Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Financial Criteria


  • There are three groups financially eligible for Medicaid covered nursing home care.

    • Mandatory Categorically Needy includes individuals who are receiving Supplemental Security Income (SSI), those receiving SSI and the State Supplemental Payment (SSP), those who have incomes no higher than the SSI/SSP level, and those who are eligible for full Medicaid benefits through any other eligibility option.

    • Optional Categorically Needy includes persons with incomes up to the special income standard of 300 percent of the SSI Federal Benefit Rate, which is $1,656 in 2003. This group must spend all of their income (minus a personal needs allowance) on nursing home care before Medicaid will begin to pay, unless spousal impoverishment provisions apply.

    • Medically Needy includes individuals whose nursing home costs exceed their income.

  • Asset limits for all three groups are $2,000 for an individual in a nursing home. When only one member of a couple applies and there is a community spouse, spousal impoverishment protections apply.

  • The monthly individual personal needs allowance is $45.

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