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


  • Three groups are financially eligible for waiver services:

    • Group A includes individuals who are receiving SSI, those receiving SSI/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.

    • Group B includes persons with incomes up to the special income standard of 300 percent of SSI, which is $1,656.

    • Group C includes medically needy individuals who spend down to the medically needy income level. There is no upper limit on income, but income can be no greater than $591.67 after deducting medical and remedial expenses.3 There is a hierarchy of spend down categories starting with out-of-pocket expenditures for medical expenses not paid by Medicaid (e.g., over-the-counter medications), followed by expenditures on long term care and other services not covered by the waiver program, then waiver-covered services, and finally Medicaid state plan services, such as prescription drugs.

  • Asset limits for all three groups are $2,000 for an individual and $4,000 for a couple when both members of the couple are eligible for the waiver and have been receiving waiver services for one year or longer. When only one spouse applies, spousal impoverishment protections apply.

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