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


  • Three groups are financially eligible for waiver services:

    • Group A includes individuals who are receiving SSI, and those who have incomes no higher than the SSI/SSP level.

    • Group B includes persons with incomes up to the special income standard of 300 percent of SSI, which $1656.

    • Group C includes individuals with incomes up to 88 percent of the Federal poverty level (FPL).4 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 HCBS waiver services are not covered 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 waiver services and other Medicaid state plan services.

4. Due to state budget shortfalls, the income eligibility criteria was reduced in April 2002 from 90 percent to 88 percent of FPL (from $662 to $651), which resulted in a loss of Medicaid eligibility for an estimated 5,000 people in Florida.

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