Medicaid is a health care program for low-income persons of all ages. While this program provides health coverage for diverse groups of Missouri residents, this page is focused on long-term care Medicaid eligibility for senior Missouri residents who are 65 years of age and over. In addition to nursing home care and assisted living services, MO Medicaid pays for many non-medical support services that help frail seniors remain living in their homes. There are three categories of Medicaid long-term care programs for which Missouri seniors may be eligible.
1) Institutional / Nursing Home Medicaid – An entitlement; anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; the number of participant slots are limited and waiting lists may exist. Intended to delay the need for nursing home admission, services and supports are provided at home, adult day care, or in assisted living. More on Waivers.
3) Regular Medicaid / MO HealthNet for the Aged, Blind, and Disabled (MHABD) – An entitlement; meeting the eligibility requirements ensures one will receive benefits. Various long-term care services, such as personal care assistance or adult day care, may be available.
Medicaid in Missouri is called MO HealthNet. While this program is jointly funded by the state and federal government, it is administered by the state under federally set parameters. The Missouri Department of Social Services is the administering agency.
The American Council on Aging now offers a free, quick and easy Medicaid Eligibility Test for seniors.
The three categories of Medicaid long-term care programs have varying medical and financial eligibility criteria. Further complicating financial eligibility is that the criteria change annually, vary with marital status, and that Missouri offers multiple pathways towards eligibility.
Simplified Eligibility Criteria: Single Nursing Home Applicant
Missouri seniors must be financially and medically eligible for long-term care Medicaid. In 2024, a single Nursing Home Medicaid applicant must meet the following criteria: 1) All available income, with just a few exceptions, must go to the nursing home 2) Assets under $5,909.25 3) Require a Nursing Home Level of Care.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from a MO HealthNet program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Missouri. More.
| 2024 Missouri Medicaid (MO HealthNet) Long-Term Care Eligibility for Seniors | |||||||||
| Type of Medicaid | Single | Married (both spouses applying) | Married (one spouse applying) | ||||||
| Income Limit | Asset Limit | Level of Care Required | Income Limit | Asset Limit | Level of Care Required | Income Limit | Asset Limit | Level of Care Required | |
| Institutional / Nursing Home Medicaid | All available income must be paid towards care* | $5,909.25 | Nursing Home | All available income must be paid towards care* | $11,818.45 | Nursing Home | All available income must be paid towards care* | $5,909.25 for applicant & $154,140 for non-applicant | Nursing Home |
| Medicaid Waivers / Home and Community Based Services | Structured Family Caregiving Waiver ($1,067 / month – eff. 4/1/24 – 3/31/25) Aged & Disabled Waiver ($1,649 / month – eff. 1/1/24-12/31/24)† | $5,909.25 | Nursing Home | Structured Family Caregiving Waiver ($1,067 / month per spouse – eff. 4/1/24 – 3/31/25) Aged & Disabled Waiver ($1,649 / month per spouse – eff. 1/1/24-12/31/24)† | $11,818.45 | Nursing Home | Structured Family Caregiving Waiver ($1,067 / month for applicant – eff. 4/1/24 – 3/31/25) Aged & Disabled Waiver ($1,649 / month for applicant – eff. 1/1/24-12/31/24)† | $5,909.25 for applicant & $154,140 for non-applicant | Nursing Home |
| Regular Medicaid / MO HealthNet for the Aged, Blind, and Disabled | $1,067 / month (eff. 4/1/24 -3/31/25)‡ | $5,909.25 | Help with ADLs | $1,448 / month (eff. 4/1/24 -3/31/25)‡ | $11,818.45 | Help with ADLs | $1,448 / month (eff. 4/1/24 -3/31/25)‡ | $11,818.45 | Help with ADLs |
*With the exception of a Personal Needs Allowance of $50 / month, Medicare premiums, and potentially a Needs Allowance for a non-applicant spouse, all of a beneficiary’s monthly income must go towards nursing home costs. This is called a Patient Liability.
†Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level.
‡These limits are only relevant for persons who are aged and disabled. For persons who are blind, the income limit is $1,255 / month for a single applicant and $1,704 / month for a married couple.
Countable vs. Non-Countable Income
Nearly any income from any source that a Medicaid applicant receives is counted towards Medicaid’s income limit. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in MO, the Aid & Attendance and Housebound Allowances, which are above and beyond the Basic VA Pension, do not count as income.
Treatment of Income for a Couple
When only one spouse of a married couple applies for Nursing Home Medicaid or a HCBS Medicaid Waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and does not impact the income eligibility of their spouse. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse. The MMMNA is a Spousal Impoverishment Provision and is the minimum amount of monthly income a non-applicant spouse is said to require to avoid spousal impoverishment.
The MMMNA is $2,555 (eff. 7/1/24 – 6/30/25). If a non-applicant’s monthly income is under $2,555, income can be transferred to them from their applicant spouse, bringing their income up to this level. In Missouri, a non-applicant spouse can further increase their Spousal Income Allowance if their housing and utility costs exceed a “shelter standard” of $766.50 / month (eff. 7/1/24 – 6/30/25). However, in 2024, a Spousal Income Allowance cannot push a non-applicant’s total monthly income over $3,854. This is the Maximum Monthly Maintenance Needs Allowance. More on how this allowance is calculated.
Income is counted differently when only one spouse applies for Regular Medicaid / MO HealthNet for the Aged, Blind, and Disabled; the income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. Furthermore, there is no Monthly Maintenance Needs Allowance for a non-applicant spouse. More about how Medicaid counts income.
Countable vs. Non-Countable Assets
The value of countable assets are calculated towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. In MO, IRA’s / 401K’s are also counted. There are also many assets that Medicaid considers to be exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts (also called personal funeral trust accounts) up to $9,999, and generally one’s primary home.
Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. However, Spousal Impoverishment Rules allow the non-applicant spouse of a Medicaid nursing home or Waiver applicant a Community Spouse Resource Allowance (CSRA). In 2024, the community spouse (the non-applicant spouse) can retain 50% of the couples’ assets, up to a maximum of $154,140. If the non-applicant’s half of the assets is under $30,828, 100% of the assets, up to $30,828 can be retained by the non-applicant. There is no CSRA for Regular Medicaid.
Medicaid’s Look-Back Rule
Missouri has a 5-year Medicaid Look-Back Period for Nursing Home Medicaid and Medicaid Waivers that immediately precedes one’s application date. This is a period in which Medicaid checks to ensure no assets were gifted or sold under fair market value. If this has been done, Medicaid assumes it was to meet Medicaid’s asset limit. Violating the Look-Back Period results in a Penalty Period of Medicaid ineligibility. There is no Look-Back Period for Regular Medicaid applicants.
The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, this rule allows one to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s 5-year Look-Back Period.
For home exemption, the Medicaid applicant or their spouse must live in the home. If there is no spouse in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of the home’s equity that is owned by the applicant. Furthermore, if there is no spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. For Regular Medicaid, there is no home equity interest limit. Other exemptions exist.
While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, Missouri’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance
An applicant must have a medical need for Medicaid long-term care. For Nursing Home Medicaid and HCBS Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Some program benefits, such as home modifications, may have additional eligibility criteria. For example, for a Waiver to cover the cost of home modifications, an inability to safely live independently without modifying the home might be required. For long-term care services via the regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NFLOC is not necessarily required.
For Missouri elderly residents, aged 65 and over, who do not meet the financial eligibility requirements above, there are other ways to qualify for long-term care Medicaid.
1) Medically Needy Pathway – Missouri has a Spend Down Program for seniors applying for Regular Medicaid / MO HealthNet for the Aged, Blind, and Disabled who have income over the Medicaid limit. Persons can become income-eligible for Medicaid services by “spending down” their income on medical expenses. This includes prescription drugs, dental and eye care services, durable medical equipment, home nursing services, and hospital bills. If a Medicaid applicant is married, medical bills accrued by one’s spouse can also be used. Effective 4/1/24 – 3/31/25, the Medically Needy Income Limit (MNIL) for persons who are aged and disabled is $1,067 / month for an individual and $1,448 / month for a couple. For persons, who are blind, the MNIL is $1,255 / month for an individual and $1,704 for a couple. The “spend down” amount, which can be thought of as a deductible, is the difference between one’s monthly income and the MNIL. Once the “spend down” is met, one will be Medicaid eligible for the remainder of the month. The Medically Needy Asset Limit is $5,909.25 for an individual and $11,818.45 for a couple.
2) Qualified Income Trusts (QIT’s) – Also called Miller Trusts, QITs offer a way for seniors over the Medicaid income limit to still become income-eligible for a Medicaid Waiver. Money deposited into an irrevocable QIT does not count towards Medicaid’s income limit. Irrevocable means that once the trust has been established, it cannot be changed or canceled. In basic terms, one’s excess income (over the Medicaid limit) is directly deposited into a trust, in which a trustee is named, giving that individual legal control of trust funds. The money can only be used for very specific purposes. This includes contributing towards the cost of long-term home and community based services, as well as paying for medical expenses and items not covered by MOHealth Net, like wheelchairs. Upon the death of the Medicaid participant, or in the event of Medicaid disenrollment, the remainder of the funds must be paid to the state of Missouri.
3) Asset Spend Down – Persons who have countable assets over MO HealthNet’s asset limit can “spend down” excess assets on non-countable ones and become asset-eligible. Examples include making home modifications (wheelchair ramps, stair lifts, and widening of doorways to allow wheelchair access), vehicle modifications (hand controls and pedal extenders), prepaying funeral and burial expenses, and paying off debt. Remember, assets cannot be gifted or sold under fair market value. Doing so violates the Look-Back Rule and can result in a Penalty Period of Medicaid ineligibility. It is recommended one keep documentation of how assets were spent as proof this rule was not violated.
Our Spend Down Calculator can assist persons in determining if they might have a spend down, and if so, provide an estimate of the amount.
4) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, yet they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid Planning Professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaid Estate Recovery. Connect with a Medicaid Planner.
In addition to paying for nursing home care, MO HealthNet offers the following programs relevant to the elderly that help them to remain living at home or in the community.
1) Aged and Disabled Waiver (ADW) – Provides adult day health care and respite care to help families who wish to care for a loved one at home. These supports are intended to enable persons to maintain full-time employment while still providing care. Supports, such as homemaker services and home delivered meals, are also available to help seniors live independently.
2) Supplemental Nursing Care (SNC) Assistance – This is a cash benefit intended to help persons afford the cost of assisted living residences and residential care facilities. It will not cover the full cost, but can be combined with other sources of income.
3) Home and Community Based Services – The services available under this program are similar to the Aged and Disabled Waiver. However, these services are under the state’s Regular Medicaid program, and therefore, are entitlements. On the downside, the financial eligibility criteria are more restrictive.
4) Consumer Directed State Plan Personal Care – Under MO’s Regular Medicaid program, this program allows family members to be hired as personal care providers and paid by the state.
5) Structured Family Caregiving Waiver (SFCW) – For persons with dementia / Alzheimer’s, this program provides for an adult foster care living situation.
6) Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care services, and Medicare are combined into one program. Additional benefits, such as dental and eye care, may be available.
7) Money Follows the Person (MFP) – Also called Show-Me Home in Missouri. This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.
Missouri seniors can apply for MO HealthNet online at myDSS, over the phone at 855-373-9994, or download and submit a completed application. Seniors must also submit the Supplemental Form. For application assistance, the MO Department of Social Services Family Support Division can be reached at 1-855-373-4636. One’s local Family Support Division Resource Center may also be useful in providing program information and help with applying for benefits. The application process may vary based on the program for which one is applying.
MO HealthNet applicants should be confident that they meet all the eligibility criteria prior to submitting a completed application. If there is any uncertainty as to whether income and / or asset limit(s) are met, or if one is over the limits, Medicaid planning can make the difference between approval and denial of benefits. The Medicaid application process can be confusing and should be taken seriously. Familiarizing oneself with general information about the application process for long-term care Medicaid can be helpful.