When our clients start thinking about Medicaid it is usually because they have an older loved one whose care has become unmanageable for their support system. Sometimes that’s because of a sudden health event, like a bad fall, that substantially increases the level of care required in the blink of an eye. Other times the increase in the need for care is far more gradual. As time passes, your loved one is requiring more and more assistance. It becomes clear that in a few short years the level of care needed will require additional time and medical expertise that simply is not available in the current situation. Usually, by the time the support system admits that the care needed is more than they can provide and starts to meaningfully look for other options, everyone is already at or near their breaking point both financially and emotionally.

It is in that second scenario, where there is a more gradual decline and steadily increasing need for care, that clients usually come to us with questions about Medicaid for Home and Community Based Services. They want to know things like ‘Will Medicaid pay for someone to come in and help us out so that Mom can stay in the house she loves?” Or, “Will Medicaid pay for Assisted Living when it’s no longer safe for Dad to be alone for any length of time?”

The answer to those questions (as with most Medicaid questions) is … it depends on the situation. Medicaid is a need-based program, which means that you should retain an experienced Elder Law attorney to help you understand what you will qualify for, what you need to do to qualify, and how long you can expect everything to take. The purpose of this article is to give you the basis for understanding how the HCBS program (Medicaid for in-home care and assisted living) works. First off, it’s important to understand that HCBS Medicaid is a different program from Medicaid for Long Term Care. If it is already clear that your loved one needs long-term full-time care in a skilled nursing facility, HCBS Medicaid is not the right option. Medicaid for Long Term Care (sometimes called “Institutional” Medicaid) is a different program, with different requirements and a different application process than Medicaid for HCBS.

HCBS, like all other types of Medicaid, has different eligibility requirements in different states. This is because Medicaid is a Federal program, administered by each State individually. Although the requirements are different in each state, all 50 states have strict asset and income limits and an application for any Medicaid program will involve close scrutiny of the applicant’s finances. It’s important to understand the distinction between assets (things like real estate, bank accounts, cash on hand, stocks, bonds, IRA’s, life insurance policies, etc.) and income (meaning monthly Social Security payments, pension payments, weekly or monthly salary payments from full time or part time work, etc.)

The following is a brief explanation of how HCBS Medicaid works in Kansas, and how HCB Medicaid works in Missouri. For whatever reason, the program is called HCBS in Kansas but drops an initial in Missouri, where it is referred to as HCB.

MISSOURI

In Missouri the in-home Medicaid program has an income cap which is adjusted periodically to keep pace with inflation. If an individual’s gross income (meaning total income before taxes, medicare premiums, etc. are deducted) is more than the income cap, the person is not eligible for HCB benefits. This policy applies to single and married applicants. In the case of a married couple, only the gross income of the spouse who is applying is considered. For example, if a husband is applying for benefits Medicaid will not consider his wife’s income when determining whether he qualifies. As of this writing (February 3, 2022), the MO income limit is $1,470.00.

If the applicant’s income is below the income cap, Medicaid will then review the applicant’s assets to determine if the applicant is resource eligible. For a single individual, assets must be below $5,035.00. For a married couple, the resource limit would be determined through a process called “division of assets.” A full explanation of how division of assets works is beyond the scope of this article, but the process involves a formula that calculates a resource limit for the non-applicant spouse based on the total amount of countable assets owned by both spouses.

If the applicant is below the income and asset limit then Missouri Medicaid will pay for care providers to come to the home at no cost.

KANSAS

In Kansas, Medicaid first looks at the assets to determine if the applicant is eligible for the in-home care program (HCBS). For a single person, countable assets must be below $2,000. For a married couple, a division of assets will determine the resource limit.

If the applicant is below the resource limit, Medicaid will determine how much of the applicant’s income must be paid towards the cost of the in-home care services before Medicaid will “close the gap” and pay the rest. This determination works much like an insurance deductible.

The starting point for this calculation is the applicant’s gross income (meaning total income before taxes, medicare premiums, etc. are deducted). Medicaid will then subtract the amount of any health insurance premiums (including Medicare premiums). Then, from that number, Medicaid subtracts the amount which the applicant is permitted to keep to cover their monthly expenses. That amount changes periodically to keep pace with inflation. As of this writing (February 3rd, 2022), that amount is $2,382.00. Any income left over after both those amounts are subtracted would need to be paid towards the cost of the in-home care services. The amount that Medicaid will pay is the difference between that “left over” income (if any), and the cost of the in-home care that the applicant receives.

Additionally, in Kansas, the HCBS program can help applicants in an assisted living facility pay for some of the costs associated with their care. If an individual resides in an assisted living facility that is licensed with Medicaid, that individual can apply for HCBS benefits to get Medicaid to help with the cost of the services provided by the facility. However, the applicant will still be responsible for the “room and board” portion of the monthly bill. There are two components to the cost of assisted living - the services portion (fees for care services that the facility provides to the resident like meals,housekeeping, monitoring medication, etc.,) and the room and board portion (monthly rent that the resident pays to occupy a space in the facility.) HCBS Medicaid in Kansas only covers the monthly “services” portion of the bill for an assisted living facility.