Medicare beneficiaries increasingly rely on long-term services and supports (LTSS) – or long-term care – which is mostly not covered by Medicare. 20% of Medicare beneficiaries who were living at home received some assistance with LTSS in 2015, and even more seniors will need these services as the population ages.
Medicaid fills this 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.
Medicaid long-term care applicants must undergo a level of care assessment.
Medicaid nursing home coverage
Most seniors used to receive long-term care in nursing homes. Today, many receive these services in their homes. But some seniors have medical or living situations that make nursing home care a better choice.
Income limits: There is no income limit for nursing home benefits in Kansas, but nursing home residents must pay all their income above $62 a month toward their care.
Assets limits: The asset limit is $2,000 if single and $3,000 if married and both spouses are applying. If only one spouse needs Medicaid, the other spouse can keep up to $148,620. (Note that certain assets like a car and many household furnishings do not count against this limit.)
Home and Community Based Services (HCBS)
Medicaid programs that cover long-term care in the community are called Home and Community Based Services (HCBS) waivers. Enrollees continue living in the community, rather than entering a nursing home.
Income limits: There is no income limit for HCBS services in Kansas, but enrollees pay all their income above $2,742 a month toward their care.
Asset limits: The asset limit is $2,000 if single and $3,000 if married (and both spouses are applying). If only one spouse needs Medicaid, the other spouse can keep up to $148,620.
Spousal impoverishment protections in Kansas
Spousal impoverishment rules enable the spouse (the “community spouse”) not receiving Medicaid LTSS to afford living expenses and home maintenance costs.
In Kansas in 2022, these spousal impoverishment rules allowed community spouses to keep:
Permitted home equity in Kansas
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.
Kansas uses the most restrictive home equity limit allowed – meaning that applicants for nursing home care or HCBS must have less than $688,000 in home equity.
Penalties for transferring assets in Kansas
Because long-term care is expensive, individuals sometimes have an incentive to give away or transfer assets to others to become eligible for Medicaid LTSS benefits. As a deterrent, states — in accordance with federal law — have a penalty period during which Medicaid will not pay for nursing home care for applicants who have transferred assets. States can also have a penalty period for HCBS.
Kansas chooses to have an asset transfer penalty for nursing home care and HCBS. This penalty is based on a 60-month lookback period where asset transfers and gifts are prohibited. The penalty’s length is determined by dividing the amount of money transferred or given away by the monthly cost of nursing home care.
Estate recovery in Kansas
State Medicaid agencies are required to attempt to “claw back” what they paid for long-term care related costs for enrollees who were 55 or older. States have the option of going further – and recovering the cost of all other Medicaid benefits.
Kansas has chosen to pursue estate recovery for all Medicaid benefits received beginning at age 55. The state also recovers from the estates of younger enrollees who were permanently institutionalized.
When a deceased beneficiary’s Medicaid coverage was administered by an insurer, the state will attempt to recover what it paid that insurer. That amount could differ from the actual cost of the Medicaid services received.
Kansas will not pursue estate recovery if an enrollee is survived by children who are under 21, blind or disabled. The state will delay its estate recovery for enrollees who are survived by their spouse, and will file its claim against the spouse’s estate after their death.