Eligibility For Medicaid
How To Qualify
To be eligible for institutional Medicaid in a nursing home or home and community based waiver services program, an individual must meet three key requirements:
- A medical need test,
- An income test, and
- An asset test.
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First Requirement: Medical Need Test
To meet the medical need test, an applicant must be assessed and certified by licensed nurses and social workers, and require nursing care at either the Intermediate or Skilled nursing level. Certification of level of care is usually done by the nursing home where the patient is residing, or by the Community Long Term Care division of the SC Department of Health and Human Services.
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If the applicant meets the required level of care, a certification letter is issued by the nursing facility or Community Long Term Care office and sent to the SCDHHS eligibility case manager. If the applicant does not initially meet the medical level of care, he or she will not qualify for nursing home Medicaid eligibility, at that time. If, however, there is a subsequent decline in the applicant’s health, he or she may be re-assessed and may then meet the nursing level.
Second Requirement: Income Test
To meet the income test, an individual’s gross monthly income must be within the Institutional Medicaid limit, which is $2829.00 for 2024. This limit usually increases annually, if there is a cost of living allowance for federal pension recipients. If an applicant is married and the spouse is living in the home, the spouse’s income is not counted in the gross income test but it is factored into any cost(s) the applicant may owe for nursing home services. The in-home or community spouse is allowed an allocation of the institutionalized spouse’s income in the cost of care determination. The Spousal Allocation for 2024 is $3,853.50.
Should an applicant’s income exceed the income limit, the applicant may still qualify for Medicaid by establishing a Qualified Income Trust; sometimes referred to as a “Miller” trust. Individuals eligible under Income Trust requirements must meet all other eligibility criteria except for the income limit. If needed, PalmettoMEC will help the family understand and complete the Income Trust documents.
Third Requirement: Asset or Resource Test
The third requirement that must be met is the asset or resource test. An applicant’s assets must be within Medicaid’s resource limit if he or she is to qualify for nursing home assistance or in-home care. The 2024 asset limit for an single individual is $2,000.00. If the applicant is married, the assets of both the applicant, and the in-home or community spouse are considered together. The allowed limit for the in-home spouse is $66,480.00 for 2024. Therefore, when counted together, the applicant's and spouse’s assets must be less than $68,480.00 for the nursing home applicant to qualify for Medicaid.
PalmettoMEC specializes in strategies to help families effectively manage and allocate their finances so that the assets are preserved, or used to the family's advantage. When our suggestions are used, the applicant may still meet South Carolina’s Medicaid eligibility requirements.