Qualifying for Medicaid

Do I Qualify for Medicaid

We are often asked what is required in order to qualify for institutional Medicaid (where the applicant resides in a nursing home or assisted living facility). Quite simply, an applicant must meet certain criteria established by Medicaid for income and assets as set forth under New Jersey's administrative regulations. They must also be medically qualified for institutional care.

What is the Income Test?

In New Jersey, the income cap for an individual applying for Medicaid changes annually. If an applicant exceeds that income level, but requires institutional care, the applicant will still qualify for Medicaid, but a Qualified Income Trust must be set up for the excess monies. This Trust is called a Miller Trust.

What is the Asset Test?

During the Medicaid process, local officials look at the applicant and his or her spouse's assets. A single person residing in a nursing home must have less than $2,000 in resources. For couples where both parties are in a nursing home, the total resources cannot exceed $3,000. If one spouse is in a nursing home and the other spouse resides in the community, there is a community resource allowance that the parties cannot exceed. The community spouse can only retain one half of the assets owed at the time the Medicaid application is made. The other one half must be spent down before the ill spouse will be qualified for Medicaid.

What is the lookback period?

A history of the applicant's financial status will also be reviewed as part of the Medicaid application process. You will be requested to provide five years of financial information if you are an individual. If you have transferred assets into a trust, the lookback period is also five years. If any transfer of assets is made during the lookback period, a penalty will be assessed against the applicant effective from the application date. That penalty means that Medicaid will not pay until the penalty period expires.