Medicare beneficiaries increasingly rely on long-term services and supports (LTSS) – or long-term care – which is mostly not covered by Medicare. In fact, 20% of Medicare beneficiaries who lived at home received some assistance with LTSS in 2015, and even more enrollees are expected to need these services as the population ages. Medicaid fills the gap in Medicare coverage for long-term care, but its complex eligibility rules can make qualifying for benefits difficult. What’s more – eligibility rules vary significantly from state to state.
Idaho uses a “special income limit” to determine eligibility for Medicaid nursing home benefits and Home and Community Based Services (HCBS). This limit is 300% of the Supplemental Security Income (SSI) payment amount.
Medicaid nursing home coverage
Income limits: The income limit is $2,762 a month if single and $5,504 a month if married (and both spouses are applying).
When only one spouse needs Medicaid, the applicant for single applicants is used – and often only the applying spouse’s income is counted.
Although the income limit is $2,762 a month (if single), nursing home enrollees can’t keep all of their income up to this limit. Instead, they have to pay all but a small portion of it toward their care, although they can keep a small personal needs allowance (of $40 each month) and money to pay for health insurance premiums (such as Medicare Part B and Medigap).
Assets limits: The asset limit is $2,000 if single and $3,000 if married (and both spouses are applying).
Spousal impoverishment rules allow spouses who don’t have Medicaid to keep up to $148,620.
Certain assets are never counted, including many household effects, family heirlooms, certain prepaid burial arrangements, and one car.
Home and Community Based Services (HCBS) waivers
Every state’s Medicaid program covers community-based long-term care services. Medicaid programs can offer these services called Home and Community Based Services (HCBS) waivers, and can offer this care in an enrollee’s home, adult day care center or another community setting. Enrollees don’t have to enter a nursing home to receive these services.
HCBS waiver programs in Idaho include the:
- Aging and Disabled (A&D) Waiver
- Developmentally Disabled (DD) Waiver
Some HCBS waiver programs in Idaho have waiting lists. New applicants aren’t allowed once the enrollment cap is reached.
Income limits: The income limit is $2,762 a month if single and $5,504 a month if married (and both spouses are applying).
Asset limits: The asset limit is $2,000 if single and $3,000 if married (and both spouses are applying). Spousal impoverishment rules allow spouses who aren’t applying to keep up to $148,620.
Qualifying for Medicaid LTSS with income above the eligibility limit in Idaho
In Idaho, applicants normally are only eligible for nursing home care or HCBS if their income is less than $2762 a month (if single). However, an applicant who has a higher income can qualify for long-term care benefits by depositing income into a Qualified Income Trust, which is also called a “Miller Trust.”
Nursing home enrollees must pay nearly all of this income toward their care from the Miller Trust. However, HCBS recipients can keep a personal needs allowance to pay for certain health and living expenses.
Spousal impoverishment protections in Idaho
Eligibility rules for Medicaid LTSS programs differ from other Medicaid benefits when only one spouse is applying. When this occurs, only the applying spouse’s income is counted. With other Medicaid benefits, income received by both spouses is counted – regardless of who is applying.
Spousal impoverishment rules allow spouses of Medicaid LTSS recipients to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s monthly income.
In Idaho in 2022, these spousal impoverishment rules allow community spouses to keep:
Permitted home value in Idaho
Federal law requires states to restrict eligibility for nursing home Medicaid and HCBS to applicants with a home equity interest below a certain dollar amount. States set these home equity levels based on a federal minimum of $688,000 and maximum of $1,033,000 in 2023.
In Idaho, applicants for Medicaid nursing home benefits or HCBS can’t have a home equity interest greater than $750,000.
Penalties for transferring assets in Idaho
Because long-term care is expensive, individuals can have an incentive to give away or transfer assets to others so they can become eligible for Medicaid LTSS benefits. To curb this incentive, federal law requires states to have a penalty period for Medicaid LTSS applicants who give away or transfer assets for less than their value. States can also have an asset transfer penalty for HCBS. Medicaid will not pay for LTSS during this penalty period.
Idaho has chosen to have an asset transfer penalty for nursing home care and HCBS. This penalty is based on a 5-year lookback period during which time asset transfers and gifts are prohibited. The penalty is calculated by dividing the value of what was transferred or given away during the lookback by the cost of private pay nursing home care (and this was $9,943.51 per month in 2023).
Estate recovery in Idaho
State Medicaid agencies have to attempt to recover what they paid for long-term care related benefits enrollees receive while 55 or older. The law also allows states to recover the cost of all other Medicaid benefits. This is called estate recovery.
Idaho has chosen to only pursue estate recovery against enrollees who receive long-term care beginning at age 55. (The state also recovers from a small number of younger enrollees who were permanently institutionalized.)
The state will not recover from enrollees who are survived by their spouse or a child who is under 21, blind, or disabled.
Idaho has an unusually aggressive estate recovery program. Estate recovery rules in every state allow costs to be recovered from recipients of Medicaid services, but Idaho also allows estate recoveries from spouses of Medicaid enrollees – even if the spouse didn’t receive Medicaid.
