Medicaid Long-Term Care Assessment

Text (operative January 1, 2026): for medically needy and state-only persons, the principal residence is exempt and remains the principal residence during absences with intent to return, while a spouse or dependent…

Text (operative January 1, 2026): on request of either spouse and receipt of documentation, the department must promptly assess and document the total value of the couple's resources, may charge a reasonable fee when…

The spend down of excess income is determined monthly, no one must incur more than one month's spend down before certification, and once incurred Medicare and health insurance cost-sharing and necessary medical services…

Text (operative January 1, 2026): a married individual living separately from a spouse is treated as having transferred for full consideration by an interspousal agreement dividing nonexempt community property into…

Text (operative January 1, 2026): a transfer or gift of income or resources for less than fair market value results in a period of ineligibility for home and facility care applied under federal law, and notes, loans,…

Medically needy persons are entitled to Medi-Cal only in months in which their spend down of excess income is met, and a medically needy person's spend down is monthly income above the maintenance amount set under…

Text (for deaths on or after January 1, 2017): the department claims against a decedent's estate only for services federal law requires it to recover, against the real property of a permanently institutionalized nursing…

Official DHCS instruction to counties: once asset limits return January 1, 2026, counties review transfers only when long-term care is requested;

Official DHCS instruction to counties: effective January 1, 2026 California's minimum monthly maintenance needs allowance is $4,067 and the community spouse resource allowance is $162,660, property limits are $130,000…

Text (operative January 1, 2026): an individual is not eligible for home and facility care if equity in the principal residence, the lesser of assessed or appraised value less encumbrances, exceeds $750,000 as indexed…

Connecticut Medicaid eligibility statute. Subsection (a) bars an institutionalized individual who disposed of property for less than fair market value to establish eligibility, treats such dispositions under 42 USC…

Connecticut rule that a transfer resulting in a penalty period is presumed made to obtain or maintain Medicaid eligibility, rebuttable only by clear and convincing evidence that eligibility was not a basis for it, and…

Connecticut direction that the Commissioner amend the Medicaid state plan to set the minimum community spouse resource allowance at fifty thousand dollars, using the federal definitions of institutionalized and…

Connecticut text making the Department of Social Services the sole agency to determine eligibility and requiring an applicant for Probate Court spousal support under section 45a-655 to send the application to the…

Connecticut limit on state recovery: on and after July 1, 2022, the state may not recover properly paid cash or medical assistance, by lien or by claim against property or an estate, unless federal law or this section…

Connecticut direction that funds from a reverse annuity mortgage or other home equity conversion loan are not treated as income or assets for Medicaid qualification if held in an account with no other funds and not…

Connecticut undue hardship rule: the Commissioner may not impose a transfer penalty that would create undue hardship, which exists when the applicant's life or health would be endangered or the applicant deprived of…

Connecticut notice procedure before a transfer penalty: the Commissioner sends a preliminary notice stating that the applicant may contest the penalty by filing an undue hardship claim or by rebutting the presumption in…

Connecticut text that a transfer resulting in a penalty period creates a debt owed to the nursing home for unpaid care during the penalty, capped at the fair market value transferred, and that the nursing home may sue…

Connecticut definition of applied income: the income a Medicaid recipient must pay the nursing home for care after all appeals, with the amount reflecting any revision of the community spouse minimum monthly needs…

Delaware estate recovery text: for an individual receiving long-term care from the Department, the Department seeks recovery of correctly paid medical assistance from the estate or on sale of liened property, but only…

Delaware text providing that medical assistance may be granted to medically and financially eligible persons under Titles IV-A, IV-E, XVI and XIX of the Social Security Act, federally approved waivers and the rules of…

Official Division of Medicaid and Medical Assistance income limits page; its SSI income standard table shows the 2026 individual SSI standard of $994 and the 250% figure of $2,485 (couple $1,491 and $3,727.50), the…

Delaware definitions for Medicaid liens and estate recovery: the estate subject to recovery means all real property and all personal property that constitutes assets of the individual's estate as described in Chapter 19…

Delaware rule that a person receiving assistance who comes into property or income beyond what was last declared must promptly notify the Department, which then reconsiders eligibility;

Delaware Administrative Code chapter for long-term care Medicaid (DSSM 20000), including categorical eligibility for nursing facility residents with income up to 250% of the SSI standard (20100.2.2), countable…

Official Division of Medicaid and Medical Assistance page on the Nursing Facility Program: an applicant whose gross monthly income exceeds the program income limit of 250% of the SSI standard must establish a Miller…

Delaware rule that for an individual 55 or older receiving long-term care facility services paid by the Department, a lien is created against the individual's real property, but only after notice and an opportunity for…

Delaware direction that the Department establish procedures to waive estate recovery under section 5003 when recovery would work an undue hardship, with a waiver lasting only as long as the hardship continues.

Delaware list of assistance categories; category (3), Medicaid assistance, is medical care, including dental care, for individuals eligible under Titles IV-A, XVI and XIX of the Social Security Act, federally approved…

Official DHCF fact sheet stating that under federal law and the District's municipal regulations DHCF must seek repayment from the estates of deceased beneficiaries who received Medicaid at 55 or older (not for Medicare…

Text of the Public Assistance Act estate claim: at the death of a person who received public assistance in the form of Old Age Assistance or Aid to the Disabled, the District has a preferred claim against the estate not…

Text of the District's Medicaid enabling statute: the Mayor may submit and modify a Title XIX plan for medical assistance, with later subsections recording Council approvals of plan changes (including clarification of…

Official District application (revised December 2016) for Medicaid payment of nursing facility, ICF/DD and home and community-based waiver (EPD and IDD) services.

Official DHCF page (marked updated January 2026). It states that Medicaid long-term care requires District residence, citizenship or eligible immigration status, income at or below 300 percent of the SSI federal benefit…

Official DHCF page: long term care services and supports eligibility combines financial and non-financial criteria (age, disability, citizenship or qualified status, District residency and level of care);

Official Department of Human Services page describing District Medicaid, the DC Healthcare Alliance and DC Healthy Families, the requirement of District residence and financial and non-financial eligibility, retroactive…

Accepting Medicaid creates a debt to AHCA for medical assistance paid after the recipient reached 55, recovered by a statement of claim in probate under part VII of chapter 733;

DCF's income chapter (about 122,000 characters, held as a reference). Its qualified income trust passage requires the individual or legal representative to deposit enough income into the trust account in the month…

Designates the Agency for Health Care Administration as the single state Medicaid agency and makes the Department of Children and Families responsible for Medicaid eligibility determinations, including policy and rules,…

DCF's step list for transfers by applicants for ICP, institutional hospice, HCBS or PACE: identify transfers within the look-back or after, apply the allowable-transfer passages, find fair market value, deduct…

DCF's tables for valuing a life estate or remainder interest in real property: find the factor for the individual's age at last birthday and multiply it by the property's equity value, recomputing at each complete…

Publishes Florida's transfer penalty divisor, the average monthly private pay nursing home rate: $10,438 effective Jan. 1, 2024 ($10,809 from Aug. 1, 2022, with earlier rates back to 2006).

DCF's asset chapter for SSI-related Medicaid (about 197,000 characters, held as a reference).

Subsection (3) covers a person needing a licensed nursing facility, ICF for the developmentally disabled, or state mental hospital whose income does not exceed 300 percent of the SSI income standard and who meets the…

Official eligibility worksheet (revised 12/08) that case managers complete for each transfer: it first screens for exempt transfers (to or for a spouse, blind or disabled son or daughter, or unmarried child under 21;

The spouse of a Medical Assistance recipient is responsible for the recipient's health care costs to the extent able to pay, limited to the amount the Program spent;

COMAR text of Maryland's resource rules for aged, blind and disabled applicants. It defines fair market value, equity value and home property;

COMAR text of Maryland's spousal impoverishment rules. Community spouse income is not deemed to the institutionalized spouse; income is attributed by the name on the payment or the trust terms;

COMAR text of Maryland's transfer penalty. An individual who, or whose spouse, disposes of assets for less than fair market value within the look-back (60 months for disposals on or after February 6, 2006, and for trust…

COMAR text. For trusts established after August 10, 1993 with the individual's assets (by the individual, spouse, or a person or court acting for them, other than by will), regardless of purpose, discretion or…

COMAR text: for a person not institutionalized, eligibility is medically needy when countable income and resources are within the medically needy levels (Schedules MA-1 and MA-2);

COMAR text (Division of State Documents online code). A person institutionalized throughout a month is categorically needy if total income before deductions does not exceed 300 percent of the current SSI payment…

Official Maryland long-term care and waiver Medical Assistance application published by the Maryland Department of Health (a 2011 version, so check with the local department for the current form).

Except for claims of the United States or the State as statute provides, every claim is forever barred unless presented by the earlier of six months after death or two months after the personal representative mails or…

Massachusetts exempt income and resources statute: a residence is exempt, but once a medical determination is made that the applicant cannot reasonably return home it becomes countable unless counting it would cause…

Official MassHealth operations memo (December 2025) stating that, effective January 15, 2026, MassHealth counts the income and assets of spouses for new applicants to the Program of All-inclusive Care for the Elderly…

Official MassHealth estate recovery page: for deaths on or after August 1, 2024, recovery is from the probate estate of members who were 55 or older when MassHealth paid for long-term services and supports (nursing…

Massachusetts spousal impoverishment provision: in determining an institutionalized spouse's eligibility the division follows 42 U.S.C.

Massachusetts transfer statute: the division imposes a period of ineligibility, consistent with Title XIX, on an institutionalized individual who, or whose spouse, disposes of resources for less than fair market value,…

Massachusetts rule that an individual receiving medical assistance who transfers an interest in real or personal property must notify the division, giving at least the name, identification number, date of transfer and…

Massachusetts estate recovery statute. For deaths on or after August 1, 2024, recovery is limited to the estate of a person who was a nursing facility or medical institution resident when assisted, or who was 55 or…

Massachusetts probate procedure for estate recovery: a petition to probate a will or for administration must include a sworn statement that the petition and death certificate were sent to the division by certified mail,…

Massachusetts statute establishing the Medicaid program under Title XIX and providing that long-term care services are available to otherwise eligible persons whose income and resources are insufficient to meet the…

MassHealth financial eligibility regulation, including the asset limit and asset reduction, countable and noncountable assets, long-term care treatment of a married couple's assets (520.016), transfers of resources and…

The April 6, 2026 communication directs use of a $420.67 daily divisor for cases received on or after April 1, 2026 and recalculation of pending cases using the former $402.74 divisor;

The June 11, 2026 communication gives a $2,705 base spousal allowance and $811.50 shelter threshold from July 1, 2026, with stated income deductions, shelter expenses, family-deduction conditions and resource bounds.

Official Division of Medical Assistance and Health Services communication: quoting 42 U.S.C.

Official Division of Medical Assistance and Health Services communication to county welfare agencies: New Jersey adopted qualified income trusts under 42 U.S.C.

Official Division of Medical Assistance and Health Services communication publishing the 2025 revisions to N.J.A.C.

The October 8, 2025 communication directs an increase in the standard utility allowance from $878 to $977 effective October 1, 2025 for community-spouse deductions when there are direct utility charges.

Agency communication directing January 1, 2026 standards: community-spouse resource bounds of $32,532 and $162,660, with the stated one-half rule and exceptions;

Official Division of Medical Assistance and Health Services page: New Jersey adopted QITs effective December 2014, and income above 300% of the Federal Benefit Rate placed in a QIT is not counted for financial…

A lien may be filed and recovery sought from the estate of a deceased recipient for assistance correctly paid for services received at 55 or older (for deaths on or after April 1, 1995 with payments on or after October…

Text of the rule as published by DMAHS: applies to trusts funded with the individual's assets by the individual, spouse or someone acting for them, regardless of purpose or trustee discretion, with a 60-month look-back;

Official New York City Human Resources Administration page (New York City residents): a person who is over 65, needs Medicaid because of disability or blindness, or has Medicare and is not a parent or caretaker of minor…

Text of New York's supplemental needs trust statute. A supplemental needs trust is a discretionary trust for a person with a severe and chronic or persistent disability whose terms clearly show the creator's intent to…

A principal may modify the statutory short form by adding language in the Modifications section that supplements or limits the standard authority, and the form remains a statutory short form for the mandatory-acceptance…

This section contains the statutory short form itself: the Caution to the Principal that opens it, the designation of agents and successor agents (co-agents must act together unless the principal initials the statement…

In a statutory short form power of attorney, authority over "personal and family maintenance" lets the agent maintain the customary standard of living of the principal's spouse, children and other dependents, provide…

Text of New York's spousal impoverishment rules. An institutionalized spouse is one in a medical institution or nursing facility expected to stay 30 consecutive days, or receiving 1915(c) waiver or managed long-term…

Official New York City Human Resources Administration page: Medicaid-funded home care programs (personal care, consumer directed personal assistance, managed long-term care, the assisted living program and the long term…

Official New York City Human Resources Administration page: the Claims and Collections Division collects cash assistance and Medicaid balances owed by current and former clients and by responsible third parties who…

A public welfare official may sue a person discovered to have real or personal property, or the estate of a person who dies leaving property, if that person or anyone the person was liable to support received assistance…

Text of New York's Medicaid eligibility section (about 143,000 characters, so held as a reference).

For an institutionalized spouse with a community spouse, no community spouse income is counted after eligibility, income follows the name on the payment, and the couple's combined countable resources as of the snapshot…

Requires ODM to seek recovery from the estate of a permanently institutionalized individual of any age, and of an individual 55 or older, for Medicaid correctly paid, and defines estate broadly to include non-probate…

Bars pre-death liens for Medicaid correctly paid except that ODM may lien the real property of a permanently institutionalized recipient and the recipient's spouse, including jointly held property, but not the home…

Requires the county to deduct a monthly personal needs allowance under 42 U.S.C. 1396a(q) before applying a nursing facility or ICF/IID recipient's income to the cost of care, at not less than $50 for an individual and…

Requires the administrator of the Medicaid estate recovery program to prescribe a form on which a surviving beneficiary of a transfer on death designation affidavit, or the beneficiary's representative, states whether…

Sets the special income level at 300 percent of the current SSI benefit rate for an individual, available only to an individual in a continuous period of institutionalization (including HCBS waiver or PACE), with…

An individual seeking Medicaid payment for long-term care who is ineligible for base eligibility due to excess income has income eligibility determined against the special income level under rule 5160:1-6-03.1, and when…

A transfer for less than fair market value by an institutionalized individual or spouse on or after the look-back date, sixty months before the baseline date, is presumed improper and produces a restricted Medicaid…

Calculates patient liability for an institutionalized individual from gross monthly income (including income attributed under the spousal rule), less listed exclusions, a $75 personal needs allowance (plus up to $65 of…

Makes an institutionalized individual ineligible for nursing facility, nursing facility equivalent and HCBS waiver services if the individual or spouse disposes of assets (all income and resources, including amounts…

Official Department of Human Services guidance: applicants apply through COMPASS or the county assistance office;

Regulation text: after initial eligibility the institutionalized spouse may transfer resources up to the protected spousal share to the community spouse or to another for the community spouse's sole benefit;

Regulation text: §§ 178.121-178.126 apply when an institutionalized spouse has a community spouse, for a continuous period of institutionalization likely to last at least 30 days (broken by absences of 30 or more…

Regulation text: at application the couple's countable resources are totaled and the greatest of the community spouse share (up to the federal maximum), the federal minimum standard, amounts transferred to the community…

Regulation text: MNO-MA spend-down eligibility exists when countable net income less deductible medical expenses is at or below the medically needy income limit in Appendix F for a 6-month period;

Nine express-authority categories with trust cross-reference exceptions, contrary-instrument limits, agent-benefit restrictions and separate gift/disclaimer rules.

Regulation text: an institutionalized individual (or HCBS waiver recipient) who, or whose spouse, disposes of assets for less than fair market value on or after the look-back date is ineligible for nursing facility care…

Regulation text: when the Department presumes a transfer was made to qualify, the individual is notified in writing of the right to rebut within 15 days of mailing, and must then present verification and convincing…

Regulation text: an individual ineligible under §§ 178.104 and 178.105 remains ineligible until the presumption is successfully rebutted at a prehearing conference, hearing or through a court order, the property is…

Statement of policy: for applications on or after March 3, 2007, consistent with 42 U.S.C.

Defines the Texas QIT: irrevocable, funded only with the person's income, naming the state residuary beneficiary up to Medicaid paid, with each covered income source deposited in full in the month received (nominal $10…

Permits transfers between spouses before institutionalization and between institutionalization and application, and lets the institutionalized spouse transfer resources to the community spouse during the initial…

Sets the Texas transfer penalty divisor as a daily private-pay rate of $262.37 for case actions disposed on or after Sept.

HHSC's Medicaid for the Elderly and People with Disabilities Handbook applies the special income limit to people who will reside in a Medicaid-approved long-term care facility or who apply for certain Home and…

States that a home placed in a revocable or living trust loses the homestead exclusion and becomes a countable resource under F-6400, valued presumptively at tax value subject to rebuttal, while a home in an irrevocable…

Applies transfer of assets policy to people in institutional settings or receiving HCBS waiver services (not to mandatory MEPD groups or Medicare Savings Programs), looks back from the later of institutionalization or…

Lists transfers of any asset, including the home, that carry no penalty under pre- and post-DRA policy: to or for the sole benefit of a spouse; to a child disabled under SSA criteria or a trust solely for that child;

For the institutional spouse's income test, no income of the community spouse is counted;

For the resource test, all resources held by either spouse or both are considered available to the institutionalized spouse regardless of Texas community property law, with one automobile, household goods and the home…

Sets the MEPD countable resource limit at $2,000 for an individual and $3,000 for a couple (1989 to present) and applies the individual limit to the institutional spouse under the Chapter J spousal impoverishment rules.

The community spouse resource allowance is the amount by which the greatest of the spousal resource standard, the spousal share (not above the maximum spousal resource standard), an amount set by a department hearing…

The community spouse monthly income allowance is the amount by which the greater of the monthly maintenance needs standard plus any excess shelter allowance, or an amount a hearing officer finds necessary because of…

Consistent with Title XIX, DMAS operates an estate recovery program for all persons who received Medicaid-financed nursing facility care, and recovery from a deceased recipient's estate may not exceed total Medicaid…

Text of Virginia's resource exclusions for Medicaid. It disregards up to $3,500 each for the individual and spouse set aside for burial (reduced by excluded life insurance face value and other burial arrangements), all…

For medical assistance, assets include all income and resources of the individual and spouse, including amounts they are entitled to but do not receive because of action by either of them, a court or other person acting…

Medically needy individuals with income above the medically needy income limit are ineligible unless the excess is insufficient to meet the cost of needed care and incurred medical or remedial expenses have been…

Resources used within 30 months before application to buy term life insurance whose death benefit is less than twice the premiums paid are an uncompensated transfer unless the policy funds a funeral under Va.

Undue hardship exists when applying the transfer penalty would endanger the individual's health or life or deprive the individual of food, clothing, shelter or other necessities;

A resource assessment is completed on every application of a married institutionalized individual with a community spouse;

At application, regardless of community property or marital property law, all resources held by either spouse or both are treated as available to the institutionalized spouse to the extent they exceed the spousal…