional LTC
The SSI-related: 209(b), Buy-In, medically needy, and special income rule pathways are available
to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the
community spouse may retain up to $2,739 in income and between $21,912 and $109,560 in
assets. The personal needs allowance for an individual in an LTC facility is $40 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related: 209(b), Buy-In,
medically needy, and special income pathways. The state applies spousal impoverishment rules to
HCBS waiver applicants. Waiver recipients may retain up to $1,314 in an MMNA.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Oklahoma
Table 41. Eligibility Pathways for Medicaid and Long-Term Care in Oklahoma, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related: 209(b)
$716 / $1,054, if
$2,000 / $3,000
Yes
Yes
Yes
one spouse is
ineligible ($1,094
if both spouses are
eligible)
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
No
Special Income Rule,
$2,022, $3,000 cap $2,000 / $3,000
Yes
Yes
Yes
Miller Trust
Source: CRS/AARP State Survey, 2009.
Traditional Benefits
Oklahoma is a 209(b) state and applies more restrictive rules to the counting of resources than is
applied under the federal government’s SSI threshold. The 100% FPL pathway is available to
individuals with incomes up to 100% of the FPL in Oklahoma. The state makes the special
income rule pathway available up to 300% of SSI. No more than $3,000 can be deposited in a
Miller Trust.
Institutional LTC
The SSI-related: 209(b), 100% FPL, and special income rule pathways are available to
individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community
spouse may retain up to $2,739 in income and between $25,000 and $109,560 in assets. The
personal needs allowance for an individual in an LTC facility is $50 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related: 209(b) and special
income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants.
Waiver recipients may retain up to $1,011 in an MMNA or up to $3,000 with a Miller Trust.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Oregon
Table 42. Eligibility Pathways for Medicaid and Long-Term Care in Oregon, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $2,257
adjusted
$5,000 (excludes
Yes Yes
Yes
earned income
spousal resources)
(excludes spousal
income)
Special Income
$2,022, or $6,494
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
cap
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the
state’s Buy-In pathway. The state makes the special income rule pathway available up to 300% of
SSI. Up to $6,494 can be deposited in a Miller Trust are unlimited.
Institutional LTC
The SSI-related, Buy-In, and special income rule pathways are available to individuals to qualify
for institutional LTC. Under spousal impoverishment, the community spouse may retain up to
$1,822 in income and up to $109,560 in assets. The personal needs allowance for an individual in
an LTC facility is $30 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, Buy-In, and special
income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants.
Waiver recipients may retain up to $1,822 in an MMNA or $6,494 with a Miller Trust.
Other Pathways
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
Congressional Research Service
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Pennsylvania
Table 43. Eligibility Pathways for Medicaid and Long-Term Care in Pennsylvania,
2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $2,257
(includes
$10,000 (includes
Yes Yes
Yes
spousal income)
spousal resources)
Medical y Needy
$2,550 / $2,650a
$2,400 / $3,200
MN benefits only
Yes (NH
Yes
(MN)
care)
Special Income Rule $2,022
$2,000 / $3,000
Yes
Yes
Yes
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010. Pennsylvania 1915(c)
waiver application, http://www.temple.edu/thetrainingpartnership/resources/mrBulletins/wv/00-09-04_attch2.pdf
a. Income threshold evaluated across six months.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state’s
Buy-In pathway. Under the medically needy pathway, certain individuals with high medical
expenses can spend down their income on medical expenses over a six month budget period to
the state’s medically needy threshold. The state makes the special income rule pathway available
up to 300% of SSI.
Institutional LTC
The SSI-related, 100% FPL Buy-In, medically needy, and special income rule pathways are
available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the
community spouse may retain between $1,821 and $2,739 in income and between $21,912 and
$109,560 in assets. The personal needs allowance for an individual in an LTC facility is $45
monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, Buy-In,
medically needy, and special income pathways. The state applies spousal impoverishment rules to
HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.
Other
The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Rhode Island
Table 44. Eligibility Pathways for Medicaid and Long-Term Care in Rhode Island,
2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $2,257
(excludes
$10,000 / $20,000
Yes
Yes
No
spousal income)
Medical y Needy
$800 / $842
$4,000 / $6,000
MN benefits only
Yes (NH
Yes
(MN)
care)
Special Income
$2,022
$2,000 / $3,000
Yes
Yes
Yes
Rule
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state’s
Buy-In pathway. Under the medically needy pathway, certain individuals with high medical
expenses can spend down their income on medical expenses over a six month budget period to
the state’s medically needy threshold. The state makes the special income rule pathway available
up to 300% of SSI.
Institutional LTC
The SSI-related, 100% FPL, Buy-In, medically needy, and special income rule pathways are
available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the
community spouse may retain up to $2,739 in income and up to $109,560 in assets. The personal
needs allowance for an individual in an LTC facility is $50 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, medically
needy, and special income pathways. The state applies spousal impoverishment rules to HCBS
waiver applicants. Waiver recipients may retain up to $923 in an MMNA.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
South Carolina
Table 45. Eligibility Pathways for Medicaid and Long-Term Care in South Carolina,
2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
Yes
Special Income
$2,022 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
Source: CRS/AARP State Survey, 2009.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 100% of the FPL. The state makes the special income rule pathway available
up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.
Institutional LTC
The SSI-related, 100% FPL, and special income rule pathways are available to individuals to
qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may
retain up to $2,739 in income and between $66,480 and $109,560 in assets. The personal needs
allowance for an individual in an LTC facility is $30 monthly.27
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL and
special income pathways. The state applies spousal impoverishment rules to HCBS waiver
applicants. MMNA was not available through survey or state contacts.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is available.
27 http://www.dhhs.state.sc.us/dhhsnew/insidedhhs/bureaus/bureauofeligibilityprocessing/nursinghome.asp
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
South Dakota
Table 46. Eligibility Pathways for Medicaid and Long-Term Care in South Dakota,
2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Buy-In
$2,257 (excludes
$8,000 (excludes
Yes Yes
Yes
spousal income)
spousal resources)
Special Income
$2,022 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the
state’s Buy-In pathway. The state makes the special income rule pathway available up to 300% of
SSI. Amounts that can be deposited in a Miller Trust are unlimited.
Institutional LTC
The SSI-related, Buy-In, and special income rule pathways are available to individuals to qualify
for institutional LTC. Under spousal impoverishment, the community spouse may retain up to
$1,821 in income and between $21,912 and $109,560 in assets. The personal needs allowance for
an individual in an LTC facility is $60 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, Buy-In, and special
income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants.
Waiver recipients may retain up to $694 in an MMNA or higher with a Miller Trust.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Tennessee
Table 47. Eligibility Pathways for Medicaid and Long-Term Care in Tennessee, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Special Income
$2,022 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
Source: CRS/AARP State Survey, 2009.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The state makes the special income rule pathway
available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.
Institutional LTC
The SSI-related and special income rule pathways are available to individuals to qualify for
institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to
$2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in
an LTC facility is $50.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related and special income
pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver
recipients may retain up to $1,348 in an MMNA or higher with a Miller Trust.
Other
The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Texas
Table 48. Eligibility Pathways for Medicaid and Long-Term Care in Texas, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $2,257
(excludes
$5,000 (excludes
Yes Yes
Yes
spousal income)a
spousal resources)b
Special Income
$2,022 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010. Texas section 1915(c)
waiver application, http://www.dads.state.tx.us/providers/CBA/CBAWaiver.pdf
a. To be eligible for Medicaid Buy-In in Texas beneficiaries must earn at least $1,090 in qualifying SSA quarter
prior to application date.
b. Half of any jointly owned (with spouse) assets considered.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the
state’s Buy-In pathway. The state makes the special income rule pathway available to individuals
who have been in an institution for at least 30 days. The state makes the special income rule
pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are
unlimited.
Institutional LTC
The SSI-related, Buy-In, and special income rule pathways are available to individuals to qualify
for institutional LTC. Under spousal impoverishment, the community spouse may retain up to
$2,739 in income and between $21,912 and $109,560 in assets. The personal needs allowance for
an individual in an LTC facility is $60 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI related, Buy-In, and special
income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants.
Waiver recipients may retain up to $2,022 in an MMNA or higher with a Miller Trust.
Other
The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Utah
Table 49. Eligibility Pathways for Medicaid and Long-Term Care in Utah, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
Yes
Buy-In
$2,257 (includes
$15,000 (includes
Yes Yes
Yes
spousal income)
spousal resources)
Medical y Needy
$903 / $1,214
$2,000 / $3,000
MN benefits only
Yes (NH
Yes
(MN)
care)
Special Income
$2,022
$2,000 / $3,000
Yes
Yes
Yes
Rule
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state’s
Buy-In pathway. Under the medically needy pathway, certain individuals with high medical
expenses can spend down their income on medical expenses over a one month budget period to
the state’s medically needy threshold. The state makes the special income rule pathway available
up to 300% of SSI.
Institutional LTC
The SSI-related, 100% FPL, Buy-In, medically needy, and special income rule pathways are
available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the
community spouse may retain up to $1,822 in income and between $21,912 and $109,560 in
assets. The personal needs allowance for an individual in an LTC facility is $45 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, Buy-In,
medically needy, and special income pathways. The state applies spousal impoverishment rules to
HCBS waiver applicants. Waiver recipients may retain up to $903 in an MMNA.
Other
The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Vermont
Table 50. Eligibility Pathways for Medicaid and Long-Term Care in Vermont, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
100% FPL
$903 / $1,214
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $2,257a
$5,000 / $6,000
Yes
Yes
No
Medical y Needy
$991
$2,000 / $3,000
MN benefits only
Yes (NH
Yes
(MN)
care)
Special Income
$2,022
$2,000 / $3,000
Yes
Yes
Yes
Rule
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
a. After disregarding SSDI and veteran’s benefits, income cannot exceed either the Medicaid protected income
level for one, or the SSI/Aid to the Aged, Blind, and Disabled (AABD) payment level for two.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state’s
Buy-In pathway. Under the medically needy pathway, certain individuals with high medical
expenses living in an LTC facility can spend down their income on medical expenses over a one-
month budget period (six-month, if living in the community) to the state’s medically needy
threshold. The state makes the special income rule pathway available up to 300% of SSI.
Institutional LTC
The SSI-related, 100% FPL, Buy-In, medically needy, and special income rule pathways are
available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the
community spouse may retain up to $1,829 in income and up to $109,560 in assets. The personal
needs allowance for an individual in an LTC facility is $47 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, medically
needy, and special income pathways. The state applies spousal impoverishment rules to HCBS
waiver applicants. Waiver recipients may retain up to $991 in an MMNA.
Other
The Katie Beckett pathway is available. The hospice only eligibility pathway is available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Virginia
Table 51. Eligibility Pathways for Medicaid and Long-Term Care in Virginia, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related: 209(b)
$722 / $972
$2,000 / $3,000
Yes
Yes
No
100% FPL
$722 / $971
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $722
(includes
$2,000 / $3,000
Yes
Yes
Yes
spousal income)
Medical y Needy
$421 / $508
$2,000 / $3,000
MN benefits only
Yes (NH
Yes
(MN)
care)
Special Income Rule
$2,022
$2,000 / $3,000
Yes
Yes
Yes
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
Virginia is a 209(b) state and applies more restrictive rules to the counting of resources than is
applied under the federal government’s SSI thresholds. The 100% FPL pathway is available to
individuals with incomes up to 80% of the FPL. Individuals with disabilities may qualify under
the state’s Buy-In pathway. Under the medically needy pathway, certain individuals with high
medical expenses can spend down their income on medical expenses over a budget period to the
state’s medically needy threshold. The state makes the special income rule pathway available up
to 300% of SSI.
Institutional LTC
The SSI-related: 209(b), 100% FPL, Buy-In, medically needy, and special income rule pathways
are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules,
the community spouse may retain up to $2,739 in income and up to $109,560 in assets. The
personal needs allowance for an individual in an LTC facility is $40 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the 100% FPL, medically needy, and
special income pathways. The state applies spousal impoverishment rules to HCBS waiver
applicants. Waiver recipients may retain up to $2,022 in an MMNA.
Other Pathways
The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Washington
Table 52. Eligibility Pathways for Medicaid and Long-Term Care in Washington, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Buy-In
$1,987 (includes
No Resource Limit
Yes
Yes
Yes
spousal income)
Medical y Needy
$467 / $592
$2,000 / $3,000
MN benefits only
Yes (NH
No
(MN)
care)
Special Income
$2,022
$2,000 / $3,000
Yes
Yes
Yes
Rule
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the
state’s Buy-In pathway. Under the medically needy pathway, certain individuals with high
medical expenses can spend down their income on medical expenses over a budget period to the
state’s medically needy threshold. The beneficiary’s budget period may have a retroactive base
period that is one, two, or three months depending on the client’s circumstances and eligibility.
The prospective base period may be either three or six months and is the beneficiary’s option. The
state makes the special income rule pathway available up to 300% of SSI.
Institutional LTC
The SSI-related, Buy-In, medically needy, and special income rule pathways are available to
individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community
spouse may retain between $1,821 and $2,739 in income and between $48,639 and $109,560 in
assets. The personal needs allowance for an individual in an LTC facility is $70 monthly for
institutionalized persons.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, Buy-In, and special
income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants.
Waiver recipients may retain up to $903 in an MMNA.
Other
The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
West Virginia
Table 53. Eligibility Pathways for Medicaid and Long-Term Care in West Virginia,
2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $2,257a
$2,000b Yes Yes
No
Special Income
$2,022
$2,000 / $3,000
Yes
Yes
Yes
Rule
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
a. Unearned income must be equal to or less than the SSI benefit plus $20.
b. Liquid assets are excluded up to $5,000.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the
state’s Buy-In pathway. The state makes the special income rule pathway available up to 300% of
SSI.
Institutional LTC
The SSI-related, Buy-In, and special income rule pathways are available to individuals to qualify
for institutional LTC. Under spousal impoverishment, the community spouse may retain between
$1,821 and $2,739 in income and between $21,912 and $109,560 in assets. The personal needs
allowance for an individual in an LTC facility is $50 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related and special income
pathways. The state does not apply spousal impoverishment rules to HCBS waiver applicants.
Waiver recipients may retain up to $2,022 in an MMNA.
Other Pathways
The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Wisconsin
Table 54. Eligibility Pathways for Medicaid and Long-Term Care in Wisconsin, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
100% FPL
$903 / $1,214
$2,000 / $3,000
No
Yes
Yes
Buy-In $2,257
(includes
$15,000 (excludes
Yes Yes
Yes
spousal income)
spousal resources)
Medical y Needy
$592
$2,000 / $3,000
MN benefits only
Yes (NH
Yes
(MN)
care)
Special Income
$2,022
$2,000 / $3,000
Yes
Yes
Yes
Rule
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
Traditional Benefits
All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals
with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state’s
Buy-In pathway. Under the medically needy pathway, certain individuals with high medical
expenses can spend down their income on medical expenses over a six month budget period to
the state’s medically needy threshold. The state makes the special income rule pathway available
up to 300% of SSI.
Institutional LTC
The SSI-related, 100% FPL, Buy-In, medically needy, and special income rule pathways are
available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the
community spouse may retain up to $2,428 in income and between $21,912 and $109,560 in
assets. The personal needs allowance for an individual in an LTC facility is $45 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, Buy-In,
medically needy, and special income pathways. The state applies spousal impoverishment rules to
HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.
Other Pathways
The Katie Beckett pathway is available. The hospice only eligibility pathway is available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Wyoming
Table 55. Eligibility Pathways for Medicaid and Long-Term Care in Wyoming, 2009
Monthly Income
Total Resources
Eligibility
Limit
Limit
Traditional
Institutional
HCBS
Pathway
(Individual/Couple)
(Individual/Couple)
Benefits
LTC
Waivers
SSI-related
$674 / $1,011
$2,000 / $3,000
Yes
Yes
Yes
Buy-In $2,022a
No Resource Limit
Yes
Yes
Yes
Special Income
$2,022 (no cap)
$2,000 / $3,000
Yes
Yes
Yes
Rule, Miller Trust
Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody
Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure,
Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.
a. Gross countable income only.
Traditional Benefits
All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the
state’s Buy-In pathway. The state makes the special income rule pathway available to individuals
who have been in an institution for at least 30 days. The state makes the special income rule
pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are
unlimited.
Institutional LTC
The SSI-related, Buy-In, and special income rule pathways are available to individuals to qualify
for institutional LTC. Under spousal impoverishment, the community spouse may retain up to
$2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in
an LTC facility is $50 monthly.
HCBS Waiver
For HCBS waiver services, individuals can qualify through the SSI-related, Buy-In, and special
income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants.
Waiver recipients may retain up to $2,022 in an MMNA or higher with a Miller Trust.
Other
The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.
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Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities
Appendix A. Eligibility Groups Excluded from
the Survey
Not all of Medicaid’s eligibility groups, or pathways, for these populations were surveyed, in part
because (1) one group was recently established, (2) information on these groups are available
through other sources, and/or (3) some groups do not bring in significant numbers of eligibles.
Among the eligibility pathways not included in our survey are the pathways for dual eligibles
(i.e., those eligible for both Medicare and Medicaid). Also not included is the new pathway
established under the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148). Section
2402 of PPACA gave states the option to extend certain home and community-based services
(HCBS), as well as full Medicaid, to individuals with income no greater than 150% of the federal
poverty level (FPL) and who meet a state’s needs-based criteria. This needs-based criteria,
defined by states, can be no more stringent than the criteria the state uses to determine eligibility
for institutional care in a nursing facility, ICF/MR, or hospital. Alternatively, states may choose to
extend this eligibility pathway to persons with income up to 300% of the SSI benefit rate who are
receiving HCBS services under a waiver authorized under sections 1915(c), (d) or (e) of the SSA.
Also not included is the optional Medicaid eligibility group for families who have children with
disabilities, known as the Family Opportunity Act (FOA). FOA was established by the Deficit
Reduction Act of 2005 (DRA, P.L. 109-171). As of January 1, 2007, states have the option to
allow families whose income is less than 300% of FPL to purchase Medicaid coverage for their
disabled children through age 18. This Medicaid buy-in can cover all disabled children up to age
18. FOA has some restrictions, such as states must require working parents to enroll in and pay
premiums for family coverage through employer-sponsored insurance, when it is offered. States
also can require families to pay a portion of the cost of their children’s participation in Medicaid
through monthly premiums using a sliding scale based on income, (i.e., families with income up
to 200% of the FPL would be responsible for payments of 5% of income, and 7.5% of income for
families with income between 200% and 300% of FPL).
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Appendix B. Medicaid’s Resources Rules for Aged
and Disabled Eligibility Pathways
SSI, and thus Medicaid, limits the countable resources persons may have to qualify for benefits.
Countable resources generally refer to liquid assets, such as money in bank accounts, stocks and
bonds, mutual fund investments, and certificates of deposit. In general, an SSI recipient can have
assets, with the exception of a home, car, and household items, worth no more than $2,000;
beneficiary-couples can have countable assets worth no more than $3,000. Eligibility for SSI is
restricted to otherwise qualifying individuals whose resources do not exceed $2,000 for an
individual and $3,000 for a couple.
Countable resources do not, however, include all resources that an individual or couple may own.
They exclude, but are not limited to, a car used for essential transportation (or, if not essential, up
to $4,500 of its current value), property essential to income-producing activity, household goods
and personal effects totaling $2,000 or less, and life insurance policies with a combined face
value of $1,500 or less.28
Under SSI, the entire value of the primary place of residence (i.e., his or her home) of Medicaid
applicants is not counted. However, the Deficit Reduction Act of 2005 (DRA) amended Medicaid
law (section 1917 of the Social Security Act) to restrict eligibility for Medicaid to certain
individuals who apply for Medicaid coverage for nursing facility or other LTSS if the applicant’s
equity interest in his or her home is greater than $500,000.29 A state may elect to substitute an
amount that exceeds $500,000 but does not exceed $750,000.30 This restriction applies only to
applicants who do not have a spouse, child under age 21, or child who is blind or disabled (as
defined by the section 1614(a)(3) of the Social Security Act for the 50 states and the District of
Columbia) lawfully residing in the home.31
For purposes of qualifying for Medicaid, people who have home equity above the state-specified
amount must reduce their total equity interest in the home. The income earned from a transaction,
such as a reverse mortgage or home equity loan, is subject to repayment. It is not considered
countable income for Medicaid eligibility purposes in the month it is received. Any amounts
retained into the following month are counted as resources and would need to be depleted to the
state’s asset thresholds before the individual could qualify for Medicaid.32 A process exists for
waiving the application of the home equity limit in the case of demonstrated hardship.
28 The SSI resource exclusions can be found in section 1613 of the Social Security Act (42 USC § 1382b) and in the
Code of Federal Regulations at 20 CFR §§ 416.1210-416.1239.
29 Applies when applicants seek Medicaid coverage for the following services: nursing facility care; a level of care in
any institution equivalent to nursing facility services; HCBS furnished under a waiver under sections 1915(c) or (d) of
the Social Security Act; and services provided to a noninstitutionalized individual that are described in paragraph (7),
(22), or (24) of section 1905(a) of the act, among other instances.
30 Beginning in 2011, these dollar amounts are increased from year to year based on the percentage increase in the
consumer price index for all urban consumers, rounded to the nearest $1,000.
31 And who are determined eligible for certain long-term care services based on an application filed on or after January
1, 2006.
32 SSR 92-8p: Policy Interpretation Ruling Title XVI: SSI Loan Policy, Including its Applicability to Advances of Food
and/or Shelter.
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For any beneficiary (and spouse, if any) who moves out of his or her home without the intent to
return, the home becomes a countable resource because it is no longer the individual’s principal
place of residence. If an individual leaves his or her home to live in an institution, the home is
still considered to be the individual’s principal place of residence, irrespective of the individual’s
intent to return, as long as a spouse or dependent relative of the eligible individual continues to
live there.
Author Contact Information
Julie Stone
Specialist in Health Care Financing
jstone@crs.loc.gov, 7-1386
Acknowledgments
Scott Talaga, health policy research intern at CRS from the Cornell Institute of Public Affairs, Cornell
University, assisted in the verification of survey results and in compiling the state profiles. Thank you to
Roy Trudel at CMS, April Grady at MACPAC, and Patricia A. Davis, David Newman, and Alison Mitchell
at CRS, for their editorial comments and suggestions.
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