Medicaid Review

Tip – There are very specific rules to become eligible for Medicaid.

In Idaho, the Idaho Department of Health and Welfare (IDHW) administers the state’s Medicaid program and provides services for nursing home care through the Home and Community Based Services or Aged and Disabled waiver program for qualified individuals who are age 65 or older who need long term care. Medicaid is a means-tested entitlement program. Eligibility for Medicaid is based on the applicant’s medical condition, their assets, and their income. When applying for Medicaid, the IDHW requires proof of citizenship or legal status, residence in Idaho, social security, pensions and other incomes, assets and for couples, proof of marriage.

Medical eligibility. To be eligible for Medicaid, a person age 65 or older must have a medical need. In Idaho, IDHW uses a Uniform Assessment Indicator form to determine whether the candidate meets the medical need requirements. An application for Medicaid will require a Level of Care Verification from a physician or nursing home representative showing that the participant meets the required level of care.

Resource Eligibility. Medicaid strictly limits the assets people may own while accepting benefits.  Generally, the assets that do not count against the beneficiary are the following:

  • The principal residence
  • One car
  • Burial plot/prepaid funeral
  • $2,000 in cash

All other assets count toward the state determined maximum, which in Idaho for a single person is $2,000. Countable assets are bank accounts, CDs, cash, stocks, retirement accounts, second cars, recreational vehicles, camp trailers, and any other items that can be turned into cash.

When there is a community spouse (the spouse still living at home), Idaho has established levels of exempt assets within a range of what’s allowable under federal standards. These exempt assets, called the Community Spouse Resource Allowance (CSRA), will be the amount of money available to a community spouse as a resource allowance when an institutionalized spouse applies for benefits under the Medicaid program. For 2023 the minimum CSRA in Idaho is $29,724 and the maximum CSRA is $148,620. If the couple’s assets are below the minimum CSRA, the community spouse is allowed to keep all the couple’s assets. If the couple’s assets exceed this amount, the community spouse may only keep half of the couple’s countable assets calculated at the time the couple’s resources are assessed up to the maximum Community Spouse Resource Allowance.

When assessing the couple’s resources to determine the resource allowance, the resources are assessed on a snapshot date which is the first day of a continuous period of long-term care that lasts at least 30 consecutive days or the date a physician states that the institutionalized spouse meets the required level of care. Establishing a snapshot date is crucial in protecting the couple’s countable assets for the community spouse.

Once the resource allowance is determined, if the couple’s assets exceed the minimum CSRA, the couple must spend down their countable assets before the institutionalized spouse will qualify for Medicaid benefits. The issue for the elder law attorney is to educate and guide the couple in spending down their countable assets. To spend down assets a couple may convert their countable assets into noncountable assets. For example, the couple may purchase a new car or pay down a mortgage.

Income eligibility. For 2023, a candidate for Medicaid cannot have more the $2,742 per month in income in order to qualify for Medicaid. Income is anything that can be used to meet needs for food or shelter. Income is cash, wages, pensions, in-kind payments, inheritances, gifts, awards, rent, dividends, interest, or royalties the participant receives during a month. If a potential participant has too much income, they may still qualify for Medicaid by creating a Miller Trust. The Medicaid applicant may divert the excess income into a Miller Trust account bringing their income below the income cap. The diverted income is used to pay for the Medicaid applicant’s monthly care costs.

View our “Senior’s Guide to a Well-Planned Future” on our website! Packer Elder Care Law – with you for life!

Tom Packer is an Elder Law Attorney serving all Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

June 2023