Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program (MSP). In Oklahoma, these programs pay for Medicare Part B premiums, Medicare Part A and B cost-sharing, and – in some cases – Part A premiums.

• Qualified Medicare Beneficiary (QMB):  The income limit is $1,235 a month if single and $1,663 a month if married. QMB pays for Part A and B cost sharing, Part B premiums, and – if a beneficiary owes them – it also pays their Part A premiums.
• Specified Low Income Medicare Beneficiary (SLMB):  The income limit is from QMB levels up to $1,478 a month if single and $1,992 a month if married. SLMB pays for Part B premiums.
• Qualified Individuals (QI): The income limit is from SLMB levels up to $1,660 a month if single and $2,239 a month if married. QI pays for Part B premiums.

Medicare covers a great number of services – including hospitalization, physician services, and prescription drugs – but Original Medicare doesn’t cover important services like vision and dental benefits. Medicare can also leave its beneficiaries with large cost sharing expenses. Some beneficiaries – those whose incomes make them eligible for Medicaid – can receive coverage for additional services through Medicaid for the aged, blind and disabled (ABD).

In Oklahoma, Medicaid ABD only covers emergency dental extractions for adults. This means Medicaid will not pay for routine dental services. The Oklahoma Dental Association has a list of low-cost dental clinics in Oklahoma.

Medicaid ABD also generally does not cover routine vision care or eyeglasses in Oklahoma. This means the principal benefit Medicaid offers (besides long-term care coverage) is payment for Medicare cost sharing expenses. In some states, Medicaid also covers home health care and medical supplies that Medicare doesn’t pay for.

Income eligibility: The income limit is $1,215 a month if single and $1,643 a month if married.

Asset limits: The asset limit is $2,000 if single and $3,000 if married.

Oklahoma does not have a Medicaid spend-down program, which allows individuals who are over-income to subtract medical expenses from income that is counted toward the eligibility limit. As a result, applicants are not able to qualify for Medicaid ABD if their incomes are higher than the limit for that program.

However, applicants with incomes too high to qualify for Medicaid long-term care benefits can become eligible for those services by depositing income into a Miller Trust.

Medicare beneficiaries who also have Medicaid, an MSP, or Supplemental Security Income (SSI) will receive Extra Help. This program lowers Medicare Part D prescription drug costs. When beneficiaries apply for this program themselves, the income limit is $1,843 a month for singles and $2,485 a month for couples. The asset limit is $16,660 for individuals and $33,240 for spouses.

Long-term care is an increasingly needed benefit in the U.S. given the aging population, but it is generally not covered under Medicare. However, Medicaid does cover long-term services and supports (LTSS) for people who meet eligibility requirements.

Medicaid nursing home coverage in Oklahoma

In past decades, most Americans received long-term care in nursing homes. Even though many beneficiaries prefer to receive this care at home, their medical conditions, living situation or finances can make nursing home care a better option. Medicaid covers nursing home benefits for an unlimited number of enrollees in each state.

Income limits: The income limit is $2,742 a month if single and $5,484 a month if married (and both spouses are applying).

However, this income limit doesn’t mean an applicant can keep all of this income up to the limit. Nursing home enrollees must pay nearly their entire income toward their care, other than a small personal needs allowance (of $75 a month) and the cost of health insurance premiums (such as Medicare Part B and Medigap).

When only one spouse needs Medicaid, the income limit for single applicants is used – and only the applicant’s income is counted.

Assets limits: The asset limit is $2,000 per applicant. If only one spouse needs Medicaid, federal rules allow the other spouse to keep up to $148,620.

Certain assets are never counted, including many household effects, family heirlooms, certain prepaid burial arrangements, and one car. Nursing home enrollees can’t have more than $688,000 in home equity.

Home and Community Based Services (HCBS) waivers

Every state’s Medicaid program pays for community based long-term care, which is provided in an enrollee’s home, adult day care center, assisted living facility, or another community location. Programs that cover this form of long-term care are called Home and Community Based Services (HCBS) waivers.

States do not have to cover HCBS benefits, but every state has chosen to cover this service. However, because HCBS benefits are expensive enough to impact state budgets, many states use waiting lists for these programs. This could mean an applicant has to receive care in a nursing home while waiting for a spot in an HCBS program.

Income limits: The income limit is $2,742 a month if single and $5,484 a month if married (and both spouses are applying).

When only one spouse needs Medicaid, the income limit for single applicants is used – and usually only the applicant’s income is counted.

Assets limits: The asset limit is $2,000 per applicant. If only one spouse needs Medicaid, federal spousal impoverishment rules allow the other spouse to keep up to $148,620. HCBS enrollees are also not allowed to have more than $688,000 in home equity.

Qualifying for Medicaid LTSS with income above the eligibility limit in Oklahoma

Oklahoma does not allow individuals with incomes above the eligibility limit for Medicaid long-term care to pay the income they have toward their care and have Medicaid pay the rest, and is known as an “income cap state.”

But if their income is less than the cost of nursing home care ($189.24 per day in 2023), they can become eligible for Medicaid nursing home or HCBS benefits by depositing income into a Qualified Income Trust, which is also called a “Miller Trust.”

Income is not counted toward the Medicaid eligibility limit if it is placed in the trust each month.

Spousal impoverishment rules in Oklahoma

Eligibility rules for Medicaid long-term care benefits differ from other Medicaid programs when only one spouse is applying. When this occurs, only the applying spouse’s income is counted. With other Medicaid benefits, the income of both spouses is counted – regardless of who is applying.

Spousal impoverishment rules allow the spouses of Medicaid LTSS recipients (i.e., the non-applying spouses) to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s monthly income, along with resource and housing allowances. These rules apply when one spouse is receiving Medicaid coverage for LTSS, and the other spouse doesn’t have Medicaid.

In Oklahoma in 2022, these rules allowed “community spouses” to keep:

• An MMMNA that is between $2,288.75 and $3,435 per month.
• A Community Spouse Resource Allowance (CSRA) that is between $27,480 and $137,400.
• A housing allowance of up to $686.63 a month.

Medicaid home equity limit in Oklahoma

Federal law requires states to limit eligibility for Medicaid nursing home and HCBS to applicants with a home equity interest below a specific dollar amount. States set these home equity levels based on a federal minimum of $688,000 and maximum of $1,033,000 in 2023.

Oklahoma uses the federal minimum home equity limit – meaning applicants with more than $688,000 in home equity are not eligible for Medicaid nursing home care or HCBS.

Penalties for transferring assets in Oklahoma

Because long-term care is expensive, individuals can have an incentive to give away or transfer assets to make themselves eligible for Medicaid nursing home or HCBS benefits. To curb these asset transfers, federal law requires states to have a penalty period for nursing home applicants who give away or transfer assets for below their value. States can also have a penalty period for HCBS. Medicaid will not pay for LTSS during this period.

Oklahoma has an asset transfer penalty for both nursing home care and HCBS. This penalty is based on a 60-month lookback period. The penalty period is calculated by dividing the value of asset transfers and gifts made during the lookback period by the cost of nursing home care (which is about $189 per day in 2023).

Estate recovery in Oklahoma

A state’s Medicaid agency is required to recover what it paid for LTSS and related medical costs beginning at the age of 55. States have the option to also recover costs for enrollees in this age group that are unrelated to LTSS, and to recover from enrollees who did not receive LTSS.

Oklahoma has chosen to recover what it paid for all Medicaid benefits beginning at the age of 55.

When Medicaid coverage was administered by a Managed Care Organization (MCO), the state will attempt to recover what it paid the MCO. That means the estate recovery amount could be more (or less) than the actual cost of Medicaid services received.

Oklahoma will grant an exemption to estate recovery in cases where recovering from an estate would cause undue hardship to the inheritor.

Senior Health Insurance Counseling Program (SHIP)

Free volunteer Medicare counseling is available by contacting the Senior Health Insurance Counseling Program (SHIP). You can reach this program by calling 800-763-2828.

The SHIP can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. Counselors may also be able to provide referrals for home care agencies or long-term care services. This website has more information about the SHIP in Oklahoma.

Elder law attorneys

You can also hire an elder law attorney to help you plan for Medicaid long-term care benefits. Use this search feature from the National Academy of Elder Law Attorneys (NAELA) to locate an elder attorney in your area.

Oklahoma’s Medicaid program is administered by the Oklahoma Health Care Authority (OHCA). You can apply for Medicaid or an MSP using this website or by visiting a local county Department of Human Services (DHS) office.

You will be interviewed and undergo a needs assessment if you apply for Medicaid long-term care benefits. But many states no longer require an interview for Medicaid ABD applicants, and they can’t require one for the MSP.