Nebraska Medicare assistance program options

As a Medicare beneficiary, where you live – meaning your state of residence – can have a significant impact on the care that you receive and how you pay for that care during your “golden years.” This page explains how Nebraska’s regulations and policies are likely to affect your bottom line.

Asset limits: Nebraska uses the federal asset limits for SLMB and QI – which are $9,090 if single and $13,630 if married.[/hio_question]

Nebraska’s Medicaid spend-down for regular Medicaid for the aged, blind and disabled benefits and LTSS

Applicants who are over-income for Medicaid benefits for the aged, blind and disabled in Nebraska can enroll in the Medicaid spend-down, which allows enrollees to subtract incurred medical expenses from their income that is counted toward the Medicaid income limit.

When an applicant is approved for the spend-down, Medicaid calculates the portion of their monthly income above the program’s income limit – which is known as “excess income.” Enrollees activate their spend-down benefits by submitting medical bills equal to this amount. Spend-down benefits are usually approved in one month increments, with submission of additional medical expenses required for additional coverage.

An applicant’s excess income is reduced by what they pay for health insurance premiums (such as Medicare Part B or Medigap).

The spend-down in Nebraska covers Long Term Services and Supports (LTSS).

Income eligibility: The income limit is $392 a month for both one and two person households (but this limit increases by $91 a month for each additional household member).

Asset limits: The asset limit is $4,000 if single and $6,000 if married.

Federal assistance with prescription drug costs in Nebraska

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.

How does Nebraska regulate long-term services and supports (LTSS)?

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 living at home received some assistance with LTSS in 2015, and the portion of seniors needing those services will keep increasing 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.

Applicants who are seeking Medicaid long-term care benefits have to complete an assessment.

Medicaid nursing home coverage

Income limits: The income limit is $1,215 a month if single and $1,643 a month if married. If only one spouse needs Medicaid, the income limit for single applicants is used (and usually only the applicant’s income is counted).

However, nursing home enrollees are not allowed to keep all of their income up to this limit. Enrollees must pay nearly all their income each month toward their care, other than a small personal needs allowance (of $60 a month) and money to pay for health insurance premiums (such as Medicare Part B and Medigap).

Assets limits: The asset limit is $4,000 if single and $8,000 for a couple. If only one spouse has Medicaid, the other spouse can 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 LTSS services. Programs that cover this type of care are called Home and Community Based Services (HCBS) waivers. Enrollees continue living in the community, rather than entering a nursing home.

Income limits: The income limit is $1,215 a month for a one person household and $1,643 a month for a two person household.

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

Asset limits: The asset limit is $4,000 for a one person household and $8,000 for a two person household. If only one spouse has Medicaid, the other spouse can keep up to $148,620.

Spousal impoverishment protections in Nebraska

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. (Normally with Medicaid benefits, the income of both spouses is counted – regardless of who is applying.)

If only one spouse has Medicaid, spousal impoverishment rules allow the other spouse to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s income (along with resource and housing allowances). These rules only apply when one spouse needs Medicaid nursing home care or HCBS, and the other spouse doesn’t receive any Medicaid benefits.

In Nebraska in 2022, these spousal impoverishment 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 Nebraska

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.

Nebraska requires applicants for Medicaid LTSS to have a home equity interest of $688,000 or less.

Penalties for transferring assets in Nebraska

Because long-term care is expensive, individuals can have an incentive to give away or transfer assets so they qualify for Medicaid. To curb these asset transfers, federal law requires states to penalize applicants for Medicaid nursing home care who have given away or transferred assets for less than their value. States can choose to also have a penalty period for HCBS. Medicaid will not pay for LTSS during this period.

Nebraska has chosen to have an asset transfer penalty for nursing home care and HCBS. This penalty is based on a 60 month lookback period, and is calculated by dividing the amount of money transferred or given away during that period by the monthly cost of nursing home care.

Estate recovery in Nebraska

A state’s Medicaid agency is required to recover what it paid for long-term care related costs while a beneficiary was 55 or older. The law allows states to also pursue estate recovery against enrollees who did not receive LTSS. This is called estate recovery.

Nebraska has chosen to recover the cost of all Medicaid benefits received beginning at the age of 55. This means the state pursues estate recovery against enrollees in that age group who received Medicaid coverage for services like primary care or hospitalizations. And under the state’s current rules, Medicaid expansion enrollees who are 55 or older will also be subject to Medicaid estate recovery when they pass away (Medicaid expansion takes effect in Nebraska in October 2020). Nebraska will also recover from the estates of younger enrollees who were institutionalized.

When Medicaid coverage was administered by a Managed Care Organization (MCO) (i.e., a private insurer with which the state contracts to administer Medicaid coverage), the state will attempt to recover what it paid the MCO. This means the estate recovery amount could be more (or less) than the actual cost of Medicaid services received. As a result, estates of enrollees who use little care may be hit with large estate recovery charges.

Nebraska may choose to not pursue estate recovery from enrollees who are survived by their spouse or a child who is under 21 or disabled. The state may also grant a hardship exemption from estate recovery for certain enrollees based on their specific situation.