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

12/01/2003

Three groups are financially eligible for Medicaid-covered nursing home care:

Group A includes individuals who are receiving Supplemental Security Income (SSI), and those who have incomes no higher than the SSI payment combined with the State Supplemental Payment (SSP).

Group B includes persons with incomes up to the special income standard of 300 percent of SSI, which is $1656. This group is subject to cost sharing. After certain deductions are made for a personal needs allowance, and a spouse or dependent allowance, any remaining income must be spent on nursing home care.

Group C includes individuals with incomes up to 88 percent of the Federal poverty level (FPL).2 The State uses 1902(r)(2) less restrictive income and resource methodologies for this group. Spousal impoverishment protections apply to community spouses.

  • Florida has a Medically Needy program for the aged, blind, and disabled, but nursing home care is not a covered service for the medically needy. In accordance with federal law, categorically eligible individuals in need of nursing home care--whose income exceeds the special income standard but is insufficient to cover the cost of care--may place income in excess of the special income level in a Qualified Income Trust, known as a Miller Trust, and receive Medicaid coverage for nursing home care and other Medicaid state plan services.

  • The monthly personal needs allowance (PNA) is $35 for individuals and $70 for couples. Persons who lose their federal SSI monthly payment upon entering a nursing home receive a federal PNA of $30. For these individuals, the state provides a supplement of $5 per month.

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