Medicare Savings Programs (MSPs) can help Medicare beneficiaries who struggle to afford the cost of Medicare coverage. MSPs pay for Medicare Part B premiums and – in some cases – Part A premiums and Medicare cost sharing.

• 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.

MSP asset limits: Arkansas uses the federal asset limits for QMB, SLMB and QI – which are $9,090 if single and $13,630 if married.

Medicaid for the aged, blind and disabled will pay for Medicare cost sharing, and may also cover some services that Medicare does not. While Medicare covers a great number of services, it doesn’t cover important benefits like vision and dental care. Medicaid for the aged, blind and disabled (ABD) programs cover Medicare cost sharing, and may also cover dental and vision benefits.

In Arkansas, Medicaid ABD covers up to $500 in adult dental benefits each year, but it doesn’t cover dentures or tooth extractions. Most enrollees receive these benefits through one of two dental managed care organizations (MCOs), but the state pays directly for dental benefits received by nursing home Medicare and Program for All-Inclusive Care for the Elderly (PACE) enrollees.

Medicaid also covers one eye exam and pair of regular glasses every 12 months, and may pay for trifocals and progressive lenses in some circumstances. (Medicaid will also pay for a second pair of glasses within a year for diabetic enrollees whose have certain vision changes.)

In Arkansas, eligibility for Medicaid ABD benefits varies based on an applicant’s age:

65 and older – ARSeniors: This program combines QMB and Medicaid ABD benefits for enrollees 65 or older. The income limit is $858.67 a month if single and $1,161.33 a month if married.

Asset limit: The asset limit is $9,090 if single and $13,630 if married. (This is the same resource limit as the MSPs in Arkansas.)

Under 65 – Workers with Disabilities: This program is available to disabled applicants who are under 65. The income limit applies only to unearned income – i.e. Social Security and pensions – and is $841 a month if single and $1,261 a month if married.

Because the income limit applies only to unearned income, enrollees in the Workers with Disabilities program can earn an unlimited amount of employment income.

Asset limit: This program has no asset limit.

Medicaid ‘spend-down’ for regular Medicaid for the aged, blind and disabled benefits in Arkansas

In Arkansas, applicants with incomes higher than the eligibility limit for Medicaid ABD can enroll in the Medicaid spend-down.

This program allows enrollees to subtract medical bills from income that is counted toward the Medicaid eligibility limit. Enrollees activate their coverage by submitting medical bills equal to the amount their income exceeds the spend-down program’s income limit.

Arkansas approves spend-down benefits in three month increments – with additional coverage requiring new medical expenses to be submitted.

Income eligibility: The income limit is $108.33 a month if single and $216.66 a month if married.

Enrollees can lower their excess income if they spend money on work-related expenses (up to $90 a month) and child care (up to $200 a month for children under two or $175 a month for a child over 2 years old.)

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

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.

Medicare beneficiaries increasingly rely on long-term care, and the portion of seniors needing these services will keep rising as the population ages. However, long-term care is mostly not covered by Medicare. While Medicaid fills the gap in Medicare coverage for long-term care, its complex eligibility rules can make qualifying for benefits difficult. What’s more – eligibility rules vary significantly from state to state.

Medicaid nursing home coverage

Many Americans used to receive long-term care in nursing homes. Today, many people prefer to receive LTSS in their homes. But some enrollees have medical conditions or living situations that make nursing home care a better choice.

Income limits: The income limit is $2,742 a month for each spouse applying. When only one spouse needs Medicaid, only the applicant’s income is counted.

Despite this income limit, nursing home enrollees can keep just $40 each month as a personal needs allowance as well as money to pay for health insurance premiums (such as Medicare Part B and Medigap).

Asset limits: The asset limit is $2,000 for one applicant, and $3,000 for a couple. Assets such as a car, many household furnishings, family heirlooms, and some prepaid burial arrangements don’t count toward the asset limit.

If only one spouse needs Medicaid, spousal impoverishment rules allow the other spouse to keep up to $148,620.

In Arkansas, applicants also can’t have more than $688,000 in home equity.

Home and Community Based Waiver (HCBS) services

Home and Community Based Services (HCBS) waivers are Medicaid programs that cover LTSS for beneficiaries who can live in the community. These services can allow enrollees to avoid entering a nursing home.

Income eligibility: The income limit is $2,742 a month for each spouse applying.

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

Asset limits: The asset limit is $2,000 for one applicant, and $3,000 for a couple. If only one spouse needs Medicaid, spousal impoverishment rules allow the other spouse to keep up to $148,620.

The ARChoices in Homecare program is one of Arkansas’ HCBS waivers for seniors and individuals with disabilities. This program offers many services including attendant care, home-delivered meals, adult day services, facility-based respite care, in-home respite care, and environmental modifications (for home safety). In Arkansas, HCBS enrollees must need a nursing home level of care.

HCBS recipients are not allowed to have more than $688,000 in home equity.

Spousal impoverishment protections in Arkansas

Eligibility rules for Medicaid LTSS programs differ from other Medicaid benefits. When only one spouse is applying, only the applying spouse’s income is counted. This is a different approach than used for other Medicaid benefits, which considers the income of both spouses regardless of who is applying.

Spousal impoverishment rules allow the non-applying or “community spouse” to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid-eligible spouse’s monthly income.

In Arkansas in 2022, these spousal impoverishment rules allow 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.

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

Arkansas does not allow applicants to use the Medicaid spend-down to qualify for LTSS benefits. But applicants with incomes above the Medicaid eligibility limit can qualify for nursing home care and HCBS by depositing income into a Qualified Income Trust, which is also called a “Miller Trust.”

Applicants can use a Miller Trust to become eligible for Medicaid LTSS coverage – but not for regular Medicaid ABD.

Permitted home value in Arkansas

States must limit the amount of home equity recipients of Medicaid nursing home benefits or HCBS can have. States set these home equity levels based on a federal minimum of $688,000 and maximum of $1,033,000 in 2023.

Arkansas uses the federal minimum home equity limit – meaning that applicants with more than $688,000 in home equity are not eligible for LTSS programs.

Penalties for transferring assets in Arkansas

Because long-term care is expensive, Medicare beneficiaries may consider giving away or transferring assets so they can qualify for Medicaid long-term care benefits. To discourage this from happening, federal law requires states to have an asset transfer penalty for applicants seeking nursing home care who give away or transfer assets for less than their value. States can also apply a penalty for HCBS. Medicaid will not pay for LTSS during the penalty period.

Arkansas has chosen to have an asset transfer penalty for nursing home benefits and HCBS. This penalty is based on a 60-month lookback period prior to applying for or receiving LTSS benefits when asset transfers and gifts are prohibited.

The length of the penalty period is calculated by dividing the amount transferred or given away by the average cost of nursing home care in Arkansas (which is $7,151 in 2023).

Estate recovery in Arkansas

All state Medicaid programs are required to recover the cost of long-term care and associated medical expenses Medicaid covered while an enrollee was 55 or older. States can choose to also recover the cost of other Medicaid benefits. This is called estate recovery.

Arkansas chooses to recover Medicaid costs only from estates of enrollees who received LTSS beginning at age 55. However, if the state does pursue estate recovery, it may attempt to recover payments for all Medicaid benefits while an enrollee received LTSS.

The state also tries to recover funds from the estates of beneficiaries who were under 55 if they were permanently institutionalized.

When Medicaid coverage was administered by a Managed Care Organization (MCO) (i.e., a private insurer with whom the state contracts to administer Medicaid benefits), the state will attempt to recover what it paid the MCO. That means the estate recovery amount could differ from the actual cost of Medicaid services received.

Arkansas will not pursue estate recovery when a Medicaid beneficiary has a surviving spouse or a child who is under 21 or disabled. The state also will not attempt estate recovery if it would not be cost-effective (e.g. if the recoverable amount is very small).

Arkansas’s State Health Insurance Assistance Program (SHIP)

Free volunteer Medicare counseling is available by calling Arkansas’ State Health Insurance Assistance Program (SHIP) at 800-224-6330.

SHIPs are available to help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. They can also make referrals to local agencies for services like home care and long-term care. This website has the locations of regional SHIP partners in Arkansas.

Elder Law Attorneys

Elder law attorneys are a helpful resource for developing plans for Medicaid long-term care benefits. You can find a local elder attorney through the National Academy of Elder Law Attorneys (NAELA) search feature.

Legal Aid of Arkansas

Low-income Medicare and Medicaid beneficiaries in Arkansas may be able to receive help qualifying for health care benefits or accessing care from Legal Aid of Arkansas. The phone number for Legal Aid’s helpline is 1-800-9 LAW AID (1-800-952-9243).

The Arkansas Department of Human Services (DHS) administers the state’s Medicaid program. You can apply for Medicaid ABD or an MSP by calling 1-800-482-8988 or visiting a local DHS county office. The DHS website also contains printable applications for Medicaid ABD or the MSP, which you can submit by mail.