Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Financial Criteria (2)


  • Three groups are financially eligible for nursing home services:

    • Group A includes individuals eligible for SSI whose monthly federal benefit is $552 per month. This group is automatically eligible for Medicaid.

    • Group B includes individuals with incomes up to100 percent of the Federal Poverty Level (FPL), which is $749 in 2003.

    • Group C includes medically needy individuals whose nursing home costs exceed their countable monthly income. Income that is not countable includes: a personal needs allowance; health insurance premiums and medical expenses not covered by insurance or government benefits; certain spousal or dependent family members' allowance; and a home maintenance allowance if the if the nursing home stay is less than six months and there is no spouse living in the home.3

  • Asset limits for both groups are $2000 for an individual and $3000 for a couple.

  • The monthly personal needs allowance is $30 for individuals and $60 for couples.

  1. Prior to 1995, North Carolina (North Carolina) was a 209(b) state and had the option of using more restrictive financial eligibility criteria than that of the Supplemental Security Income (SSI) program to determine financial eligibility for Medicaid. During this time, persons who were eligible for SSI, either because they were disabled or 65 years or older, were not automatically eligible for Medicaid, as they were in most states.

    Individuals could become eligible for Medicaid by spending down to $242, or $317 for a couple. Resource limits were also more restrictive than SSI. The one exception to this income standard was linked to receipt of the SSI state supplement, called Special Assistance (SA), which was provided only to individuals residing in adult care homes.

    In January 1995, the state began covering all SSI recipients under Medicaid, and in 1999 increased the income standard to 100 percent of the federal poverty standard. This standard is used to determine eligibility for all long term care services in the state, including nursing homes. The state also has a medically needy program.

  2. As permitted under the §1902(r)(2) less restrictive income methodologies, the state excludes wages paid by the Census Bureau for temporary employment; it also does not count the following: personal effects & household goods; life estate interest and tenancy in common interest (except for optional state supplements); burial plots; cash value of life insurance if the total face value does not exceed a specified amount.

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