{ "schema_version": 1, "reviewed": "2026-11-16", "federal": { "year": 2026, "reviewed": "2026-11-16", "ssi_individual": 994, "ssi_couple": 1491, "income_cap_300_ssi": 2982, "csra_min": 32532, "csra_max": 162660, "mmmna_min": 2705, "mmmna_min_effective": "2026-07-01", "mmmna_max": 4066.5, "mmmna_max_effective": "2026-01-01", "home_equity_min": 752000, "home_equity_max": 1130000, "source": "https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf", "source_title": "CMS: Updated 2026 SSI and Spousal Impoverishment Standards, April 27, 2026", "scope": "Federal reference standards; not a universal state eligibility table. MMMNA minimum shown is effective July 1 for the contiguous states. State adoption, program applicability and individual calculations must be checked." }, "states": [ { "code": "AZ", "state": "Arizona", "state_es": "Arizona", "slug_en": "arizona-medicaid-income-asset-limits", "slug_es": "arizona-limites-ingresos-bienes-medicaid", "medicaid_name": "AHCCCS / ALTCS", "agency_url": "https://www.azahcccs.gov/Members/GetCovered/Categories/altcs.html", "reviewed": "2026-11-16", "income_rule_type": "income_cap_qit", "single_income_limit_ltc": 2982, "single_asset_limit_ltc": 2000, "csra_max_spouse_assets": 162660, "home_equity_limit": 752000, "lookback_months": 60, "personal_needs_allowance": null, "sources": [ { "id": "AZ-1", "title": "ALTCS application guide, 2026", "url": "https://www.azahcccs.gov/Members/Downloads/Publications/DE-828_english.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Individual gross income $2,982, resources $2,000, financial application and share of cost." }, { "id": "AZ-2", "title": "ALTCS community-spouse policy, June 2026", "url": "https://www.azahcccs.gov/Members/Downloads/Publications/DE-817_english.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Spousal resource assessment, $162,660 maximum and alternative income attribution; conditional Miller trust." }, { "id": "AZ-3", "title": "AHCCCS eligibility standards desk aid", "url": "https://azahcccs.gov/Members/Downloads/EligibilityStandardsDeskAid.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "2026 SSI-MAO countable-income standards $1,330 individual/$1,804 two-person household and disregards." }, { "id": "AZ-4", "title": "ALTCS program eligibility, September 2026", "url": "https://epm.azahcccs.gov/epmplus/Policy/Chapter_400_AHCCCS_Medical_Assistance_Programs/MA0403.htm", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "ALTCS institutional and community eligibility; $2,000 individual/$3,000 couple resource categories." }, { "id": "AZ-5", "title": "AHCCCS home property policy", "url": "https://epm.azahcccs.gov/epmplus/Policy/Chapter_700_Resources/705_Resource_Types/K_Home_Property.htm", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "2026 home equity $752,000, exclusion conditions and separate long-term-care restriction." }, { "id": "AZ-6", "title": "ALTCS financial interview procedure", "url": "https://epm.azahcccs.gov/epmplus/Procedures/P1303_Processing_ALTCS_Applications/A_How_to_Schedule_and_Complete_the_ALTCS_Interview.htm", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Five-year financial look-back and interview preparation." }, { "id": "AZ-7", "title": "AHCCCS estate recovery brochure, July 2026", "url": "https://www.azahcccs.gov/Members/Downloads/Publications/DE-810.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Estate claims, notice process and statutory exemptions." }, { "id": "AZ-8", "title": "Transfer penalty policy", "url": "https://epm.azahcccs.gov/epmplus/Policy/Chapter_900_Transfers/905_Transfer_Penalty_Period.htm", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Uncompensated transfers, exemptions and penalty calculation vary by county." }, { "id": "AZ-9", "title": "SSI Medical Assistance Only eligibility", "url": "https://epm.azahcccs.gov/epmplus/Policy/Chapter_400_AHCCCS_Medical_Assistance_Programs/MA0413.htm", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "SSI-MAO categories and income criteria; separate from ALTCS." } ], "programs": { "nursing_home": { "name": { "en": "ALTCS nursing-facility coverage", "es": "Cobertura ALTCS en residencia de enfermería" }, "income_rule_type": "income_cap_qit", "single": { "income": 2982, "assets": 2000, "income_basis": "gross", "asset_basis": "individual", "income_note": { "en": "ALTCS individual gross monthly reference for 2026.", "es": "Referencia mensual bruta individual de ALTCS para 2026." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "AZ-1" ] }, "married_one": { "income": null, "assets": 2000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "ALTCS compares half of combined countable income, then applicant income if needed, with $2,982.", "es": "ALTCS compara la mitad del ingreso computable conjunto y, si procede, el del solicitante con $2.982." }, "asset_note": { "en": "Applicant-side limit after the applicable spousal assessment; not total marital assets.", "es": "Límite del solicitante tras la evaluación conyugal; no representa todos los bienes matrimoniales." }, "source_ids": [ "AZ-2" ] }, "married_both": { "income": null, "assets": 3000, "income_basis": "contextual", "asset_basis": "couple_combined", "income_note": { "en": "Do not turn the individual ALTCS income figure into a combined couple limit.", "es": "No conviertas la cifra individual ALTCS en un límite conjunto de pareja." }, "asset_note": { "en": "Combined countable resources where this couple rule applies.", "es": "Recursos computables conjuntos cuando corresponde esta regla de pareja." }, "source_ids": [ "AZ-4" ] }, "note": { "en": "Financial eligibility also requires the ALTCS medical assessment.", "es": "La elegibilidad económica también requiere evaluación médica ALTCS." } }, "hcbs_waiver": { "name": { "en": "ALTCS home and community-based services", "es": "Servicios domiciliarios y comunitarios ALTCS" }, "income_rule_type": "income_cap_qit", "single": { "income": 2982, "assets": 2000, "income_basis": "gross", "asset_basis": "individual", "income_note": { "en": "ALTCS individual gross monthly reference for 2026.", "es": "Referencia mensual bruta individual de ALTCS para 2026." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "AZ-1" ] }, "married_one": { "income": null, "assets": 2000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "ALTCS compares half of combined countable income, then applicant income if needed, with $2,982.", "es": "ALTCS compara la mitad del ingreso computable conjunto y, si procede, el del solicitante con $2.982." }, "asset_note": { "en": "Applicant-side limit after the applicable spousal assessment; not total marital assets.", "es": "Límite del solicitante tras la evaluación conyugal; no representa todos los bienes matrimoniales." }, "source_ids": [ "AZ-2" ] }, "married_both": { "income": null, "assets": 3000, "income_basis": "contextual", "asset_basis": "couple_combined", "income_note": { "en": "Do not turn the individual ALTCS income figure into a combined couple limit.", "es": "No conviertas la cifra individual ALTCS en un límite conjunto de pareja." }, "asset_note": { "en": "Combined countable resources where this couple rule applies.", "es": "Recursos computables conjuntos cuando corresponde esta regla de pareja." }, "source_ids": [ "AZ-4" ] }, "note": { "en": "ALTCS can serve eligible members at home; service planning remains separate.", "es": "ALTCS puede atender en casa a personas elegibles; la planificación es independiente." } }, "abd_regular": { "name": { "en": "SSI Medical Assistance Only, non-cash category", "es": "SSI Medical Assistance Only, modalidad sin pago en efectivo" }, "income_rule_type": "program_specific", "single": { "income": 1330, "assets": null, "income_basis": "countable", "asset_basis": "unknown", "income_note": { "en": "SSI-MAO non-cash standard; income deductions can permit higher actual income.", "es": "Estándar SSI-MAO sin efectivo; las deducciones pueden permitir ingresos reales mayores." }, "asset_note": { "en": "No numeric resource threshold is assigned here; do not import ALTCS rules.", "es": "No se asigna aquí un umbral patrimonial; no importes las reglas ALTCS." }, "source_ids": [ "AZ-3", "AZ-9" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "AZ-3", "AZ-9" ] }, "married_both": { "income": 1804, "assets": null, "income_basis": "countable", "asset_basis": "unknown", "income_note": { "en": "Two-person SSI-MAO standard, subject to household and income rules.", "es": "Estándar SSI-MAO para dos personas, sujeto a reglas de hogar e ingresos." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "AZ-3", "AZ-9" ] }, "note": { "en": "SSI-MAO is distinct from the long-term-care ALTCS pathway.", "es": "SSI-MAO es distinto de la vía ALTCS para cuidados prolongados." } } }, "summary": { "en": "Arizona’s long-term-care program is the Arizona Long Term Care System, usually called ALTCS. AHCCCS reviews finances and medical need; choosing a nursing facility or asking for help at home does not remove either test. The 2026 application guide identifies an individual gross monthly income reference of $2,982 and a $2,000 countable-resource limit. These figures do not describe every AHCCCS category. SSI Medical Assistance Only has its own income budgeting, and the amount deposited into a bank account is not necessarily the amount the eligibility specialist counts.", "es": "El programa de cuidados prolongados de Arizona se llama Arizona Long Term Care System, habitualmente ALTCS. AHCCCS revisa economía y necesidad médica; elegir una residencia o pedir ayuda domiciliaria no elimina ninguna prueba. La guía de solicitud de 2026 identifica una referencia individual de ingresos brutos mensuales de $2.982 y un límite de recursos computables de $2.000. Estas cifras no describen todas las modalidades AHCCCS. SSI Medical Assistance Only calcula los ingresos de otra forma, y el abono bancario no coincide necesariamente con lo que contabiliza el especialista." }, "excess_income_solution": { "en": "For ALTCS, the state describes a possible Income Only, or Miller, trust when income exceeds the applicable test. The community-spouse guide adds conditions concerning the living arrangement and the relationship between income and the private nursing-home rate. A trust therefore is not a universal answer to excess income, excess assets or missing medical eligibility. Ask the benefits specialist which calculation failed and which recognized route applies. Also distinguish becoming income eligible from the share-of-cost calculation that can require a contribution after enrollment.", "es": "Para ALTCS, el estado describe un posible fideicomiso Income Only o Miller cuando los ingresos superan la prueba aplicable. La guía conyugal añade condiciones sobre alojamiento y relación entre ingresos y tarifa privada de residencia. Por eso un fideicomiso no resuelve universalmente exceso de ingresos, exceso de bienes o falta de elegibilidad médica. Pregunta al especialista qué cálculo no se cumple y qué vía reconoce el programa. Distingue también cumplir el requisito económico de la participación en el coste que puede exigirse después de inscribirse." }, "exempt_assets_notes": { "en": "AHCCCS evaluates whether property is available and whether a specific exclusion applies. Home ownership needs a separate review: the 2026 ALTCS home-equity reference is $752,000, but exclusion conditions and exceptions matter. Equity means the applicant’s ownership value after applicable debt, not simply the advertised sale price. The policy also treats out-of-state property and property held in trusts separately. Bring the deed, ownership shares and mortgage information rather than assuming that every property called a family home receives the same treatment.", "es": "AHCCCS evalúa la disponibilidad de cada bien y si corresponde una exclusión concreta. La vivienda requiere revisión independiente: la referencia de patrimonio neto inmobiliario ALTCS para 2026 es $752.000, pero importan las condiciones y excepciones. Ese patrimonio representa el valor de la participación del solicitante descontando la deuda aplicable, no simplemente el precio anunciado. La política también trata por separado inmuebles fuera del estado y en fideicomisos. Presenta escritura, porcentajes de propiedad e hipoteca, sin suponer que cualquier vivienda familiar recibe idéntico tratamiento." }, "spousal_notes": { "en": "Arizona’s married-applicant income method is especially important. Under community-spouse rules, AHCCCS first considers half of the couple’s countable income and can then use the applicant’s own income if the first method exceeds the standard. Resources require a different assessment, with a protected spousal amount rather than a comparison of all marital savings with $2,000. The published 2026 maximum protected amount is $162,660; it is not automatically awarded to every spouse. Request both calculations, including their assessment dates, so the family can understand the decision.", "es": "El método de ingresos para solicitantes casados merece especial atención en Arizona. Bajo las reglas del cónyuge comunitario, AHCCCS considera primero la mitad del ingreso computable conjunto y puede utilizar después el ingreso propio del solicitante si el primer método supera el estándar. Los bienes requieren otra evaluación, con una protección conyugal, no comparar todos los ahorros matrimoniales con $2.000. El máximo protegido publicado para 2026 es $162.660, sin concesión automática. Solicita ambos cálculos y sus fechas para entender la resolución." }, "lookback_rules": { "en": "ALTCS financial review can examine transfers during the five-year look-back. A transfer for less than fair value may create a period without long-term-care payment unless a recognized exception applies. The penalty is not simply the amount transferred, and Arizona’s published calculation uses regional nursing-home cost figures. Do not confuse the review period with the eventual penalty length. Collect explanations and supporting records for unusual payments, gifts or property changes, and ask what evidence is needed for any claimed exception.", "es": "La revisión económica ALTCS puede examinar transmisiones durante los cinco años anteriores. Entregar bienes por debajo de su valor puede producir un período sin pago de cuidados prolongados, salvo excepción reconocida. La penalización no equivale simplemente al importe transferido; Arizona utiliza costes regionales de residencia para calcularla. No confundas el período revisado con la duración final de la penalización. Reúne explicaciones y justificantes de pagos inusuales, regalos o cambios de propiedad, y pregunta qué documentos exige cualquier excepción alegada." }, "estate_recovery_merp": { "en": "AHCCCS may seek repayment from an estate after an ALTCS member’s death, including for qualifying benefits received at age 55 or older. Its July 2026 brochure explains notices, the estate questionnaire and circumstances that can postpone a claim. An asset excluded when applying is not automatically protected from estate recovery. Conversely, recovery is not an automatic eviction when care starts. The estate representative should retain the state’s notices and identify surviving-family or hardship circumstances for review rather than ignore a claim letter.", "es": "AHCCCS puede reclamar reembolso a la herencia tras fallecer un beneficiario ALTCS, incluidos determinados beneficios recibidos desde los 55 años. Su folleto de julio de 2026 explica avisos, cuestionario sucesorio y circunstancias que pueden aplazar una reclamación. Un bien excluido al solicitar no queda automáticamente protegido frente a recuperación sucesoria. Tampoco supone un desalojo automático al empezar los cuidados. El representante de la herencia debe conservar los avisos e indicar circunstancias familiares o de dificultad para revisión, sin ignorar la reclamación." }, "document_notes": { "en": "Start with the official ALTCS application and the assigned Benefits and Eligibility Specialist. Prepare income award letters showing deductions, current account statements, property records and information about the spouse when relevant. Keep a timeline of application, interview requests and missing-document notices. Ask which historic statements are actually required; a five-year look-back does not mean this page can prescribe an identical document package to every household. Save the eventual eligibility notice and share-of-cost explanation as separate records. If the member changes living arrangements, ask which financial review and care-contribution update is required for that move.", "es": "Empieza por la solicitud oficial ALTCS y el especialista asignado. Prepara cartas de prestaciones con deducciones, extractos actuales, documentos inmobiliarios e información del cónyuge cuando corresponda. Anota solicitud, entrevistas y peticiones pendientes. Pregunta qué extractos históricos se necesitan realmente: revisar cinco años no permite a esta página imponer idéntico expediente a todos los hogares. Conserva por separado la resolución de elegibilidad y la explicación de participación en el coste. Si cambia el alojamiento del beneficiario, pregunta qué revisión económica y actualización de aportación exige ese cambio concreto." }, "faqs": [ { "q": { "en": "Is SSI-MAO the same as ALTCS?", "es": "¿SSI-MAO equivale a ALTCS?" }, "a": { "en": "No. SSI-MAO medical coverage and ALTCS long-term-care eligibility use different pathways and financial rules.", "es": "No. La cobertura médica SSI-MAO y los cuidados ALTCS siguen vías y reglas económicas distintas." } }, { "q": { "en": "Does my spouse’s income automatically disqualify me?", "es": "¿Los ingresos de mi cónyuge me excluyen automáticamente?" }, "a": { "en": "No. Arizona applies specific attribution methods; the gross household total alone is insufficient.", "es": "No. Arizona aplica métodos específicos de atribución; el total bruto del hogar no basta." } }, { "q": { "en": "Is $752,000 a cash-asset allowance?", "es": "¿$752.000 es una franquicia de dinero disponible?" }, "a": { "en": "No. It is the 2026 home-equity reference for ALTCS, with separate conditions and exceptions.", "es": "No. Es la referencia inmobiliaria ALTCS de 2026, con condiciones y excepciones independientes." } }, { "q": { "en": "Will a Miller trust remove my care contribution?", "es": "¿Un fideicomiso Miller elimina mi aportación al coste?" }, "a": { "en": "Not automatically. Income eligibility and the later share-of-cost calculation are different decisions.", "es": "No automáticamente. Elegibilidad económica y participación posterior en el coste son decisiones diferentes." } } ] }, { "code": "CA", "state": "California", "state_es": "California", "slug_en": "california-medicaid-income-asset-limits", "slug_es": "california-limites-ingresos-bienes-medicaid", "medicaid_name": "Medi-Cal", "agency_url": "https://www.dhcs.ca.gov/medi-cal/help/", "reviewed": "2026-11-16", "income_rule_type": "share_of_cost", "single_income_limit_ltc": null, "single_asset_limit_ltc": 130000, "csra_max_spouse_assets": 162660, "home_equity_limit": null, "lookback_months": 30, "personal_needs_allowance": null, "sources": [ { "id": "CA-1", "title": "DHCS: restored asset limits and transfer review", "url": "https://www.dhcs.ca.gov/medi-cal/help/asset-limit-frequently-asked%20questions/", "accessed": "2026-11-16", "method": "page", "supports": "2026 non-MAGI assets 130000 individual+65000 additional member; exclusions;30-month lookback excluding pre 2026 transfers" }, { "id": "CA-2", "title": "DHCS ACWDL 26-02: spousal impoverishment renewals", "url": "https://www.dhcs.ca.gov/lo/wp-content/uploads/2026/04/26-02.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Applicant 130000;2026 CSRA 162660; special renewal treatment" }, { "id": "CA-3", "title": "DHCS: Medi-Cal help and share of cost", "url": "https://www.dhcs.ca.gov/medi-cal/help/", "accessed": "2026-11-16", "method": "page", "supports": "County eligibility and monthly SOC mechanics" }, { "id": "CA-4", "title": "DHCS: Estate Recovery Program", "url": "https://www.dhcs.ca.gov/services/estate-recovery-program/", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Deaths 2017+: probate estate and specified LTC-related benefits after 55" }, { "id": "CA-5", "title": "DHCS MEDIL I 26-05: HCBS institutional deeming", "url": "https://www.dhcs.ca.gov/km/wp-content/uploads/2026/04/I-26-05.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Non-MAGI asset reinstatement; HCBS waiver family-budget treatment" }, { "id": "CA-6", "title": "DHCS: 1915(c) HCBS waivers", "url": "https://www.dhcs.ca.gov/services/1915c-home-and-community-based-services-waivers/", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Full-scope Medi-Cal required; separate waiver care criteria" }, { "id": "CA-7", "title": "DHCS: 2026 managed-care aid code reference", "url": "https://www.dhcs.ca.gov/lo/wp-content/uploads/2026/06/2026-Managed-Care-Aid-Code-Reference-List.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "LTC medically-needy categories may meet income standard with medical expenses" } ], "programs": { "nursing_home": { "name": { "en": "Non-MAGI Medi-Cal nursing-facility coverage", "es": "Cobertura residencial Medi-Cal no MAGI" }, "income_rule_type": "share_of_cost", "single": { "income": null, "assets": 130000, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "Income is assessed under the applicable Medi-Cal category and share-of-cost rules; no universal gross cap is entered.", "es": "Se valoran ingresos según categoría Medi-Cal y participación en costes; no se introduce un tope bruto universal." }, "asset_note": { "en": "2026 countable resources for one person; excluded property is separate.", "es": "Recursos computables de una persona en 2026; los bienes excluidos se tratan aparte." }, "source_ids": [ "CA-1", "CA-7" ] }, "married_one": { "income": null, "assets": 130000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "Income is assessed under the applicable Medi-Cal category and share-of-cost rules; no universal gross cap is entered.", "es": "Se valoran ingresos según categoría Medi-Cal y participación en costes; no se introduce un tope bruto universal." }, "asset_note": { "en": "Applicant-only amount after applicable spousal assessment; not a limit on all marital property.", "es": "Importe del solicitante tras la evaluación conyugal; no limita todo el patrimonio matrimonial." }, "source_ids": [ "CA-1", "CA-2" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Income is assessed under the applicable Medi-Cal category and share-of-cost rules; no universal gross cap is entered.", "es": "Se valoran ingresos según categoría Medi-Cal y participación en costes; no se introduce un tope bruto universal." }, "asset_note": { "en": "Institutional budget units must be established; do not automatically use the community couple total.", "es": "Deben determinarse unidades presupuestarias institucionales; no se aplica automáticamente el total comunitario." }, "source_ids": [ "CA-1", "CA-2" ] }, "note": { "en": "A financial category and nursing level-of-care decision are both required.", "es": "Se necesitan categoría económica y decisión de nivel asistencial." } }, "hcbs_waiver": { "name": { "en": "Home and Community-Based Alternatives (HCBA)", "es": "Home and Community-Based Alternatives (HCBA)" }, "income_rule_type": "program_specific", "single": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Income is assessed under the applicable Medi-Cal category and share-of-cost rules; no universal gross cap is entered.", "es": "Se valoran ingresos según categoría Medi-Cal y participación en costes; no se introduce un tope bruto universal." }, "asset_note": { "en": "Full-scope category and any institutional-deeming rules determine the resource test.", "es": "La categoría de cobertura y posible valoración institucional determinan la prueba patrimonial." }, "source_ids": [ "CA-5", "CA-6" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Income is assessed under the applicable Medi-Cal category and share-of-cost rules; no universal gross cap is entered.", "es": "Se valoran ingresos según categoría Medi-Cal y participación en costes; no se introduce un tope bruto universal." }, "asset_note": { "en": "County must establish applicable spousal or institutional-deeming treatment.", "es": "El condado debe determinar la protección conyugal o valoración institucional aplicable." }, "source_ids": [ "CA-2", "CA-5" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Income is assessed under the applicable Medi-Cal category and share-of-cost rules; no universal gross cap is entered.", "es": "Se valoran ingresos según categoría Medi-Cal y participación en costes; no se introduce un tope bruto universal." }, "asset_note": { "en": "Each waiver participant needs an individual category review.", "es": "Cada participante necesita revisión individual de categoría." }, "source_ids": [ "CA-5" ] }, "note": { "en": "HCBA eligibility is not automatically identical to an ordinary nursing-home financial budget.", "es": "La elegibilidad HCBA no equivale automáticamente al presupuesto económico residencial." } }, "abd_regular": { "name": { "en": "Non-MAGI aged, blind or disabled Medi-Cal", "es": "Medi-Cal no MAGI para mayores, personas ciegas o con discapacidad" }, "income_rule_type": "program_specific", "single": { "income": null, "assets": 130000, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "Income is assessed under the applicable Medi-Cal category and share-of-cost rules; no universal gross cap is entered.", "es": "Se valoran ingresos según categoría Medi-Cal y participación en costes; no se introduce un tope bruto universal." }, "asset_note": { "en": "General 2026 non-MAGI resource standard; special protected categories require separate review.", "es": "Referencia general no MAGI 2026; categorías protegidas requieren revisión separada." }, "source_ids": [ "CA-1" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Income is assessed under the applicable Medi-Cal category and share-of-cost rules; no universal gross cap is entered.", "es": "Se valoran ingresos según categoría Medi-Cal y participación en costes; no se introduce un tope bruto universal." }, "asset_note": { "en": "Household and spouse treatment must be established before comparing assets.", "es": "Debe determinarse el tratamiento del hogar y cónyuge antes de comparar." }, "source_ids": [ "CA-1", "CA-2" ] }, "married_both": { "income": null, "assets": 195000, "income_basis": "contextual", "asset_basis": "couple_combined", "income_note": { "en": "Income is assessed under the applicable Medi-Cal category and share-of-cost rules; no universal gross cap is entered.", "es": "Se valoran ingresos según categoría Medi-Cal y participación en costes; no se introduce un tope bruto universal." }, "asset_note": { "en": "General two-person non-MAGI household standard, not 195000 for each spouse.", "es": "Referencia general de hogar no MAGI de dos personas, no 195000 por cónyuge." }, "source_ids": [ "CA-1" ] }, "note": { "en": "Income categories include different deductions and share-of-cost pathways; a single gross threshold is not verified here.", "es": "Las categorías incluyen distintas deducciones y vías de participación en costes; no se verifica un único umbral bruto." } } }, "summary": { "en": "California restored an asset test for specified non-MAGI Medi-Cal categories in January 2026. For the general one-person category, the published countable-property standard is $130,000; this does not mean every bank balance and possession counts. Older articles saying California has no asset limit can therefore mislead an older adult preparing for care. Start with the county eligibility office and identify whether the request concerns nursing-facility coverage, ordinary aged or disabled Medi-Cal, or a particular waiver. The HCBA waiver also requires a separate service assessment and full-scope Medi-Cal eligibility.", "es": "California recuperó la prueba patrimonial para determinadas categorías no MAGI de Medi-Cal en enero de 2026. La referencia general de una persona es $130,000 en bienes computables; no significa que cuenten todos los saldos y pertenencias. Las guías antiguas que afirman que California no tiene límite pueden confundir a quien prepara cuidados. Empieza en la oficina del condado e identifica si solicitas cobertura residencial, Medi-Cal ordinario para mayores o personas con discapacidad, o una exención concreta. HCBA exige además evaluación de servicios y elegibilidad Medi-Cal de cobertura completa." }, "excess_income_solution": { "en": "California should not be placed in a generic $2,982 income-cap calculator. Some non-MAGI categories use a share of cost: the county calculates the amount the member must incur for covered health expenses before Medi-Cal pays in the relevant month. The written Notice of Action identifies that amount. Ask which deductions and medical expenses were recognized, and whether another eligibility category was considered. A facility’s monthly bill and the resident’s personal-needs deduction are different numbers. Neither is a universal income eligibility ceiling for every Californian seeking care.", "es": "California no encaja en una calculadora genérica con tope de ingresos de $2,982. Algunas categorías no MAGI utilizan participación en costes: el condado calcula los gastos sanitarios que debe asumir la persona antes de que Medi-Cal pague ese mes. La notificación escrita identifica el importe. Pregunta qué deducciones y gastos se reconocieron y si se evaluó otra categoría de elegibilidad. La factura residencial y la deducción para necesidades personales son cifras distintas. Ninguna es un techo universal de ingresos para toda persona que solicita cuidados en California." }, "exempt_assets_notes": { "en": "DHCS distinguishes countable property from exclusions, including a qualifying home, a vehicle and certain personal property. Ownership, use and the applicable category still matter. This guide leaves a universal home-equity figure blank because it has not verified one that applies across these California situations. List each account, property interest and policy before asking the county how it is classified. Do not interpret an exemption during eligibility as a promise that the same property can never be relevant to a later estate claim.", "es": "DHCS distingue bienes computables de exclusiones, como una vivienda que cumple los requisitos, un vehículo y determinados bienes personales. Importan titularidad, uso y categoría aplicable. Esta guía deja vacío un valor universal de patrimonio inmobiliario porque no ha verificado uno válido para todas estas situaciones de California. Enumera cuentas, participaciones inmobiliarias y pólizas antes de preguntar al condado su clasificación. Una exclusión durante la elegibilidad no promete que ese mismo bien nunca pueda influir en una reclamación sucesoria posterior." }, "spousal_notes": { "en": "A spouse remaining in the community is not evaluated by simply adding all marital property and comparing the result with $130,000. DHCS’s 2026 instructions discuss a community-spouse allowance of $162,660 and the applicant’s separate property limit. They also distinguish an initial determination from a renewal for an existing spousal-impoverishment case. Ask for the county’s calculation and which ownership date it used. If both spouses need care, establish their budget units separately; the ordinary two-person household amount should not automatically replace institutional rules.", "es": "Cuando un cónyuge permanece en la comunidad, no basta sumar todo el patrimonio y compararlo con $130,000. Las instrucciones DHCS de 2026 describen una asignación conyugal de $162,660 y el límite separado del solicitante. También distinguen la evaluación inicial de una renovación con protección conyugal existente. Solicita el cálculo del condado y la fecha de titularidad utilizada. Si ambos necesitan atención, determina por separado sus unidades presupuestarias; la cifra ordinaria de un hogar de dos personas no sustituye automáticamente las reglas institucionales." }, "lookback_rules": { "en": "California’s published transfer review uses 30 months for entry into nursing-home care, with a critical restart rule: transfers before January 1,2026 are not counted under the reinstated policy. Transfers from that date may affect payment for care when no exception applies. This is not the same as a five-year rule copied from another state, nor a requirement that every recent transaction creates a penalty. Preserve dates, values, explanations and supporting records, and ask the county which transfer policy applies to the specific service requested.", "es": "La revisión publicada para ingresar en atención residencial utiliza 30 meses, con una regla esencial de reinicio: las transferencias anteriores al 1 de enero de 2026 no se cuentan conforme a la política restablecida. Las posteriores pueden afectar al pago de cuidados si no existe excepción. No equivale a copiar una regla de cinco años de otro estado ni a suponer que toda operación reciente genera sanción. Conserva fechas, valores, explicaciones y justificantes y pregunta qué política corresponde al servicio concreto solicitado." }, "estate_recovery_merp": { "en": "DHCS treats estate recovery separately from financial eligibility. For deaths from 2017 onward, its published rule limits recovery to probate assets and specified nursing-facility, home-and-community-based and related services received at age 55 or later. Family protections and hardship procedures can affect a claim. A home’s exclusion while someone receives benefits does not settle that later question. Keep eligibility notices and care records so the estate representative can identify what coverage was provided and request an explanation of any recovery notice.", "es": "DHCS trata la recuperación sucesoria por separado de la elegibilidad económica. Para fallecimientos desde 2017, la norma publicada limita la reclamación a bienes sujetos al procedimiento sucesorio y determinados servicios residenciales, comunitarios y relacionados recibidos desde los 55 años. Las protecciones familiares y procedimientos por dificultades pueden afectar a la reclamación. La exclusión de una vivienda durante la cobertura no resuelve esa cuestión posterior. Conserva notificaciones y registros asistenciales para que el representante sucesorio pueda identificar la cobertura y solicitar explicación de cualquier reclamación." }, "document_notes": { "en": "Prepare current income statements, account ownership details, property information and any existing trust or insurance documents. Add the county’s renewal notice or prior aid-category information if coverage is already active. For HCBA, keep waiver communications alongside the Medi-Cal application because financial approval and service enrollment have different decision makers. Request a written list of missing evidence and retain submission receipts. The county, not this checklist, determines the period and documents needed for the case; sensitive records should go through its official channel.", "es": "Prepara justificantes actuales de ingresos, titularidad de cuentas, información inmobiliaria y documentos existentes de fideicomisos o seguros. Si ya hay cobertura, añade renovación del condado o categoría anterior. En HCBA, guarda comunicaciones de la exención junto a la solicitud Medi-Cal, porque aprobación económica e inscripción asistencial tienen responsables distintos. Pide una lista escrita de documentación pendiente y conserva comprobantes de entrega. El condado determina periodo y documentos necesarios; esta lista no sustituye su petición. Envía información sensible mediante su canal oficial." }, "faqs": [ { "q": { "en": "Does California still ignore all assets?", "es": "¿California sigue ignorando todos los bienes?" }, "a": { "en": "No. The 2026 reinstatement affects specified non-MAGI groups; the county must identify the applicable category and exclusions.", "es": "No. El restablecimiento de 2026 afecta a determinadas categorías no MAGI; el condado identifica categoría y exclusiones." } }, { "q": { "en": "Is a share of cost an application fee?", "es": "¿La participación en costes es una tasa de solicitud?" }, "a": { "en": "No. It concerns health expenses for a relevant month, as stated in the eligibility notice.", "es": "No. Corresponde a gastos sanitarios del mes, según la notificación de elegibilidad." } }, { "q": { "en": "Does HCBA approval follow automatically from Medi-Cal?", "es": "¿Medi-Cal aprueba automáticamente HCBA?" }, "a": { "en": "No. Full-scope coverage and waiver service eligibility are separate determinations.", "es": "No. Cobertura completa y elegibilidad para servicios de la exención son decisiones separadas." } }, { "q": { "en": "Are transfers from 2025 included in the restarted lookback?", "es": "¿La revisión reiniciada incluye transferencias de 2025?" }, "a": { "en": "DHCS says transfers before January 1,2026 are not counted under the reinstated transfer policy.", "es": "DHCS indica que las transferencias anteriores al 1 de enero de 2026 no se cuentan en la política restablecida." } } ] }, { "code": "CO", "state": "Colorado", "state_es": "Colorado", "slug_en": "colorado-medicaid-income-asset-limits", "slug_es": "colorado-limites-ingresos-bienes-medicaid", "medicaid_name": "Health First Colorado", "agency_url": "https://hcpf.colorado.gov/", "reviewed": "2026-11-16", "income_rule_type": "income_cap_qit", "single_income_limit_ltc": 2982, "single_asset_limit_ltc": 2000, "csra_max_spouse_assets": 162660, "home_equity_limit": 1130000, "lookback_months": 60, "personal_needs_allowance": null, "sources": [ { "id": "CO-1", "title": "Colorado HCPF:2026 COLA and financial references", "url": "https://hcpf.colorado.gov/sites/hcpf/files/HCPF%20OM%2025-073%202026%20Social%20Security%20Cost%20of%20Living%20Adjustments.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "2026 special income 2982; home equity 1130000; CSRA 162660; regional income-trust references" }, { "id": "CO-2", "title": "Colorado regulations:10 CCR 2505-10,8.100", "url": "https://www.sos.state.co.us/CCR/GenerateRulePdf.do?fileName=10+CCR+2505-10+8.100&ruleVersionId=12172", "accessed": "2026-11-16", "method": "pdf", "supports": "Gross 300%institutional/HCBS standard; resources 2000/3000; same-room exception; income-trust regional condition;60-month transfers" }, { "id": "CO-3", "title": "Boulder County: Long-Term Services and Supports", "url": "https://bouldercounty.gov/families/seniors/long-term-care/", "accessed": "2026-11-16", "method": "page", "supports": "Current 2026 income 2982; resource and marital distinctions; functional and financial application roles" }, { "id": "CO-4", "title": "Colorado HCPF: estate and trust recovery fact sheet", "url": "https://hcpf.colorado.gov/sites/hcpf/files/Fraud%20Waste%20and%20Abuse%20Fact%20Sheet%204-29-2025.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Estate recovery for specified institutional/LTSS benefits and trust recovery distinctions" }, { "id": "CO-5", "title": "Colorado HCPF: July 2025 provider bulletin", "url": "https://hcpf.colorado.gov/sites/hcpf/files/Bulletin%200725_B2500525.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Affectedattendant services moved to CFC by July 2026; CFC is not all HCBS waivers" }, { "id": "CO-6", "title": "CMS-approved Colorado CFC state plan amendment CO 25-0040", "url": "https://www.medicaid.gov/medicaid/spa/downloads/CO-25-0040.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "State-specific approved CFC coverage and relation to waiver eligibility, effective April 2026" } ], "programs": { "nursing_home": { "name": { "en": "Institutional special-income nursing-facility category", "es": "Categoría residencial de ingresos institucionales especiales" }, "income_rule_type": "income_cap_qit", "single": { "income": 2982, "assets": 2000, "income_basis": "gross", "asset_basis": "individual", "income_note": { "en": "300%SSI institutional special-income reference for the named financial pathway.", "es": "Referencia especial institucional 300%SSI de la vía económica indicada." }, "asset_note": { "en": "Individual countable-resource standard.", "es": "Referencia individual de recursos computables." }, "source_ids": [ "CO-1", "CO-2" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "gross", "asset_basis": "applicant_only", "income_note": { "en": "Applicant gross income under institutional spousal-attribution rules.", "es": "Ingresos brutos del solicitante según atribución conyugal institucional." }, "asset_note": { "en": "Applicant resources separate from the protected community-spouse amount.", "es": "Recursos del solicitante separados de la protección del cónyuge comunitario." }, "source_ids": [ "CO-1", "CO-2" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Both-applicant income depends on living arrangement and attribution; no combined figure inferred.", "es": "Los ingresos de ambos dependen de convivencia y atribución; no se deduce cifra conjunta." }, "asset_note": { "en": "Generally 3000 combined; the same nursing-room rule allows 2000 each. Confirm before comparing.", "es": "Generalmente 3000 conjuntos; misma habitación residencial permite 2000 por persona. Confirma antes de comparar." }, "source_ids": [ "CO-2", "CO-3" ] }, "note": { "en": "A valid income-trust pathway has additional conditions, including regional private-care cost references; it is not an unlimited income exemption.", "es": "La vía de fideicomiso tiene condiciones adicionales, incluidas referencias regionales de coste; no excluye ingresos sin límite." } }, "hcbs_waiver": { "name": { "en": "HCBS waiver: special-income pathway, confirm the waiver", "es": "Exención HCBS: vía de ingresos especiales, confirma la exención" }, "income_rule_type": "income_cap_qit", "single": { "income": 2982, "assets": 2000, "income_basis": "gross", "asset_basis": "individual", "income_note": { "en": "300%SSI institutional special-income reference for the named financial pathway.", "es": "Referencia especial institucional 300%SSI de la vía económica indicada." }, "asset_note": { "en": "Individual countable-resource standard.", "es": "Referencia individual de recursos computables." }, "source_ids": [ "CO-1", "CO-2" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "gross", "asset_basis": "applicant_only", "income_note": { "en": "Applicant gross income under institutional spousal-attribution rules.", "es": "Ingresos brutos del solicitante según atribución conyugal institucional." }, "asset_note": { "en": "Applicant resources separate from the protected community-spouse amount.", "es": "Recursos del solicitante separados de la protección del cónyuge comunitario." }, "source_ids": [ "CO-1", "CO-2" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Both-applicant income depends on living arrangement and attribution; no combined figure inferred.", "es": "Los ingresos de ambos dependen de convivencia y atribución; no se deduce cifra conjunta." }, "asset_note": { "en": "Generally 3000 combined; the same nursing-room rule allows 2000 each. Confirm before comparing.", "es": "Generalmente 3000 conjuntos; misma habitación residencial permite 2000 por persona. Confirma antes de comparar." }, "source_ids": [ "CO-2", "CO-3" ] }, "note": { "en": "A valid income-trust pathway has additional conditions, including regional private-care cost references; it is not an unlimited income exemption.", "es": "La vía de fideicomiso tiene condiciones adicionales, incluidas referencias regionales de coste; no excluye ingresos sin límite." } }, "abd_regular": { "name": { "en": "Community aged, blind or disabled categories", "es": "Categorías comunitarias para mayores, personas ciegas o con discapacidad" }, "income_rule_type": "program_specific", "single": { "income": null, "assets": 2000, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "SSI-related, protected and other categories have distinct income treatment; no single universal amount entered.", "es": "Categorías SSI, protegidas y otras tienen distinto tratamiento; no se introduce cifra universal." }, "asset_note": { "en": "General ABD resource standard; separate buy-in and protected categories may differ.", "es": "Referencia patrimonial ABD general; categorías protegidas ybuy-in pueden diferir." }, "source_ids": [ "CO-2" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Spouse deeming and coverage category require review.", "es": "Debe revisarse imputación conyugal y categoría." }, "asset_note": { "en": "No applicant-only amount inferred from general couple rules.", "es": "No se deduce importe individual de las reglas generales de pareja." }, "source_ids": [ "CO-2" ] }, "married_both": { "income": null, "assets": 3000, "income_basis": "contextual", "asset_basis": "couple_combined", "income_note": { "en": "No universal combined income reference across all ABD categories.", "es": "No existe referencia conjunta universal para todas las categorías ABD." }, "asset_note": { "en": "General community couple resource standard; not 3000 per spouse.", "es": "Referencia general comunitaria conjunta, no 3000 por cónyuge." }, "source_ids": [ "CO-2" ] }, "note": { "en": "The institutional 300%SSI reference must not be applied to ordinary community coverage solely because the person is older.", "es": "No se aplica la referencia institucional 300%SSI a cobertura ordinaria solo por tratarse de una persona mayor." } } }, "summary": { "en": "Colorado’s long-term-care financial pathway uses a special institutional income category that can also apply to qualifying HCBS waiver cases. HCPF’s 2026 update sets the 300%SSI reference at $2,982 monthly. The financial eligibility site and the Case Management Agency perform different work: one reviews the budget, while the other assesses functional needs and services. Ask which pathway is being considered before using the table. Colorado’s Community First Choice transition also changed where many attendant services are funded; a CFC service should not automatically be treated as identical to every older waiver arrangement.", "es": "La vía económica de cuidados prolongados de Colorado utiliza una categoría institucional especial que también puede aplicarse a casos HCBS admisibles. La actualización HCPF 2026 establece referencia 300%SSI de $2,982 mensuales. La oficina económica y Case Management Agency tienen trabajos distintos: una revisa presupuesto y otra necesidades funcionales y servicios. Pregunta qué vía se evalúa antes de utilizar la tabla. La transición Community First Choice también cambió la financiación de muchos asistentes; un servicio CFC no equivale automáticamente a todas las modalidades antiguas de exención." }, "excess_income_solution": { "en": "Colorado regulations permit an income-trust pathway for qualifying long-term-care cases above the special income standard. The rule includes a regional private-pay care-cost condition, so exceeding $2,982 does not mean a trust is automatically suitable at any income. HCPF publishes annual regional references. Ask the eligibility site to identify the current rule and review any existing instrument through the official process. Income used through a trust can still affect the patient payment, and trust remainder recovery is a separate obligation. This page does not instruct families to create or transfer funds into a trust.", "es": "Las normas permiten una vía de fideicomiso de ingresos para ciertos casos de larga duración por encima del estándar. Incluyen una condición regional de coste privado asistencial; superar $2,982 no convierte automáticamente un fideicomiso en solución para cualquier ingreso. HCPF publica referencias regionales anuales. Pide a la oficina identificar la regla actual y revisar documentos existentes mediante su proceso. Los ingresos del fideicomiso pueden afectar a la aportación y la devolución del saldo es otra obligación. Esta página no indica crear ni transferir fondos a fideicomisos." }, "exempt_assets_notes": { "en": "The general individual resource reference is $2,000, but it concerns countable assets after the applicable exclusions. Colorado’s 2026 home-equity reference is $1,130,000, rather than the lower federal floor used by some states. Equity is not the same as a home’s sale price when debt remains, and protected occupants or other exceptions can change the analysis. Provide ownership, loan and use information for the residence and other property. Ordinary community ABD resource rules also have exceptions for certain categories, so a work-related buy-in case should not inherit the nursing-home test without review.", "es": "La referencia individual general es $2,000, pero corresponde a activos computables tras exclusiones. El patrimonio inmobiliario de referencia Colorado 2026 es $1,130,000, no el mínimo federal usado por otros estados. Patrimonio neto no equivale a precio de venta si hay deuda, y ocupantes protegidos u otras excepciones pueden cambiar el análisis. Facilita titularidad, préstamos y uso de vivienda y otros bienes. Las reglas ABD comunitarias también tienen excepciones por categoría; un caso de incorporación laboralbuy-in no debe heredar sin revisión la prueba residencial." }, "spousal_notes": { "en": "For one applicant with a spouse remaining in the community, the applicant’s resource amount is separate from the protected spouse allowance. HCPF’s 2026 reference lists $162,660 for the community spouse. Both-applicant cases are more complicated than simply doubling one number: Colorado regulations distinguish spouses sharing a nursing-facility room, and county guidance describes different combined-resource outcomes. The simulator therefore leaves that comparison open. Ask the eligibility site which living arrangement and ownership rules apply, and request the separate income-allocation calculation if a spouse remains outside the care setting.", "es": "Para un solicitante con cónyuge comunitario, el importe propio es distinto de la protección conyugal. HCPF 2026 indica $162,660 para el cónyuge comunitario. Cuando solicitan ambos, no basta duplicar una cifra: las normas distinguen a quienes comparten habitación residencial y la guía del condado describe distintos resultados conjuntos. Por eso el simulador deja abierta esa comparación. Pregunta qué reglas de convivencia y titularidad se aplican, y solicita cálculo separado de asignación de ingresos cuando un cónyuge permanece fuera del entorno asistencial." }, "lookback_rules": { "en": "Colorado’s transfer rules identify a 60-month lookback for relevant long-term-care applications, including institutional and HCBS settings. Transactions without fair consideration can affect coverage, but the office must evaluate the facts and any exception. Keep the original ownership documents, transaction date, value and evidence of what was received. A current resource balance alone cannot settle the transfer question. If a transaction was completed for another purpose, provide the records and explanation requested by the eligibility site rather than assuming that an informal family explanation establishes an exemption.", "es": "Las reglas Colorado identifican 60 meses de revisión para solicitudes pertinentes de larga duración, incluidos entornos institucionales y HCBS. Operaciones sin contraprestación suficiente pueden afectar cobertura, pero la oficina debe evaluar hechos y excepciones. Conserva documentos originales de titularidad, fecha, valor y prueba de lo recibido. Un saldo actual no resuelve la cuestión de transferencias. Si la operación tenía otra finalidad, aporta registros y explicación solicitados, en vez de suponer que una explicación familiar informal demuestra por sí sola una excepción." }, "estate_recovery_merp": { "en": "HCPF distinguishes estate recovery from trust recovery. Its published explanation concerns specified long-term-care benefits for people age 55 or older and certain permanently institutionalized recipients. A primary home may be excluded for eligibility yet still require separate estate analysis after death. Survivor protections and hardship procedures must be checked through the recovery process; a calculator cannot predict a claim from home value alone. Keep benefit notices, service dates and any trust correspondence so the estate representative can identify the type and basis of a request for repayment.", "es": "HCPF distingue recuperación sucesoria y de fideicomisos. Su explicación aborda determinados beneficios de larga duración desde 55 años y ciertos beneficiarios institucionalizados permanentemente. Una vivienda principal puede excluirse para elegibilidad y requerir otro análisis sucesorio después. Deben comprobarse protecciones de supervivientes y procedimientos por dificultades; una calculadora no predice una reclamación solo por el valor de vivienda. Conserva notificaciones, fechas de servicios y comunicaciones de fideicomisos para identificar tipo y fundamento de una petición de devolución." }, "document_notes": { "en": "Prepare benefit statements, pension details, account records, property ownership and loan balances. Existing trust documents and their review correspondence should be included when relevant. Coordinate the financial application with the Case Management Agency’s functional assessment, keeping each office’s requests and deadlines distinct. For services affected by CFC, ask which eligibility category supports the current care plan rather than relying on an old waiver approval alone. Keep copies of the written budget, service authorization and patient-payment notice; they serve different purposes and may change on different dates.", "es": "Prepara prestaciones, pensiones, cuentas, titularidad y saldos de préstamos. Incluye fideicomisos existentes y comunicaciones de revisión cuando corresponda. Coordina solicitud económica y evaluación funcional de Case Management Agency, separando peticiones y plazos de cada oficina. En servicios afectados por CFC, pregunta qué categoría sostiene el plan actual en vez de basarte únicamente en una aprobación antigua. Conserva presupuesto escrito, autorización asistencial y aportación del paciente: son documentos con fines distintos y pueden cambiar en fechas diferentes durante el periodo de cobertura." }, "faqs": [ { "q": { "en": "Can I use the lower federal home-equity figure?", "es": "¿Puedo usar el mínimo federal de patrimonio inmobiliario?" }, "a": { "en": "Colorado’s 2026 HCPF reference is $1,130,000; the individual case still needs review for exceptions and equity calculation.", "es": "HCPF 2026 publica $1,130,000; deben revisarse excepciones y cálculo del patrimonio neto." } }, { "q": { "en": "Do both spouses always have one combined resource amount?", "es": "¿Ambos cónyuges tienen siempre un único importe conjunto?" }, "a": { "en": "No. Colorado distinguishes living arrangements, including spouses sharing a nursing-facility room.", "es": "No. Colorado distingue convivencia, incluidos cónyuges que comparten habitación residencial." } }, { "q": { "en": "Does any income above $2,982 qualify through a trust?", "es": "¿Cualquier ingreso superior a $2,982 admite fideicomiso?" }, "a": { "en": "No. The income-trust rule has additional requirements, including a regional private-care cost condition.", "es": "No. Hay requisitos adicionales, incluida una condición regional de coste privado asistencial." } }, { "q": { "en": "Is CFC simply another name for every HCBS waiver?", "es": "¿CFC es otro nombre de toda exención HCBS?" }, "a": { "en": "No. CFC is a state-plan benefit; the applicable financial pathway and remaining waiver services must be identified.", "es": "No. CFC es un beneficio del plan estatal; deben identificarse vía económica y servicios de exención restantes." } } ] }, { "code": "CT", "state": "Connecticut", "state_es": "Connecticut", "slug_en": "connecticut-medicaid-income-asset-limits", "slug_es": "connecticut-limites-ingresos-bienes-medicaid", "medicaid_name": "HUSKY C / Connecticut Medicaid", "agency_url": "https://portal.ct.gov/husky/how-to-qualify", "reviewed": "2026-11-16", "income_rule_type": "program_specific", "single_income_limit_ltc": 2982, "single_asset_limit_ltc": 1600, "csra_max_spouse_assets": 162660, "home_equity_limit": 1130000, "lookback_months": 60, "personal_needs_allowance": 75, "sources": [ { "id": "CT-1", "title": "DSS program standards, October 2026", "url": "https://portal.ct.gov/dss/-/media/departments-and-agencies/dss/fact-sheets-and-issue-briefs/fact-sheets/dss-program-standards-chart-effective-100126.pdf?hash=77ABD2762166ADA3CE354D477140E450&rev=f5b00ab1ef7a431db97e602bf31f9d00", "accessed": "2026-11-16", "method": "pdf", "supports": "Current DSS standards; W01 $2,982, home equity $1,130,000, CSPA $50,000 minimum/$162,660 maximum." }, { "id": "CT-2", "title": "HUSKY qualification guide", "url": "https://portal.ct.gov/husky/how-to-qualify", "accessed": "2026-11-16", "method": "page", "supports": "HUSKY C countable-income standards $851/$1,153 excluding disregard; assets $1,600/$2,400; institutional reference $2,982." }, { "id": "CT-3", "title": "DSS long-term-care FAQ", "url": "https://portal.ct.gov/dss/health-and-home-care/long-term-care/long-term-services-and-supports---ltss/faq", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Applicant resource $1,600, spouse assessment and application documentation." }, { "id": "CT-4", "title": "OPM government programs and long-term care", "url": "https://portal.ct.gov/OPM/PDPD-HHS-Long-Term-Care/Consumer/Partnership-Consumer-Government-Programs", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Home exceptions, spouse treatment and ordinary $75 personal-needs amount; some income allowances on page are older." }, { "id": "CT-5", "title": "DSS 2026 medically needy decision", "url": "https://portal.ct.gov/dss/-/media/departments-and-agencies/dss/fair-hearings/other-medicaid-eligibility/other-medicaid-eligibility-2026/omel_2026_281818.pdf?rev=bf9c29ca676e44e380b670f55805dd0e", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Applied income, $851 MNIL and six-month medical-expense spend-down methodology." }, { "id": "CT-6", "title": "DSS decision quoting LTSS transfer and recovery policy", "url": "https://portal.ct.gov/dss/-/media/departments-and-agencies/dss/fair-hearings/ltss-eligibility/ltss-eligibility-2025/ltel_2025_267924.pdf?rev=9fa2cbae981641118a0cd13b451d036c", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "60-month transfer review and UPM7025.10 family protections in recovery." }, { "id": "CT-7", "title": "DAS estate questions for nursing-home Medicaid", "url": "https://portal.ct.gov/das/knowledge-base/articles/collections/my-relative-passed-away-while-residing-in-a-nursing-home-while-on-title-19", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "DAS Collections and probate estate investigation." }, { "id": "CT-8", "title": "Connecticut FY2026–2027 program addendum", "url": "https://portal.ct.gov/-/media/opm/budget/2026_2027_biennial_budget/biennial-budget-program-addendum-fy-2026-2027.pdf?hash=DEFFEEB1C5B1061A27C143D95E50396A&rev=ee44e39b2e4440628075c0caf5bf93bf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Different state-funded and Medicaid home-care pathways; general HUSKY C assets and spend-down." } ], "programs": { "nursing_home": { "name": { "en": "HUSKY C institutional long-term services", "es": "Servicios prolongados institucionales HUSKY C" }, "income_rule_type": "program_specific", "single": { "income": 2982, "assets": 1600, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "Published institutional reference; DSS must determine applicable income pathway and contribution.", "es": "Referencia institucional publicada; DSS determina la vía económica y aportación aplicables." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "CT-2", "CT-3" ] }, "married_one": { "income": null, "assets": 1600, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Applicant-side limit after the applicable spousal assessment; not total marital assets.", "es": "Límite del solicitante tras la evaluación conyugal; no representa todos los bienes matrimoniales." }, "source_ids": [ "CT-2", "CT-3" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "CT-2", "CT-3" ] }, "note": { "en": "The public reference is not an automatic rejection threshold for every LTSS case.", "es": "La referencia pública no es un umbral automático de rechazo en cualquier caso LTSS." } }, "hcbs_waiver": { "name": { "en": "DSS Medicaid waiver financial category W01", "es": "Categoría económica W01 de waivers Medicaid de DSS" }, "income_rule_type": "program_specific", "single": { "income": 2982, "assets": 1600, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "W01 reference; confirm the named waiver and budgeting with DSS.", "es": "Referencia W01; confirma con DSS el waiver concreto y su cálculo." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "CT-1", "CT-8" ] }, "married_one": { "income": null, "assets": 1600, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Applicant-side limit after the applicable spousal assessment; not total marital assets.", "es": "Límite del solicitante tras la evaluación conyugal; no representa todos los bienes matrimoniales." }, "source_ids": [ "CT-1", "CT-3", "CT-8" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "CT-1", "CT-8" ] }, "note": { "en": "This does not supply one eligibility rule for every Connecticut home-care program.", "es": "No establece una regla única para todos los programas domiciliarios de Connecticut." } }, "abd_regular": { "name": { "en": "HUSKY C medically needy community coverage", "es": "Cobertura comunitaria HUSKY C para necesidades médicas" }, "income_rule_type": "medically_needy_spenddown", "single": { "income": 851, "assets": 1600, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "MNIL excludes the unearned-income disregard; do not compare directly with gross receipts.", "es": "MNIL sin incluir deducción de ingreso no laboral; no comparar directamente con cobros brutos." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "CT-1", "CT-2", "CT-5" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "CT-2", "CT-5" ] }, "married_both": { "income": 1153, "assets": 2400, "income_basis": "countable", "asset_basis": "couple_combined", "income_note": { "en": "Published married-couple standard before applicable disregard.", "es": "Estándar publicado de pareja antes de la deducción aplicable." }, "asset_note": { "en": "Combined countable resources where this couple rule applies.", "es": "Recursos computables conjuntos cuando corresponde esta regla de pareja." }, "source_ids": [ "CT-2" ] }, "note": { "en": "MED-Connect and other HUSKY categories have different financial rules.", "es": "MED-Connect y otras categorías HUSKY tienen reglas económicas distintas." } } }, "summary": { "en": "Connecticut’s HUSKY C covers older adults and people who are blind or disabled, including several long-term-care routes. DSS publishes $1,600 as the ordinary individual countable-asset reference, which is lower than the $2,000 often repeated in national articles. Its current public qualification page lists a $2,982 institutional income reference, but that number alone does not describe every income pathway or contribution calculation. For community medically needy coverage, the $851 standard concerns income after the applicable rules, not a simple comparison with the amount of a Social Security deposit.", "es": "HUSKY C cubre en Connecticut a adultos mayores y personas ciegas o con discapacidad, incluidas varias vías de cuidados prolongados. DSS publica $1.600 como referencia patrimonial computable individual, inferior a los $2.000 repetidos en artículos nacionales. Su página vigente indica una referencia institucional de ingresos de $2.982, pero esa cifra no describe todas las vías ni aportaciones. En cobertura comunitaria por necesidad médica, el estándar de $851 se relaciona con el ingreso calculado según las reglas, no simplemente con el abono de Seguridad Social." }, "excess_income_solution": { "en": "Connecticut recognizes a medically needy spend-down for eligible coverage groups. DSS compares applied income over the relevant budget period with its medically needy standard and considers allowable medical expenses. That process is distinct from reducing countable assets and from the amount a nursing-home resident contributes toward care. Ask DSS which program and budget period it is using before assembling bills. This guide does not recommend a QIT as a universal Connecticut solution, nor assume that a community spend-down automatically provides access to any requested waiver.", "es": "Connecticut reconoce un spend-down por necesidad médica para grupos elegibles. DSS compara los ingresos aplicados durante el período pertinente con su estándar y considera gastos médicos permitidos. Ese proceso difiere de reducir bienes computables y de la aportación de un residente al coste. Pregunta qué programa y período utiliza DSS antes de reunir facturas. Esta guía no recomienda QIT como solución universal en Connecticut ni supone que un spend-down comunitario dé acceso automáticamente a cualquier waiver solicitado." }, "exempt_assets_notes": { "en": "A home must be reviewed for both ordinary exclusion rules and any separate equity restriction. The October 2026 DSS standards list $1,130,000 for the institutional home-equity reference. Family occupancy and other recognized circumstances can change the analysis, so a property value alone is insufficient. Connecticut’s public long-term-care information also discusses qualifying Partnership insurance, which can affect asset protection under its own rules. Bring the policy if relevant rather than assuming any private long-term-care insurance creates the same protection. Classification comes before comparing countable assets with the limit.", "es": "Hay que revisar la vivienda según exclusiones ordinarias y restricción patrimonial independiente. Los estándares DSS de octubre de 2026 indican $1.130.000 para patrimonio neto inmobiliario institucional. La ocupación familiar y otras circunstancias pueden modificar el análisis; el valor solo no basta. La información estatal también trata seguros Partnership que permiten protección bajo sus propias reglas. Aporta la póliza si corresponde, sin suponer que cualquier seguro privado de cuidados produce la misma protección. Clasificar precede a comparar los bienes computables con el límite." }, "spousal_notes": { "en": "Connecticut calls the protected community-spouse assets the CSPA. Its current DSS standards show a $50,000 minimum and a $162,660 maximum for 2026; the state minimum should not be replaced with the smaller federal minimum found in some summaries. The actual protected amount still requires a spousal assessment. The applicant’s $1,600 reference applies after that analysis, not to the entire couple’s property. Income maintenance is another calculation. Explain whether the other spouse remains in the community or also needs institutional or waiver care.", "es": "Connecticut denomina CSPA a los bienes protegidos del cónyuge comunitario. Los estándares actuales DSS indican mínimo de $50.000 y máximo de $162.660 para 2026; no debe sustituirse el mínimo estatal por el federal inferior de algunos resúmenes. La protección concreta sigue requiriendo evaluación. La referencia de $1.600 del solicitante se aplica después, no a todos los bienes de la pareja. El mantenimiento de ingresos es otro cálculo. Explica si el otro cónyuge permanece en la comunidad o también necesita cuidados residenciales o waiver." }, "lookback_rules": { "en": "For relevant long-term-care applications, DSS reviews transfers within a 60-month look-back. It examines whether the applicant received fair value and whether a protected transfer or other exception applies. Historical changes in property ownership can matter even when the person currently has little cash. Keep the original transaction documents and explain any unusual account activity. A five-year review does not mean every family must independently obtain the same stack of statements before asking for help; follow the eligibility worker’s specific verification requests.", "es": "En solicitudes pertinentes de cuidados prolongados, DSS revisa transmisiones durante 60 meses. Examina si hubo contraprestación adecuada y si corresponde una transmisión protegida u otra excepción. Cambios históricos de propiedad pueden importar aunque ahora quede poco efectivo. Conserva documentos originales y explica movimientos inusuales. Revisar cinco años no obliga a toda familia a obtener por su cuenta idéntica pila de extractos antes de pedir ayuda; sigue las peticiones concretas del trabajador que evalúa la elegibilidad." }, "estate_recovery_merp": { "en": "Connecticut’s estate process involves DSS policy and the Department of Administrative Services Collections unit. State guidance describes investigation of estates following the death of people who received nursing-home Medicaid. Recovery rules include protections involving surviving spouses and qualifying children; the actual claim requires review. A home excluded from the application resource test is not automatically exempt from later recovery. Retain notices and probate documents, and ask which payments and property are included. An eligibility calculator cannot decide an estate’s obligations or an heir’s personal liability.", "es": "El proceso sucesorio implica reglas de DSS y la unidad Collections del Departamento de Servicios Administrativos. La información estatal describe investigaciones tras fallecer personas que recibieron Medicaid residencial. Existen protecciones relativas a cónyuges e hijos que cumplen requisitos; la reclamación concreta requiere revisión. Excluir una vivienda al solicitar no la exime automáticamente de recuperación posterior. Conserva avisos y documentos sucesorios y pregunta qué pagos y bienes se incluyen. Una calculadora no determina obligaciones hereditarias ni responsabilidad personal del heredero." }, "document_notes": { "en": "Prepare the HUSKY C or LTSS application appropriate to the requested services, rather than choosing a form solely by the word Medicaid. DSS may request income verification, account statements, property documents and spouse shelter costs. Keep records showing deductions from pensions or Social Security, since applied income can differ from gross payments. Ask for the written budget and identify whether a notice concerns eligibility, a spend-down or applied income toward care. These are different decisions and may require different supporting information. Keep the current dated DSS standards with the notice. This helps distinguish a change in published references from a change in the income attributed to your household.", "es": "Prepara la solicitud HUSKY C o LTSS correspondiente al servicio, sin elegir formulario únicamente por la palabra Medicaid. DSS puede pedir ingresos, extractos, inmuebles y gastos de vivienda del cónyuge. Conserva documentos de deducciones de pensiones o Seguridad Social, porque el ingreso aplicado puede diferir del bruto. Solicita el cálculo escrito e identifica si el aviso trata elegibilidad, spend-down o aportación a cuidados. Son decisiones distintas y pueden necesitar información justificativa diferente. Guarda los estándares DSS vigentes, con fecha, junto a la notificación. Así distinguirás un cambio de referencias publicadas de otro en los ingresos atribuidos a tu hogar." }, "faqs": [ { "q": { "en": "Is Connecticut’s individual asset limit $2,000?", "es": "¿El límite individual de Connecticut es $2.000?" }, "a": { "en": "The cited HUSKY C and LTSS guidance uses $1,600 for an individual.", "es": "Las guías HUSKY C y LTSS citadas utilizan $1.600 por persona." } }, { "q": { "en": "Can I compare gross income directly with $851?", "es": "¿Puedo comparar ingresos brutos directamente con $851?" }, "a": { "en": "No. The medically needy standard and applicable disregards require DSS budgeting.", "es": "No. El estándar y las deducciones requieren cálculo de DSS." } }, { "q": { "en": "Does every home-care program use W01 rules?", "es": "¿Todos los programas domiciliarios utilizan W01?" }, "a": { "en": "No. Connecticut has different Medicaid and state-funded home-care routes.", "es": "No. Existen vías distintas financiadas por Medicaid y por el estado." } }, { "q": { "en": "Why is the minimum CSPA not the federal figure?", "es": "¿Por qué el mínimo CSPA difiere del federal?" }, "a": { "en": "The October 2026 DSS chart explicitly lists Connecticut’s $50,000 minimum.", "es": "La tabla DSS de octubre de 2026 publica expresamente el mínimo estatal de $50.000." } } ] }, { "code": "FL", "state": "Florida", "state_es": "Florida", "slug_en": "florida-medicaid-income-asset-limits", "slug_es": "florida-limites-ingresos-bienes-medicaid", "medicaid_name": "Florida Medicaid", "agency_url": "https://www.myflfamilies.com/medicaid/", "reviewed": "2026-11-16", "income_rule_type": "income_cap_qit", "single_income_limit_ltc": 2982, "single_asset_limit_ltc": 2000, "csra_max_spouse_assets": 162660, "home_equity_limit": 752000, "lookback_months": 60, "personal_needs_allowance": 160, "sources": [ { "id": "FL-1", "title": "Florida DCF: July 2026 SSI-related financial standards", "url": "https://www.myflfamilies.com/documents/30451.pdf", "accessed": "2026-11-16", "method": "pdf", "supports": "ICP/HCBS 2982/5964 and resources 2000/3000; MEDS-AD 1171/1588 and 5000/6000; CSRA 162660; equity 752000; NH PNA 160; PDF visually inspected" }, { "id": "FL-2", "title": "Florida DCF: Qualified Income Trust information", "url": "https://www.myflfamilies.com/documents/27551.pdf", "accessed": "2026-11-16", "method": "pdf", "supports": "Gross-income basis; QIT legal review; patient responsibility and remainder repayment" }, { "id": "FL-3", "title": "Florida DCF: SSI-related Medicaid fact sheet", "url": "https://www.myflfamilies.com/documents/MSSI%20Fact%20Sheet.pdf", "accessed": "2026-11-16", "method": "pdf", "supports": "ICP assessment;60-month transfers; spousal evaluation; older dollar examples not used" }, { "id": "FL-4", "title": "Florida DCF: Medicaid program and applications", "url": "https://www.myflfamilies.com/medicaid/", "accessed": "2026-11-16", "method": "page", "supports": "MyACCESS; regular HCBS standards; WPwD separate expanded pathway" }, { "id": "FL-5", "title": "Florida AHCA: Third Party Liability", "url": "https://ahca.myflorida.com/medicaid/medicaid-policy-quality-and-operations/medicaid-operations/third-party-liability-tpl.html", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "State channel for estate and trust claims" }, { "id": "FL-6", "title": "Florida Elder Affairs: managed long-term care", "url": "https://elderaffairs.org/programs-and-services/statewide-medicaid-managed-care-long-term-care-program/", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "ADRC screening and LTC service enrollment distinct from financial eligibility" } ], "programs": { "nursing_home": { "name": { "en": "Institutional Care Program: standard 300%FBR route", "es": "Institutional Care Program: vía ordinaria 300%FBR" }, "income_rule_type": "income_cap_qit", "single": { "income": 2982, "assets": 2000, "income_basis": "gross", "asset_basis": "individual", "income_note": { "en": "Standard 300%FBR route before deductions; QIT review may be relevant above the reference.", "es": "Vía ordinaria 300%FBR antes de deducciones; puede corresponder revisión QIT si se supera." }, "asset_note": { "en": "Standard ICP/HCBS route; other coverage groups can have different resource rules.", "es": "Vía ordinaria ICP/HCBS; otras categorías pueden tener reglas patrimoniales diferentes." }, "source_ids": [ "FL-1", "FL-2" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "gross", "asset_basis": "applicant_only", "income_note": { "en": "Applicant’s gross income, not the sum of both spouses’ income.", "es": "Ingresos brutos del solicitante, no la suma de ambos cónyuges." }, "asset_note": { "en": "Applicant amount under the standard route after separate community-spouse protection.", "es": "Importe del solicitante en la vía ordinaria tras protección conyugal separada." }, "source_ids": [ "FL-1", "FL-2", "FL-3" ] }, "married_both": { "income": 5964, "assets": 3000, "income_basis": "gross", "asset_basis": "couple_combined", "income_note": { "en": "Published combined couple reference for this coverage group; DCF must confirm individual allocations.", "es": "Referencia conjunta publicada para esta categoría; DCF debe confirmar las asignaciones." }, "asset_note": { "en": "Combined couple resources, not 3000 per spouse.", "es": "Recursos conjuntos de pareja, no 3000 por cónyuge." }, "source_ids": [ "FL-1" ] }, "note": { "en": "Figures describe the standard 300%FBR route, not MEDS-AD or Working People with Disabilities.", "es": "Las cifras describen la vía ordinaria 300%FBR, no MEDS-AD ni Working People with Disabilities." } }, "hcbs_waiver": { "name": { "en": "SMMC Long-Term Care HCBS: standard route", "es": "SMMC Long-Term Care HCBS: vía ordinaria" }, "income_rule_type": "income_cap_qit", "single": { "income": 2982, "assets": 2000, "income_basis": "gross", "asset_basis": "individual", "income_note": { "en": "Standard 300%FBR route before deductions; QIT review may be relevant above the reference.", "es": "Vía ordinaria 300%FBR antes de deducciones; puede corresponder revisión QIT si se supera." }, "asset_note": { "en": "Standard ICP/HCBS route; other coverage groups can have different resource rules.", "es": "Vía ordinaria ICP/HCBS; otras categorías pueden tener reglas patrimoniales diferentes." }, "source_ids": [ "FL-1", "FL-2" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "gross", "asset_basis": "applicant_only", "income_note": { "en": "Applicant’s gross income, not the sum of both spouses’ income.", "es": "Ingresos brutos del solicitante, no la suma de ambos cónyuges." }, "asset_note": { "en": "Applicant amount under the standard route after separate community-spouse protection.", "es": "Importe del solicitante en la vía ordinaria tras protección conyugal separada." }, "source_ids": [ "FL-1", "FL-2", "FL-3" ] }, "married_both": { "income": 5964, "assets": 3000, "income_basis": "gross", "asset_basis": "couple_combined", "income_note": { "en": "Published combined couple reference for this coverage group; DCF must confirm individual allocations.", "es": "Referencia conjunta publicada para esta categoría; DCF debe confirmar las asignaciones." }, "asset_note": { "en": "Combined couple resources, not 3000 per spouse.", "es": "Recursos conjuntos de pareja, no 3000 por cónyuge." }, "source_ids": [ "FL-1" ] }, "note": { "en": "Figures describe the standard 300%FBR route, not MEDS-AD or Working People with Disabilities.", "es": "Las cifras describen la vía ordinaria 300%FBR, no MEDS-AD ni Working People with Disabilities." } }, "abd_regular": { "name": { "en": "MEDS-AD: aged or disabled community Medicaid", "es": "MEDS-AD: Medicaid comunitario para mayores o personas con discapacidad" }, "income_rule_type": "program_specific", "single": { "income": 1171, "assets": 5000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "July 2026 MEDS-AD reference; income disregards and categorical requirements apply.", "es": "Referencia MEDS-AD de julio 2026; se aplican exclusiones de ingresos y requisitos de categoría." }, "asset_note": { "en": "MEDS-AD resource reference, not the standard ICP amount.", "es": "Referencia patrimonial MEDS-AD, no el importe ICP ordinario." }, "source_ids": [ "FL-1", "FL-3" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "DCF must determine spouse deeming and coverage group.", "es": "DCF debe determinar imputación conyugal y categoría." }, "asset_note": { "en": "Married one-applicant budget not verified as a universal applicant-only amount.", "es": "No se verifica un importe universal para un solicitante casado." }, "source_ids": [ "FL-1", "FL-3" ] }, "married_both": { "income": 1588, "assets": 6000, "income_basis": "countable", "asset_basis": "couple_combined", "income_note": { "en": "Published MEDS-AD couple reference; not a gross-income automatic cutoff.", "es": "Referencia MEDS-AD de pareja; no es exclusión automática por ingresos brutos." }, "asset_note": { "en": "Combined MEDS-AD couple resource amount.", "es": "Importe conjunto de recursos MEDS-AD." }, "source_ids": [ "FL-1" ] }, "note": { "en": "MEDS-AD, SSI-linked Medicaid and medically-needy coverage are different categories; this is not a single rule for every older Floridian.", "es": "MEDS-AD, Medicaid vinculado a SSI y cobertura por necesidad médica son categorías distintas." } } }, "summary": { "en": "Florida divides financial eligibility work from the approval of long-term services. DCF determines most SSI-related Medicaid financial cases, while the care pathway involves other agencies and assessments. The standard Institutional Care Program and regular HCBS references for 2026 are $2,982 monthly income and $2,000 countable resources for an individual. They do not describe every aged-or-disabled category. The July state chart also lists MEDS-AD and a separate Working People with Disabilities pathway. Select the actual coverage group before interpreting a number or assuming a household cannot qualify.", "es": "Florida separa la elegibilidad económica de la aprobación de cuidados. DCF determina la mayoría de casos económicos Medicaid relacionados con SSI, mientras otras agencias y evaluaciones intervienen en los servicios. Las referencias ordinarias de Institutional Care Program y HCBS para 2026 son $2,982 mensuales y $2,000 de recursos computables individuales. No describen todas las categorías para mayores o personas con discapacidad. La tabla estatal de julio también incluye MEDS-AD y una vía separada Working People with Disabilities. Identifica la categoría antes de interpretar una cifra o descartar al hogar." }, "excess_income_solution": { "en": "DCF’s Qualified Income Trust guidance tests income before deductions such as Medicare premiums. A properly reviewed QIT may address excess income for specified long-term-care programs; it does not erase the resource test or the care assessment. Income considered through this arrangement can still affect patient responsibility. The ordinary Medically Needy share-of-cost pathway is a different coverage mechanism and should not be substituted for ICP or an HCBS waiver. Ask DCF which route applies and obtain its written requirements; this guide does not provide trust drafting or funding instructions.", "es": "Las instrucciones QIT de DCF examinan ingresos antes de deducciones como primas Medicare. Un fideicomiso de ingresos debidamente revisado puede abordar el exceso en determinados programas de larga duración; no elimina la prueba patrimonial ni asistencial. Esos ingresos pueden seguir afectando la aportación del paciente. La vía ordinaria Medically Needy con participación en costes es distinta y no sustituye ICP ni una exención HCBS. Pregunta a DCF cuál corresponde y solicita requisitos escritos; esta guía no proporciona instrucciones para redactar o financiar fideicomisos." }, "exempt_assets_notes": { "en": "The resource test depends on ownership and exclusions, not the total value of everything in the house. A qualifying residence, vehicles and other property can receive different treatment under the relevant coverage rules. Florida’s July 2026 chart lists a $752,000 home-equity reference, but protected occupants and other exceptions matter. Separately, the chart gives MEDS-AD resource figures of $5,000 for one person and $6,000 for a couple. Those figures cannot be mixed with the income test from the standard ICP route to manufacture a more favorable combination.", "es": "La prueba patrimonial depende de titularidad y exclusiones, no del valor de todo lo que hay en casa. Vivienda, vehículos y otros bienes pueden recibir tratamientos distintos según cobertura. La tabla de julio 2026 incluye una referencia de $752,000 de patrimonio inmobiliario, con excepciones por ocupantes protegidos y otras circunstancias. También establece recursos MEDS-AD de $5,000 individuales y $6,000 de pareja. No pueden mezclarse con la prueba de ingresos de ICP ordinario para crear una combinación más favorable que no corresponde a ninguna categoría." }, "spousal_notes": { "en": "When one spouse needs institutional or qualifying community long-term care and the other remains at home, DCF applies special spouse rules. The community-spouse resource allowance is separate from the applicant’s own resource amount. Income owned by the applicant is also distinguished from the at-home spouse’s income when the relevant institutional rules apply. Request the resource assessment and the calculation of any spouse income allocation. If both spouses apply, use the correct couple coverage category rather than treating both as if each had a spouse remaining outside the program.", "es": "Cuando un cónyuge necesita cuidados institucionales o comunitarios admisibles y el otro permanece en casa, DCF aplica reglas especiales. La asignación patrimonial comunitaria es distinta del importe propio del solicitante. También distingue ingresos del solicitante y del cónyuge en casa cuando corresponden reglas institucionales. Pide evaluación patrimonial y cálculo de cualquier asignación de ingresos. Si ambos solicitan cobertura, utiliza la categoría correcta de pareja; no trates a cada uno como si tuviera un cónyuge fuera del programa." }, "lookback_rules": { "en": "The DCF fact sheet identifies a 60-month review of transfers for institutional care. A sale, gift or change of ownership can require an explanation of value received and the circumstances. Some transfers have exceptions; a review period is not itself a period of ineligibility. Tell the eligibility office which long-term-care service is requested and ask which historical records it needs. Ordinary current resource eligibility, transfer penalties and estate recovery are three different questions. A favorable answer to one does not automatically resolve the other two.", "es": "El documento DCF identifica 60 meses de revisión de transferencias para cuidados institucionales. Una venta, donación o cambio de titular puede exigir explicar contraprestación y circunstancias. Algunas transferencias tienen excepciones; el periodo de revisión no es por sí mismo una sanción. Indica qué servicio solicitas y pregunta qué registros históricos necesita la oficina. Elegibilidad patrimonial actual, sanciones por transferencias y recuperación sucesoria son tres cuestiones diferentes. Una respuesta favorable en una de ellas no resuelve automáticamente las otras dos." }, "estate_recovery_merp": { "en": "AHCA’s Third Party Liability office handles Medicaid estate and trust claim information. A QIT can have its own remaining-balance repayment requirement, which is distinct from the broader estate-recovery process. The existence of Medicaid coverage does not by itself mean the state immediately takes a home. Household protections, ownership, the type of claim and applicable exceptions need review. The person administering an estate should request the actual claim and follow its response instructions, keeping the record of benefits and any trust correspondence available.", "es": "La oficina Third Party Liability de AHCA gestiona información de reclamaciones sucesorias y de fideicomisos. Un QIT puede exigir devolución de saldo restante, distinta de la recuperación sucesoria general. Tener Medicaid no significa por sí solo que el estado tome inmediatamente la vivienda. Deben revisarse protecciones familiares, titularidad, tipo de reclamación y excepciones. Quien administra la herencia debe pedir la reclamación concreta y seguir sus instrucciones, conservando registros de prestaciones y comunicaciones de cualquier fideicomiso." }, "document_notes": { "en": "Use MyACCESS or the official DCF application route and identify nursing-home or HCBS services when requested. Prepare current benefit letters, pension statements, account ownership, property information and relevant medical bills. If already screened for SMMC LTC, keep the ADRC or plan correspondence so the financial and service records can be matched. A QIT already in place needs official review documentation, not merely a bank account label. Keep a list of documents requested and submitted, and use the eligibility notice to identify the next outstanding decision.", "es": "Utiliza MyACCESS o la vía oficial DCF e identifica servicios residenciales o HCBS cuando se solicite. Prepara cartas de prestaciones, pensiones, titularidad de cuentas, información inmobiliaria y facturas pertinentes. Si ya hay evaluación SMMC LTC, conserva comunicaciones ADRC o del plan para enlazar expediente económico y asistencial. Un QIT existente necesita documentación de revisión oficial, no solo una etiqueta bancaria. Lleva una lista de documentos pedidos y entregados y consulta la notificación para identificar la siguiente decisión pendiente." }, "faqs": [ { "q": { "en": "Does Medicare premium withholding reduce the ICP income test?", "es": "¿La prima Medicare reduce la prueba de ingresos ICP?" }, "a": { "en": "DCF’s QIT guidance uses income before those deductions for the long-term-care income reference.", "es": "La guía QIT utiliza ingresos anteriores a esas deducciones para la referencia de larga duración." } }, { "q": { "en": "Is a QIT the same as a resource exemption?", "es": "¿Un QIT equivale a una exclusión patrimonial?" }, "a": { "en": "No. It addresses income under specific rules; resource eligibility and other requirements remain separate.", "es": "No. Aborda ingresos según reglas específicas; recursos y demás requisitos siguen separados." } }, { "q": { "en": "Why is MEDS-AD listed separately?", "es": "¿Por qué aparece MEDS-AD separado?" }, "a": { "en": "Its income and resource standards differ from the standard 300%FBR institutional and HCBS route.", "es": "Sus referencias económicas difieren de la vía institucional y HCBS ordinaria 300%FBR. También deben cumplirse los requisitos personales de cobertura." } }, { "q": { "en": "Is the $160 personal-needs allowance an eligibility limit?", "es": "¿Los $160 personales son un límite de acceso?" }, "a": { "en": "No. The nursing-home allowance concerns income retained after eligibility, not the gross-income ceiling.", "es": "No. La asignación residencial es dinero conservado tras elegibilidad, no el techo bruto." } } ] }, { "code": "IL", "state": "Illinois", "state_es": "Illinois", "slug_en": "illinois-medicaid-income-asset-limits", "slug_es": "illinois-limites-ingresos-bienes-medicaid", "medicaid_name": "Illinois Medicaid / AABD Medical", "agency_url": "https://www.dhs.state.il.us/page.aspx?item=21741", "reviewed": "2026-11-16", "income_rule_type": "medically_needy_spenddown", "single_income_limit_ltc": null, "single_asset_limit_ltc": 17500, "csra_max_spouse_assets": 143172, "home_equity_limit": 752000, "lookback_months": 60, "personal_needs_allowance": null, "sources": [ { "id": "IL-1", "title": "Illinois IDHS:2026 medical income and resource standards", "url": "https://www.dhs.state.il.us/page.aspx?item=21741", "accessed": "2026-11-16", "method": "page", "supports": "AABD 1330/1803, countable resource 17500 individual/couple; CSRA 143172; home equity 752000" }, { "id": "IL-2", "title": "Illinois HFS: AABD resource increase notice", "url": "https://hfs.illinois.gov/medicalproviders/notices/notice.prn230519a.html", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "17500 resource limit applies to individual and couple AABD Medical cases" }, { "id": "IL-3", "title": "Illinois Department on Aging: Community Care Program", "url": "https://ilaging.illinois.gov/programs/ccp.html", "accessed": "2026-11-16", "method": "page", "supports": "CCP age 60+,17500 nonexemptassets; home/car/furnishings exemptions; CCU assessment; Medicaid application requirement" }, { "id": "IL-4", "title": "Illinois HFS: community-care spousal protections", "url": "https://hfs.illinois.gov/info/brochures-and-forms/brochures/hfs2538a.html", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Special CCP spouse budgeting and 60-month transfer review; not old numericexamples" }, { "id": "IL-5", "title": "Illinois HFS: Medicaid Estate Recovery guide", "url": "https://hfs.illinois.gov/medicalclients/medicaidestaterecovery/guidetothemedicaidestaterecoveryprogram.html", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Survivor and hardship exceptions; estate claims" }, { "id": "IL-6", "title": "Illinois HFS: Estate Recovery FAQs", "url": "https://hfs.illinois.gov/medicalclients/medicaidestaterecovery/faqs.html", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Heirs notrequired to pay estate claims from own funds; property treatment" }, { "id": "IL-7", "title": "Illinois Administrative Code: medical assistance and spenddown", "url": "https://my.ilga.gov/agencies/JCAR/EntirePart?titlepart=08900120", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Countable-income/resource spenddown; medical expenses and coverage period" }, { "id": "IL-8", "title": "Illinois ABE: medical program descriptions", "url": "https://abe.illinois.gov/access/jsp/access/ABApplyWithoutAccount.jsp", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "AABD Medical and spenddown versus ACA pathways" } ], "programs": { "nursing_home": { "name": { "en": "AABD Medical nursing-facility budget", "es": "Presupuesto AABD Medical para residencia" }, "income_rule_type": "medically_needy_spenddown", "single": { "income": null, "assets": 17500, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "Institutional budgeting and allowable care expenses determine the income result; no universal gross limit entered.", "es": "Presupuesto institucional y gastos admisibles determinan el resultado; no se introduce tope bruto universal." }, "asset_note": { "en": "AABD Medical individual countable resources; not an exemption for every asset.", "es": "Recursos computables individuales AABD; no excluye automáticamente cada bien." }, "source_ids": [ "IL-1", "IL-2", "IL-7" ] }, "married_one": { "income": null, "assets": 17500, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "Applicant budgeting and spouse allowances require an FCRC calculation.", "es": "El FCRC debe calcular presupuesto del solicitante y asignaciones conyugales." }, "asset_note": { "en": "Applicant resource standard after any community-spouse treatment, not total marital assets.", "es": "Referencia del solicitante tras protección conyugal, no patrimonio matrimonial total." }, "source_ids": [ "IL-1", "IL-2" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Two institutional budgets are not replaced with a community household income reference.", "es": "Dos presupuestos institucionales no se sustituyen por referencia de hogar comunitario." }, "asset_note": { "en": "Combined institutional treatment needs confirmation; do not double 17500 automatically.", "es": "Debe confirmarse tratamiento institucional conjunto; no dupliques 17500 automáticamente." }, "source_ids": [ "IL-1", "IL-7" ] }, "note": { "en": "The table separates the institutional contribution calculation from ordinary community AABD income standards.", "es": "Se separa la aportación institucional de las referencias de ingresos AABD comunitarias." } }, "hcbs_waiver": { "name": { "en": "Older-adult HCBS through Community Care Program: program review", "es": "HCBS para mayores mediante Community Care Program: revisión del programa" }, "income_rule_type": "program_specific", "single": { "income": null, "assets": 17500, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "CCP service eligibility and Medicaid income eligibility are separate; no universal HCBS gross cap verified.", "es": "Elegibilidad CCP y económica Medicaid son separadas; no se verifica tope bruto HCBS universal." }, "asset_note": { "en": "CCP published nonexempt asset reference.", "es": "Referencia publicada CCP de activos no exentos." }, "source_ids": [ "IL-3" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Special CCP spouse budgeting may apply; ask the CCU and FCRC.", "es": "Puede corresponder presupuesto conyugal CCP; consulta CCU y FCRC." }, "asset_note": { "en": "Do not apply 17500 to the couple’s entire estate without spouse assessment.", "es": "No apliques 17500 a todo el patrimonio matrimonial sin evaluar protección." }, "source_ids": [ "IL-3", "IL-4" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Both participants need CCP service assessment and the applicable Medicaid category.", "es": "Ambos necesitan evaluación CCP y categoría Medicaid aplicable." }, "asset_note": { "en": "No combined waiver threshold is inferred from an individual service reference.", "es": "No se deduce umbral conjunto de una referencia asistencial individual." }, "source_ids": [ "IL-3", "IL-4" ] }, "note": { "en": "CCP includes a state-funded context; Medicaid enrollment when eligible and waiver financial rules must be identified.", "es": "CCP incluye un contexto de financiación estatal; deben identificarse afiliación Medicaid y reglas económicas de exención." } }, "abd_regular": { "name": { "en": "Community AABD Medical", "es": "AABD Medical comunitario" }, "income_rule_type": "medically_needy_spenddown", "single": { "income": 1330, "assets": 17500, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "2026 AABD one-person countable-income standard; deductions and spenddown may matter.", "es": "Referencia AABD 2026 individual de ingresos computables; importan deducciones yspenddown." }, "asset_note": { "en": "One-person AABD Medical resource standard.", "es": "Referencia individual AABD Medical." }, "source_ids": [ "IL-1" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Household and spouse-deeming treatment must be established.", "es": "Debe determinarse hogar e imputación conyugal." }, "asset_note": { "en": "No applicant-only amount inferred from the couple reference.", "es": "No se deduce importe individual de la referencia de pareja." }, "source_ids": [ "IL-1" ] }, "married_both": { "income": 1803, "assets": 17500, "income_basis": "countable", "asset_basis": "couple_combined", "income_note": { "en": "Official IDHS two-person standard, not rounded up from a federal calculation.", "es": "Referencia oficial IDHS de dos personas, no redondeada desde cálculo federal." }, "asset_note": { "en": "17500 combined for two people, not 17500 each.", "es": "17500 conjuntos para dos personas, no 17500 cada una." }, "source_ids": [ "IL-1" ] }, "note": { "en": "Use AABD Medical figures, not AABD cash or Medicare Savings Program resource amounts.", "es": "Utiliza cifras AABD Medical, no ayudas en efectivo AABD ni programas de ahorro Medicare." } } }, "summary": { "en": "Illinois publishes different rules for AABD Medical, nursing-facility budgeting and older-adult services through the Community Care Program. The 2026 IDHS table gives community AABD countable-income references of $1,330 for one person and $1,803 for two, with a $17,500 resource standard for either unit size. Those are not gross-income cutoffs for every long-term-care situation. Begin with the Family Community Resource Center for Medicaid finances and a local Care Coordination Unit for CCP services. The service assessment and the financial decision should be followed as separate parts of the application.", "es": "Illinois publica reglas diferentes para AABD Medical, presupuesto residencial y servicios para mayores mediante Community Care Program. La tabla IDHS 2026 indica ingresos computables comunitarios de $1,330 para una persona y $1,803 para dos, con referencia patrimonial de $17,500 en ambos tamaños. No son topes brutos para toda situación de cuidados prolongados. Empieza en Family Community Resource Center para finanzas Medicaid y Care Coordination Unit para servicios CCP. Conviene seguir evaluación asistencial y decisión económica como partes separadas de la solicitud." }, "excess_income_solution": { "en": "Illinois has an AABD spenddown framework for eligible people whose countable income or resources exceed the regular standard. Qualifying medical expenses and, in an applicable arrangement, a pay-in process can affect the spenddown obligation. The office decides which expense dates and amounts count and when coverage begins. This is not permission to assume that any purchase reduces an eligibility problem. Nursing-facility budgeting also considers care costs and applicable allowances. Ask for the written spenddown or contribution calculation, rather than using a QIT formula taken from an income-cap state.", "es": "Illinois dispone de un sistema spenddown AABD para personas elegibles cuyos ingresos o recursos computables exceden la referencia ordinaria. Gastos médicos admisibles y, en modalidades apropiadas, un proceso de pago pueden afectar la obligación. La oficina determina fechas, importes y comienzo de cobertura. No significa que cualquier compra resuelva un problema económico. El presupuesto residencial también contempla costes asistenciales y asignaciones. Solicita cálculo escrito de spenddown o aportación, en lugar de aplicar una fórmula QIT de un estado con tope de ingresos." }, "exempt_assets_notes": { "en": "The $17,500 AABD Medical reference applies to a one-person or two-person unit; it is not automatically doubled for a couple. Do not confuse it with the lower AABD cash-assistance resource figures displayed in the same manual. CCP identifies the home, car and personal furnishings as excluded examples, while Medicaid long-term-care home equity has its own reference and exceptions. List ownership and use before asking how an item is treated. A resource excluded for current eligibility can still raise a different question under estate-recovery rules after death.", "es": "La referencia AABD Medical de $17,500 corresponde a una unidad de una o dos personas; no se duplica automáticamente para pareja. No la confundas con cifras inferiores de ayuda en efectivo AABD que aparecen en el mismo manual. CCP identifica vivienda, coche y muebles como ejemplos excluidos, mientras el patrimonio inmobiliario Medicaid de larga duración tiene referencia y excepciones propias. Enumera titularidad y uso antes de consultar su tratamiento. Un recurso excluido actualmente puede plantear otra cuestión en recuperación sucesoria después del fallecimiento." }, "spousal_notes": { "en": "The current IDHS 2026 standards list an Illinois community-spouse resource allowance of $143,172. That matters because a national chart may instead show the larger federal maximum and incorrectly label it the Illinois amount. The applicant’s own resource allowance and a possible spouse income allocation are separate. For CCP, HFS provides specific guidance for married people when one receives community services. Request the calculation for the actual program and household, including which spouse’s income was considered. Two applicants should not each be assigned the protection intended for a spouse outside care.", "es": "Los estándares IDHS 2026 indican asignación patrimonial conyugal de Illinois de $143,172. Importa porque una tabla nacional puede mostrar el máximo federal superior y etiquetarlo incorrectamente como importe estatal. El recurso propio del solicitante y una posible asignación de ingresos son conceptos separados. HFS ofrece reglas específicas CCP para matrimonios donde uno recibe servicios comunitarios. Pide cálculo del programa y hogar reales, incluidos ingresos considerados. No asignes a cada solicitante la protección concebida para un cónyuge fuera de los cuidados." }, "lookback_rules": { "en": "HFS describes a 60-month transfer review in the relevant long-term-care context, including its guidance for married CCP participants. A recent gift or ownership change needs review of the transaction and any exception; the passage of time alone does not establish whether a penalty applies. Keep records showing the asset, date, value and consideration received. Explain the service requested when asking the office for documentation requirements. Ordinary AABD resource budgeting and a long-term-care transfer penalty are different tests, so satisfying one does not necessarily settle the other.", "es": "HFS describe revisión de 60 meses en el contexto pertinente de larga duración, incluida su guía para matrimonios CCP. Un regalo o cambio de titular reciente exige revisar operación y excepciones; el tiempo transcurrido no determina por sí solo una sanción. Guarda bien, fecha, valor y contraprestación recibida. Explica qué servicio solicitas al preguntar requisitos documentales. El presupuesto patrimonial AABD ordinario y una sanción por transferencias son pruebas distintas; cumplir una no resuelve necesariamente la otra en el expediente de atención." }, "estate_recovery_merp": { "en": "Illinois HFS explains that recovery is directed at an estate and provides exceptions for protected surviving family members and undue hardship. Its FAQ distinguishes an estate claim from a demand that heirs use their own money. The rules concerning real-property liens have also changed over time, making old blanket statements about the state taking every house unreliable. An estate representative should request the claim detail and submit relevant survivor or hardship information through the official process. The result depends on the estate and applicable rules, not simply whether Medicaid once covered a doctor visit.", "es": "HFS explica que la recuperación se dirige al patrimonio sucesorio y contempla excepciones por supervivientes protegidos y dificultades. Su FAQ distingue reclamación a la herencia de exigir dinero propio a los herederos. Las reglas de gravámenes inmobiliarios también han cambiado; no son fiables afirmaciones antiguas de que el estado toma toda vivienda. El representante debe pedir detalle y aportar información familiar o de dificultades por el proceso oficial. El resultado depende de herencia y reglas aplicables, no simplemente de que Medicaid pagara alguna consulta." }, "document_notes": { "en": "Prepare current benefit statements, pension information, bank ownership and balances, property records and medical expenses relevant to a spenddown review. Include prior notices identifying AABD Medical rather than cash assistance or a Medicare Savings Program. For CCP, retain the CCU needs assessment and provider communications, but do not assume they replace Medicaid financial verification. Ask the FCRC to state missing documents and the budget unit used. Keep submission receipts and review dates, particularly when a household change or a new service request requires a different calculation.", "es": "Prepara prestaciones actuales, pensiones, titularidad y saldos bancarios, inmuebles y gastos médicos relevantes. Incluye notificaciones que identifiquen AABD Medical, no ayuda en efectivo ni programa de ahorro Medicare. Para CCP, conserva evaluación CCU y comunicaciones de proveedores, sin suponer que sustituyen verificación económica Medicaid. Pide al FCRC documentos pendientes y unidad presupuestaria utilizada. Guarda comprobantes y fechas de revisión, especialmente cuando cambia el hogar o se solicita un servicio que requiere otro cálculo y debe comunicarse a la oficina competente." }, "faqs": [ { "q": { "en": "Does an Illinois couple get $35,000 automatically?", "es": "¿Una pareja recibe automáticamente $35,000 de margen?" }, "a": { "en": "No. The community AABD Medical table lists $17,500 for a two-person unit, subject to applicable budgeting rules.", "es": "No. La tabla AABD Medical comunitaria indica $17,500 para dos personas, según reglas presupuestarias." } }, { "q": { "en": "Is the federal CSRA maximum the Illinois figure?", "es": "¿El máximo federal CSRA es la cifra de Illinois?" }, "a": { "en": "No. The reviewed IDHS 2026 table lists $143,172 for Illinois; use the state assessment.", "es": "No. La tabla IDHS 2026 revisada indica $143,172; utiliza la evaluación estatal." } }, { "q": { "en": "Does a CCP assessment approve Medicaid finances?", "es": "¿La evaluación CCP aprueba las finanzas Medicaid?" }, "a": { "en": "No. The CCU service assessment and Medicaid financial determination have distinct roles.", "es": "No. Evaluación asistencial CCU y decisión económica Medicaid tienen funciones diferentes." } }, { "q": { "en": "Must heirs pay estate claims with personal savings?", "es": "¿Los herederos deben pagar con ahorros propios?" }, "a": { "en": "HFS states heirs are not required to use their own funds to pay an estate-recovery claim.", "es": "HFS indica que no se exige a herederos usar fondos propios para la reclamación sucesoria." } } ] }, { "code": "IN", "state": "Indiana", "state_es": "Indiana", "slug_en": "indiana-medicaid-income-asset-limits", "slug_es": "indiana-limites-ingresos-bienes-medicaid", "medicaid_name": "Indiana Medicaid / PathWays for Aging", "agency_url": "https://www.in.gov/medicaid/members/apply-for-medicaid/eligibility-guide", "reviewed": "2026-11-16", "income_rule_type": "income_cap_qit", "single_income_limit_ltc": 2982, "single_asset_limit_ltc": 2000, "csra_max_spouse_assets": 162660, "home_equity_limit": 752000, "lookback_months": 60, "personal_needs_allowance": null, "sources": [ { "id": "IN-1", "title": "Indiana Medicaid manual chapter 3000", "url": "https://secure.in.gov/fssa/ompp/files/Medicaid_PM_3000.pdf", "accessed": "2026-11-16", "method": "pdf", "supports": "2026 SIL $2,982, individual/spousal resource rules and $3,000 combined when both spouses receive institutional/waiver services." }, { "id": "IN-2", "title": "Indiana Medicaid eligibility guide, 2026", "url": "https://www.in.gov/medicaid/members/apply-for-medicaid/eligibility-guide", "accessed": "2026-11-16", "method": "page", "supports": "2026 ABD public reference $1,330/$1,803.33; assets $2,000/$3,000 and application routes." }, { "id": "IN-3", "title": "Miller trust instructional materials", "url": "https://www.in.gov/dA/a4caf582b2/Millertrustinstructions.pdf?language_id=1", "accessed": "2026-11-16", "method": "pdf", "supports": "Institutional/HCBS trust scope, gross earned and unearned versus net self-employment/rental treatment." }, { "id": "IN-4", "title": "Indiana spousal impoverishment protection", "url": "https://www.in.gov/iltcp/medicaid/spousal-impoverishment-protection-law", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "2026 community-spouse maximum $162,660 and individual applicant $2,000." }, { "id": "IN-5", "title": "Indiana Medicaid combined policy manual", "url": "https://www.in.gov/fssa/ompp/files/Medicaid_Combined_PM.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "2026 home-equity restriction $752,000 and transfer/trust considerations." }, { "id": "IN-6", "title": "Transfer review period policy", "url": "https://www.in.gov/fssa/ompp/files/2640.10.10DETERMINING-THE-TRANSFER-REVIEW-PERIOD.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "60-month review applies in institutional/HCBS circumstances." }, { "id": "IN-7", "title": "Indiana Medicaid estate recovery", "url": "https://secure.in.gov/fssa/ompp/medicaid-estate-recovery/", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Estate recovery, QIT remaining funds and notice requirements." }, { "id": "IN-8", "title": "PathWays waiver provider module, June 2026", "url": "https://www.in.gov/medicaid/providers/files/modules/ompp-hcbs-waiver.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "PathWays waiver age60+, distinct authorization and waiver liability." }, { "id": "IN-9", "title": "HCBS waiver waiting-list information", "url": "https://secure.in.gov/fssa/ddars/resources/individuals/hcbs-waiver-waiting-list-information/", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "PathWays and Health and Wellness eligibility and capacity-based waiver waiting lists." }, { "id": "IN-10", "title": "Indiana Medicaid estate recovery manual", "url": "https://www.in.gov/fssa/ompp/files/Medicaid_PM_4700.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Hardship review and recovery procedures." } ], "programs": { "nursing_home": { "name": { "en": "Indiana institutional Medicaid special income level", "es": "Nivel especial de ingresos Medicaid institucional de Indiana" }, "income_rule_type": "income_cap_qit", "single": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "2026 SIL; wages/pensions use gross amounts, while self-employment and rental categories use specified net rules.", "es": "SIL de 2026; salarios/pensiones utilizan bruto y actividad propia/alquiler las reglas netas correspondientes." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "IN-1", "IN-3" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "Individual SIL reference; DFR must confirm attribution and income types.", "es": "Referencia SIL individual; DFR debe confirmar atribución y tipos de ingreso." }, "asset_note": { "en": "Applicant-side limit after the applicable spousal assessment; not total marital assets.", "es": "Límite del solicitante tras la evaluación conyugal; no representa todos los bienes matrimoniales." }, "source_ids": [ "IN-1", "IN-3", "IN-4" ] }, "married_both": { "income": null, "assets": 3000, "income_basis": "contextual", "asset_basis": "couple_combined", "income_note": { "en": "No verified combined income ceiling; each applicable income budget needs review.", "es": "Sin tope conjunto verificado; revisar cada presupuesto de ingresos aplicable." }, "asset_note": { "en": "Chapter 3000 specifies $3,000 combined when spousal-impoverishment rules do not apply, including both spouses receiving LTC/waiver.", "es": "El capítulo 3000 especifica $3.000 conjuntos sin protección conyugal, incluido cuando ambos reciben LTC/waiver." }, "source_ids": [ "IN-1" ] }, "note": { "en": "Financial approval does not replace institutional clinical eligibility.", "es": "La aprobación económica no sustituye elegibilidad clínica institucional." } }, "hcbs_waiver": { "name": { "en": "PathWays for Aging HCBS waiver", "es": "Waiver HCBS PathWays for Aging" }, "income_rule_type": "income_cap_qit", "single": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "2026 SIL; wages/pensions use gross amounts, while self-employment and rental categories use specified net rules.", "es": "SIL de 2026; salarios/pensiones utilizan bruto y actividad propia/alquiler las reglas netas correspondientes." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "IN-1", "IN-3" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "Individual SIL reference; DFR must confirm attribution and income types.", "es": "Referencia SIL individual; DFR debe confirmar atribución y tipos de ingreso." }, "asset_note": { "en": "Applicant-side limit after the applicable spousal assessment; not total marital assets.", "es": "Límite del solicitante tras la evaluación conyugal; no representa todos los bienes matrimoniales." }, "source_ids": [ "IN-1", "IN-3", "IN-4" ] }, "married_both": { "income": null, "assets": 3000, "income_basis": "contextual", "asset_basis": "couple_combined", "income_note": { "en": "No verified combined income ceiling; each applicable income budget needs review.", "es": "Sin tope conjunto verificado; revisar cada presupuesto de ingresos aplicable." }, "asset_note": { "en": "Chapter 3000 specifies $3,000 combined when spousal-impoverishment rules do not apply, including both spouses receiving LTC/waiver.", "es": "El capítulo 3000 especifica $3.000 conjuntos sin protección conyugal, incluido cuando ambos reciben LTC/waiver." }, "source_ids": [ "IN-1" ] }, "note": { "en": "PathWays waiver admission and any service liability remain separate from the SIL reference.", "es": "Admisión al waiver y aportación son independientes de la referencia SIL." } }, "abd_regular": { "name": { "en": "Aged, blind or disabled community Medicaid", "es": "Medicaid comunitario para mayores, ciegos o personas con discapacidad" }, "income_rule_type": "program_specific", "single": { "income": 1330, "assets": 2000, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "State public ABD reference; categorical budgeting and disregards require DFR review.", "es": "Referencia pública ABD estatal; DFR debe revisar categoría y deducciones." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "IN-1", "IN-2" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Spouse income budgeting must be determined individually.", "es": "Debe determinarse individualmente la atribución de ingresos conyugales." }, "asset_note": { "en": "The ordinary community couple reference is $3,000 combined; an applicant-only amount is not verified here.", "es": "La referencia ordinaria comunitaria es $3.000 conjuntos; aquí no se verifica un importe exclusivo del solicitante." }, "source_ids": [ "IN-1", "IN-2" ] }, "married_both": { "income": 1803.33, "assets": 3000, "income_basis": "contextual", "asset_basis": "couple_combined", "income_note": { "en": "Published two-person ABD reference; not an unconditional gross-income test.", "es": "Referencia ABD publicada de dos personas; no es prueba bruta incondicional." }, "asset_note": { "en": "Combined countable resources where this couple rule applies.", "es": "Recursos computables conjuntos cuando corresponde esta regla de pareja." }, "source_ids": [ "IN-1", "IN-2" ] }, "note": { "en": "The ordinary ABD reference is not the special institutional or HCBS income level.", "es": "La referencia ordinaria ABD no es el nivel especial institucional o HCBS." } } }, "summary": { "en": "Indiana distinguishes the Medicaid eligibility determination from enrollment in a particular care program. The 2026 special income level for institutional and qualifying waiver services is $2,982 per month, while the public aged, blind or disabled guide lists a different community reference. PathWays for Aging serves adults aged 60 and older, but health-plan enrollment is not the same as access to the PathWays HCBS waiver. Identify the requested service first, then ask the Division of Family Resources which financial category applies. A calculation below one reference cannot establish the required clinical level of care.", "es": "Indiana distingue la decisión de elegibilidad Medicaid de la inscripción en un programa concreto. El nivel especial de ingresos de 2026 para servicios institucionales y waivers pertinentes es $2.982 mensuales, mientras la guía pública ABD indica otra referencia comunitaria. PathWays for Aging atiende desde los 60 años, pero inscribirse en el plan médico no equivale a acceder al waiver HCBS. Identifica primero el servicio y pregunta a la División de Recursos Familiares qué categoría económica corresponde. Estar por debajo de una cifra no acredita la necesidad clínica exigida." }, "excess_income_solution": { "en": "Indiana’s Miller trust guidance addresses people in nursing homes or receiving Medicaid waiver services whose income exceeds the applicable special level. It specifically distinguishes gross wages and pensions from the net treatment used for certain self-employment and rental income. For that reason, the table does not treat every gross receipt as identical. A trust concerns income and carries continuing conditions; it does not remove the asset test or guarantee a waiver place. Ask DFR which income was counted and what further review is needed, without moving property based on a calculator result.", "es": "Las instrucciones Miller de Indiana se refieren a personas en residencia o con servicios waiver cuyos ingresos superan el nivel especial. Distinguen expresamente salarios y pensiones brutos del tratamiento neto de determinados ingresos por actividad propia y alquiler. Por eso la tabla no trata todos los cobros brutos igual. El fideicomiso se refiere a ingresos y exige cumplimiento continuo; no elimina la prueba patrimonial ni garantiza una plaza. Pregunta a DFR qué ingresos contó y qué revisión falta, sin mover bienes basándote en la calculadora." }, "exempt_assets_notes": { "en": "Chapter 3000 sets a $2,000 countable-resource reference for a single applicant or an applicant with a qualifying community spouse. Indiana’s public guide distinguishes the home occupied by the applicant, a vehicle and burial spaces from ordinary cash resources, but individual exclusions require verification. The 2026 home-equity reference is $752,000 for the relevant long-term-care restriction. Give the worker ownership and debt information rather than just a real-estate listing. A home exclusion, a Partnership-insurance disregard and protection from estate recovery are related but separate determinations.", "es": "El capítulo 3000 fija $2.000 computables para solicitante individual o con cónyuge comunitario pertinente. La guía distingue vivienda ocupada, vehículo y espacios funerarios de recursos monetarios ordinarios, pero hay que verificar cada exclusión. La referencia inmobiliaria de 2026 es $752.000 para la restricción prolongada correspondiente. Facilita titularidad y deudas, no únicamente un anuncio inmobiliario. Exclusión de vivienda, protección por seguro Partnership y recuperación sucesoria son decisiones relacionadas pero distintas que necesitan su propia comprobación." }, "spousal_notes": { "en": "Indiana’s manual is unusually clear about the difference between one and two spouses receiving long-term care. Community-spouse protections may apply when one spouse receives institutional or waiver services and the other remains outside those arrangements. When both spouses receive specified institutional, HCBS or PACE services, the manual describes a $3,000 combined resource standard instead. It is therefore incorrect to publish $2,000 times two as a universal couple allowance. For a qualifying community spouse, the 2026 maximum protected amount is $162,660, subject to the assessment rather than an automatic award.", "es": "El manual de Indiana aclara especialmente la diferencia entre uno y dos cónyuges con cuidados prolongados. Puede existir protección comunitaria si uno recibe servicios institucionales o waiver y el otro permanece fuera de esas modalidades. Si ambos reciben determinados servicios institucionales, HCBS o PACE, describe un estándar patrimonial conjunto de $3.000. Por eso no procede publicar $2.000 multiplicado por dos como franquicia universal. Para cónyuge comunitario pertinente, el máximo protegido de 2026 es $162.660, sujeto a evaluación y sin concesión automática." }, "lookback_rules": { "en": "Indiana’s transfer-review policy uses a 60-month look-back in the relevant institutional and HCBS cases. It examines whether property was transferred for less than fair value, with specific exceptions and trust rules. The policy also distinguishes the baseline date from transactions occurring after it, so the review is not limited to a one-time snapshot. Keep records explaining unusual payments, changes in title and earlier care arrangements. Ask for the written reason if a transfer is questioned; an unexplained withdrawal and a documented purchase are not necessarily equivalent.", "es": "La política de transmisiones utiliza 60 meses en los casos institucionales y HCBS pertinentes. Examina entregas patrimoniales por debajo de valor, con excepciones y reglas fiduciarias. Distingue además la fecha de referencia de operaciones posteriores; no es una instantánea única. Conserva explicaciones de pagos inusuales, cambios de titularidad y acuerdos de cuidados previos. Pide por escrito el motivo de una operación cuestionada: una retirada sin explicar y una compra documentada no son necesariamente equivalentes para esta evaluación." }, "estate_recovery_merp": { "en": "FSSA’s estate-recovery information explains that the state may claim repayment after a Medicaid member’s death and separately identifies funds remaining in a Qualified Income Trust. Managed-care payments can also be relevant; the claim is not necessarily limited to bills the family saw from individual providers. Recovery procedures include a hardship-review process, and the applicable family protections require case-specific review. Retain the state notice and the estate’s records. Excluding an asset when applying does not promise that the same property is permanently outside every recovery rule.", "es": "FSSA explica que el estado puede reclamar reembolso tras fallecer un miembro Medicaid e identifica por separado fondos restantes en un Qualified Income Trust. También pueden importar pagos a planes gestionados; la reclamación no se limita necesariamente a facturas de proveedores que vio la familia. Existe revisión por dificultad y las protecciones familiares requieren análisis individual. Conserva notificación y documentos hereditarios. Excluir un bien al solicitar no promete que quede permanentemente fuera de todas las reglas de recuperación." }, "document_notes": { "en": "Use the DFR financial application route and keep contact details for the person coordinating the care assessment. For PathWays HCBS, also verify whether the applicant is waiting for waiver access; a financial approval does not resolve capacity. Prepare benefit letters showing gross and withheld amounts, financial statements, property ownership and spouse information. Ask which historical records are requested and for what period. Keep notices about eligibility, waiver status and any patient or waiver liability separately so a change in one is not mistaken for a change in all three. If one spouse moves between a facility and home services, ask whether the resource assessment must be updated for the changed living arrangement.", "es": "Utiliza la solicitud económica DFR y conserva el contacto que coordina la evaluación de cuidados. Para PathWays HCBS verifica además si existe espera de acceso; una aprobación económica no resuelve disponibilidad. Prepara cartas con importes brutos y retenidos, extractos, propiedad y datos conyugales. Pregunta qué registros históricos se necesitan y para qué período. Separa avisos de elegibilidad, situación del waiver y aportación del paciente, evitando interpretar un cambio en uno como modificación de los tres. Si un cónyuge pasa de residencia a servicios domiciliarios, pregunta si debe actualizarse la evaluación patrimonial para reflejar esa nueva organización de cuidados." }, "faqs": [ { "q": { "en": "Do both spouses always receive $2,000 each in assets?", "es": "¿Cada cónyuge dispone siempre de $2.000 de bienes?" }, "a": { "en": "No. Indiana’s manual specifies a $3,000 combined standard in the listed two-recipient situations.", "es": "No. El manual indica $3.000 conjuntos en las situaciones enumeradas con ambos beneficiarios." } }, { "q": { "en": "Does PathWays enrollment guarantee HCBS access?", "es": "¿La inscripción PathWays garantiza acceso HCBS?" }, "a": { "en": "No. The waiver has its own eligibility and capacity process.", "es": "No. El waiver tiene su propio proceso de elegibilidad y disponibilidad." } }, { "q": { "en": "Does Indiana count every income source gross?", "es": "¿Indiana cuenta todo tipo de ingreso en bruto?" }, "a": { "en": "No. Its Miller guidance distinguishes gross wages and pensions from specified net income categories.", "es": "No. Las instrucciones Miller distinguen salarios y pensiones brutos de determinadas categorías netas." } }, { "q": { "en": "Does a Miller trust protect ordinary savings?", "es": "¿Un fideicomiso Miller protege ahorros ordinarios?" }, "a": { "en": "No. The cited guidance concerns income and leaves other eligibility requirements in place.", "es": "No. Las instrucciones se refieren a ingresos y mantienen los demás requisitos de elegibilidad." } } ] }, { "code": "MA", "state": "Massachusetts", "state_es": "Massachusetts", "slug_en": "massachusetts-medicaid-income-asset-limits", "slug_es": "massachusetts-limites-ingresos-bienes-medicaid", "medicaid_name": "MassHealth", "agency_url": "https://www.mass.gov/info-details/program-financial-guidelines-for-certain-masshealth-applicants-and-members", "reviewed": "2026-11-16", "income_rule_type": "program_specific", "single_income_limit_ltc": null, "single_asset_limit_ltc": 2000, "csra_max_spouse_assets": 162660, "home_equity_limit": 1130000, "lookback_months": 60, "personal_needs_allowance": 72.8, "sources": [ { "id": "MA-1", "title": "MassHealth financial guidelines, 2026", "url": "https://www.mass.gov/info-details/program-financial-guidelines-for-certain-masshealth-applicants-and-members", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "2026 PNA $72.80, home equity $1,130,000, spouse resources maximum $162,660 and community asset standards." }, { "id": "MA-2", "title": "Frail Elder Waiver fact sheet, February 2026", "url": "https://www.mass.gov/doc/frail-elder-waiver-fact-sheet-0/download", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "FEW income $2,982, applicant assets $2,000, spouse assets $162,660 and program access." }, { "id": "MA-3", "title": "HCBS eligibility operations memo 23-24", "url": "https://www.mass.gov/doc/eligibility-operations-memo-23-24-applying-for-home-and-community-based-services-waivers-0/download", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Waiver income is countable; certain waiver applicants may qualify using a deductible." }, { "id": "MA-4", "title": "MassHealth estate recovery", "url": "https://www.mass.gov/info-details/massachusetts-medicaid-estate-recovery", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Current recovery scope for deaths from August 2024, probate estate, exclusions, delays and hardship." }, { "id": "MA-5", "title": "Hearing decision quoting LTC eligibility regulations", "url": "https://www.mass.gov/doc/appeal-2510851/download", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "130 CMR 519.006 individual LTC countable assets $2,000 and spousal assessment." }, { "id": "MA-6", "title": "Hearing decision quoting transfer provisions", "url": "https://www.mass.gov/doc/appeal-2503397/download", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "130 CMR 520.019 60-month transfer review and exceptions." }, { "id": "MA-7", "title": "Financial eligibility deductible provisions", "url": "https://www.mass.gov/doc/emergency-adoption-date-filed-march-29-2024-6/download", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "130 CMR 520.028–520.030: contextual LTC income, deductions and deductible calculation." }, { "id": "MA-8", "title": "HCBS waiver overview", "url": "https://www.mass.gov/info-details/home-and-community-based-services-waivers", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Clinical need, safe community service, waiver capacity and operating-agency role." } ], "programs": { "nursing_home": { "name": { "en": "MassHealth Standard long-term-care facility", "es": "MassHealth Standard en centro de cuidados prolongados" }, "income_rule_type": "program_specific", "single": { "income": null, "assets": 2000, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "Institutional income and contribution depend on deductions and care costs; PNA is not an income cap.", "es": "Ingreso y aportación dependen de deducciones y coste; PNA no es un tope de ingresos." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "MA-1", "MA-5", "MA-7" ] }, "married_one": { "income": null, "assets": 2000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Applicant-side limit after the applicable spousal assessment; not total marital assets.", "es": "Límite del solicitante tras la evaluación conyugal; no representa todos los bienes matrimoniales." }, "source_ids": [ "MA-1", "MA-5", "MA-7" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "MA-5", "MA-7" ] }, "note": { "en": "Do not substitute the Frail Elder Waiver reference for the facility income determination.", "es": "No sustituyas el cálculo residencial por la referencia del Frail Elder Waiver." } }, "hcbs_waiver": { "name": { "en": "Frail Elder Waiver (FEW)", "es": "Frail Elder Waiver (FEW)" }, "income_rule_type": "program_specific", "single": { "income": 2982, "assets": 2000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "FEW 2026 countable-income reference; an authorized deductible pathway may be relevant.", "es": "Referencia FEW de ingreso computable de 2026; puede existir una vía mediante deducible." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "MA-2", "MA-3" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "countable", "asset_basis": "applicant_only", "income_note": { "en": "Applicant countable income; community-spouse asset rules are separate.", "es": "Ingreso computable del solicitante; bienes del cónyuge comunitario se evalúan aparte." }, "asset_note": { "en": "Applicant-side limit after the applicable spousal assessment; not total marital assets.", "es": "Límite del solicitante tras la evaluación conyugal; no representa todos los bienes matrimoniales." }, "source_ids": [ "MA-2", "MA-3" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "MA-2", "MA-3" ] }, "note": { "en": "FEW requires clinical eligibility and safe community service as well as financial review.", "es": "FEW exige elegibilidad clínica y atención comunitaria segura, además de revisión económica." } }, "abd_regular": { "name": { "en": "MassHealth Standard community residents aged 65+", "es": "MassHealth Standard para residentes comunitarios de 65 años o más" }, "income_rule_type": "medically_needy_spenddown", "single": { "income": null, "assets": 2000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "Current countable-income budgeting and deductions require confirmation; no gross ceiling is supplied.", "es": "Hay que confirmar ingresos computables y deducciones; no se publica un tope bruto." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "MA-1", "MA-7" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "MA-1", "MA-7" ] }, "married_both": { "income": null, "assets": 3000, "income_basis": "countable", "asset_basis": "couple_combined", "income_note": { "en": "Community couple income calculation is distinct from FEW and institutional rules.", "es": "El cálculo comunitario de pareja difiere de FEW y de las reglas residenciales." }, "asset_note": { "en": "Combined countable resources where this couple rule applies.", "es": "Recursos computables conjuntos cuando corresponde esta regla de pareja." }, "source_ids": [ "MA-1", "MA-7" ] }, "note": { "en": "CommonHealth, Medicare Savings Programs and other categories have different conditions.", "es": "CommonHealth, Medicare Savings Programs y otras categorías tienen condiciones distintas." } } }, "summary": { "en": "MassHealth separates financial eligibility for a long-term-care facility from eligibility in the community. That distinction prevents a common error: applying the Frail Elder Waiver’s $2,982 monthly reference to every nursing-home applicant. The facility route considers its own income deductions and contribution rules. FEW is a named waiver with a 2026 countable-income reference and a $2,000 applicant asset limit. Its clinical assessment and community-service requirements remain essential. For regular community coverage at age 65 or older, the table deliberately avoids presenting an unverified gross-income cutoff.", "es": "MassHealth separa elegibilidad económica residencial y comunitaria. Esa distinción evita un error frecuente: aplicar la referencia mensual de $2.982 del Frail Elder Waiver a cualquier solicitante de residencia. La vía residencial tiene sus propias deducciones y reglas de aportación. FEW es un waiver concreto con referencia de ingreso computable para 2026 y límite patrimonial del solicitante de $2.000. Sigue requiriendo evaluación clínica y condiciones de atención comunitaria. Para cobertura ordinaria desde los 65 años, la tabla evita presentar un tope bruto sin verificar." }, "excess_income_solution": { "en": "MassHealth has deductible rules for certain people whose countable income exceeds the relevant standard. The HCBS operations memo also identifies a deductible route for specified waiver applicants, including FEW. This is not permission to import a Qualified Income Trust strategy from an income-cap state. Ask which regulation and budget period apply to your case, and which medical expenses MassHealth can recognize. An amount paid privately does not automatically count toward a deductible. For nursing-facility care, distinguish the income eligibility review from the amount owed toward care after eligibility.", "es": "MassHealth contempla deducibles para determinadas personas cuyo ingreso computable supera el estándar. El memorando HCBS identifica también esa vía para ciertos solicitantes de waiver, incluido FEW. No permite importar una estrategia Qualified Income Trust de otro estado. Pregunta qué norma y período presupuestario corresponden y qué gastos médicos puede reconocer MassHealth. Un pago privado no computa automáticamente para el deducible. En residencia, distingue la revisión de elegibilidad de la cantidad que debe aportarse después al coste de atención." }, "exempt_assets_notes": { "en": "For the populations represented here, MassHealth publishes a $2,000 individual asset reference and a $3,000 reference for a community couple. Property must first be classified as countable or excluded. The 2026 maximum home-equity reference is $1,130,000, but ownership, occupancy and applicable exceptions require review. A deed showing a home’s assessed value does not by itself establish the applicant’s equity. Keep mortgage and ownership information available. Eligibility exclusions also do not answer whether property could later be included in an estate-recovery claim.", "es": "Para las poblaciones aquí representadas, MassHealth publica referencias patrimoniales de $2.000 individuales y $3.000 para pareja comunitaria. Primero debe clasificarse cada bien como computable o excluido. La referencia máxima inmobiliaria de 2026 es $1.130.000, pero hay que revisar propiedad, ocupación y excepciones. Una escritura con valor tasado no establece por sí sola el patrimonio neto del solicitante. Conserva hipoteca y datos de titularidad. Las exclusiones de elegibilidad tampoco resuelven si el bien podría incluirse posteriormente en una reclamación sucesoria." }, "spousal_notes": { "en": "The community spouse’s resource protection is different from the applicant’s asset allowance. Massachusetts publishes 2026 minimum and maximum spousal standards, with the maximum at $162,660, but the actual assessment depends on the applicable arrangement. FEW’s fact sheet separately identifies the spouse’s countable-asset reference. Do not combine a community couple’s $3,000 rule with institutional spousal protection as though both automatically apply. Request the written resource assessment and any income-maintenance calculation. If both spouses need services, explain each person’s setting and coverage category before comparing numbers.", "es": "La protección patrimonial del cónyuge comunitario difiere del límite del solicitante. Massachusetts publica estándares conyugales mínimos y máximos para 2026, con máximo de $162.660, pero la evaluación depende de la modalidad. La ficha FEW identifica por separado la referencia patrimonial del cónyuge. No combines la regla comunitaria de $3.000 con la protección residencial como si ambas se aplicaran automáticamente. Pide evaluación escrita y cálculo de mantenimiento de ingresos. Si ambos necesitan servicios, explica alojamiento y cobertura de cada uno antes de comparar cifras." }, "lookback_rules": { "en": "MassHealth transfer provisions generally examine a 60-month period for relevant nursing-facility applications, with rules also addressing the Frail Elder Waiver. Transfers below fair market value can affect payment for care, subject to permitted transfers and other exceptions. The review is not simply a test of today’s bank balance. Keep the date, purpose and supporting evidence for significant property changes or payments. Ask MassHealth to identify the transaction and rule behind any adverse finding; do not infer a penalty solely because money went to a family member.", "es": "Las reglas de transmisiones MassHealth revisan generalmente 60 meses en las solicitudes residenciales pertinentes y también contemplan Frail Elder Waiver. Las operaciones por debajo del valor de mercado pueden afectar al pago, con transmisiones permitidas y otras excepciones. No basta comprobar el saldo actual. Conserva fecha, finalidad y justificantes de cambios patrimoniales o pagos relevantes. Pide a MassHealth que identifique operación y norma de cualquier decisión desfavorable; no deduzcas una penalización únicamente porque recibió dinero un familiar." }, "estate_recovery_merp": { "en": "Massachusetts changed the scope of recovery for members dying on or after August 1, 2024. Current guidance focuses on specified long-term services and supports received at 55 or older, alongside applicable institutional-care rules regardless of age. It also describes probate-estate limitations, delays and hardship relief. Older explanations saying every benefit after age 55 is recoverable can therefore mislead families. Ask which dates and services the notice covers. A residence excluded during eligibility and property outside the probate estate raise different questions that should not be merged.", "es": "Massachusetts cambió el alcance de recuperación para fallecimientos desde el 1 de agosto de 2024. La información vigente se centra en determinados cuidados prolongados recibidos desde los 55 años, además de reglas institucionales aplicables sin límite de edad. Describe también límites al patrimonio sucesorio, aplazamientos y alivio por dificultad. Las explicaciones antiguas que incluyen cualquier beneficio desde los 55 pueden inducir a error. Pregunta qué fechas y servicios cubre el aviso. Vivienda excluida y bienes ajenos al patrimonio sucesorio plantean cuestiones distintas." }, "document_notes": { "en": "For FEW, start with the local Aging Services Access Point and MassHealth’s financial application instructions. For facility coverage, identify who submits the long-term-care supplement and who receives verification requests. Gather income notices, account ownership records, property information and any spouse details requested. Keep the $72.80 facility personal-needs allowance separate from income eligibility: it concerns money retained in the cost-of-care calculation. Save the approval, deductible or contribution notices so future changes can be checked against the correct decision. If several organizations assist with FEW, record who handles financial eligibility and who handles the clinical assessment, so missing information reaches the correct office.", "es": "Para FEW, empieza por el Aging Services Access Point local y las instrucciones económicas de MassHealth. Para residencia, identifica quién entrega el suplemento y recibe peticiones de verificación. Reúne avisos de ingresos, titularidad, inmuebles y datos conyugales solicitados. Distingue la asignación personal residencial de $72,80 de la elegibilidad: corresponde al dinero retenido en el cálculo de aportación. Conserva resoluciones de aprobación, deducible o contribución para contrastar futuros cambios con la decisión adecuada. Si varias entidades ayudan con FEW, anota quién gestiona elegibilidad económica y quién la evaluación clínica, para enviar cualquier información pendiente a la oficina correcta." }, "faqs": [ { "q": { "en": "Is $72.80 the maximum monthly income?", "es": "¿$72,80 es el máximo de ingreso mensual?" }, "a": { "en": "No. It is the published facility personal-needs allowance, not a universal eligibility cap.", "es": "No. Es la asignación personal residencial publicada, no un tope universal de elegibilidad." } }, { "q": { "en": "Does FEW use gross wages directly?", "es": "¿FEW compara directamente salarios brutos?" }, "a": { "en": "Its financial reference concerns countable income; MassHealth must apply the relevant budgeting rules.", "es": "Su referencia es ingreso computable; MassHealth debe aplicar las reglas de cálculo." } }, { "q": { "en": "Is a QIT the default over-income solution?", "es": "¿Un QIT es la solución habitual al exceso de ingresos?" }, "a": { "en": "No. Massachusetts has program-specific deductible rules; ask which route applies.", "es": "No. Massachusetts contempla deducibles según programa; consulta la vía aplicable." } }, { "q": { "en": "Can an older estate-recovery article be misleading?", "es": "¿Puede inducir a error un artículo sucesorio antiguo?" }, "a": { "en": "Yes. The date of death matters because current guidance distinguishes deaths from August 2024 onward.", "es": "Sí. Importa la fecha de fallecimiento, pues la guía distingue los ocurridos desde agosto de 2024." } } ] }, { "code": "MI", "state": "Michigan", "state_es": "Míchigan", "slug_en": "michigan-medicaid-income-asset-limits", "slug_es": "michigan-limites-ingresos-bienes-medicaid", "medicaid_name": "Michigan Medicaid", "agency_url": "https://www.michigan.gov/mdhhs/assistance-programs/medicaid/health-care-programs-eligibility", "reviewed": "2026-11-16", "income_rule_type": "program_specific", "single_income_limit_ltc": null, "single_asset_limit_ltc": 2000, "csra_max_spouse_assets": 162660, "home_equity_limit": 752000, "lookback_months": 60, "personal_needs_allowance": null, "sources": [ { "id": "MI-1", "title": "2026 home and community-based services comparison", "url": "https://www.michigan.gov/-/media/Project/Websites/mdhhs/Adult-and-Childrens-Services/Adults-and-Seniors/Forms-and-Publications/HCBS_Comparison_Chart-FINAL.pdf?rev=c430b04e26ac4fbf9718b09adc5909f2", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "MI Choice $2,982 gross monthly income reference and distinctions from other home services." }, { "id": "MI-2", "title": "BEM 400 Assets, November 2026", "url": "https://mdhhs-pres-prod.michigan.gov/olmweb/ex/BP/Public/BEM/400.pdf", "accessed": "2026-11-16", "method": "pdf", "supports": "SSI-related countable resources $2,000/$3,000, exceptions and $752,000 home-equity restriction." }, { "id": "MI-3", "title": "BEM 402 Special MA asset rules", "url": "https://mdhhs-pres-prod.michigan.gov/olmweb/ex/BP/Public/BEM/402.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "2026 protected-spouse calculation and maximum $162,660." }, { "id": "MI-4", "title": "RFT 242 AD-Care income references", "url": "https://mdhhs-pres-prod.michigan.gov/olmweb/EX/RF/Public/RFT/242.pdf", "accessed": "2026-11-16", "method": "pdf", "supports": "Retrieved PDF is dated April 2025; not treated as verified 2026 ABD amount." }, { "id": "MI-5", "title": "Michigan Medicaid program eligibility", "url": "https://www.michigan.gov/mdhhs/assistance-programs/medicaid/health-care-programs-eligibility", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Different SSI-related and MI Choice pathways." }, { "id": "MI-6", "title": "BEM 405 divestment, current manual compilation", "url": "https://mdhhs-pres-prod.michigan.gov/olmweb/ex/BP/Mobile/BEM/BEM%20Mobile.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "60-month look-back, baseline and restricted payment situations." }, { "id": "MI-7", "title": "Michigan estate recovery", "url": "https://www.michigan.gov/mdhhs/assistance-programs/medicaid/third-party-liability/estate-recovery", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Estate recovery scope, notice, hardship and partnership treatment." }, { "id": "MI-8", "title": "Bridges July policy update: patient pay", "url": "https://mdhhs-pres-prod.michigan.gov/olmweb/ex/BP/Public/BPB/2025-017.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Distinguishes Group 2 eligibility income and post-eligibility patient-pay calculation." }, { "id": "MI-9", "title": "MI Choice program", "url": "https://www.michigan.gov/mdhhs/assistance-programs/medicaid/portalhome/medicaid-providers/programs/mi-choice-waiver-program", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "MI Choice assessment, enrollment and waiting-list screening." } ], "programs": { "nursing_home": { "name": { "en": "SSI-related nursing-facility Medicaid", "es": "Medicaid vinculado a SSI en residencia de enfermería" }, "income_rule_type": "program_specific", "single": { "income": null, "assets": 2000, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "Multiple eligibility categories and patient-pay rules; no universal gross ceiling entered.", "es": "Varias categorías y reglas de aportación; no se introduce un tope bruto universal." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "MI-2", "MI-5", "MI-8" ] }, "married_one": { "income": null, "assets": 2000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Applicant-side limit after the applicable spousal assessment; not total marital assets.", "es": "Límite del solicitante tras la evaluación conyugal; no representa todos los bienes matrimoniales." }, "source_ids": [ "MI-2", "MI-3" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "MI-2", "MI-3" ] }, "note": { "en": "Do not apply the MI Choice cap to every nursing-facility application.", "es": "No apliques el tope MI Choice a todas las solicitudes en residencia." } }, "hcbs_waiver": { "name": { "en": "MI Choice waiver", "es": "Waiver MI Choice" }, "income_rule_type": "program_specific", "single": { "income": 2982, "assets": 2000, "income_basis": "gross", "asset_basis": "individual", "income_note": { "en": "MI Choice 2026 gross monthly reference.", "es": "Referencia mensual bruta MI Choice de 2026." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "MI-1", "MI-2" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "Applicant reference; verify spouse attribution and waiver budgeting.", "es": "Referencia del solicitante; verificar atribución conyugal y cálculo del waiver." }, "asset_note": { "en": "Applicant-side limit after the applicable spousal assessment; not total marital assets.", "es": "Límite del solicitante tras la evaluación conyugal; no representa todos los bienes matrimoniales." }, "source_ids": [ "MI-1", "MI-2", "MI-3" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "MI-1", "MI-2" ] }, "note": { "en": "MI Choice financial screening does not itself provide an available service slot.", "es": "El examen económico MI Choice no garantiza una plaza disponible." } }, "abd_regular": { "name": { "en": "AD-Care / SSI-related community Medicaid", "es": "AD-Care / Medicaid comunitario vinculado a SSI" }, "income_rule_type": "program_specific", "single": { "income": null, "assets": 2000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "The retrieved AD-Care income table was dated 2025; no 2026 number is asserted.", "es": "La tabla AD-Care recuperada era de 2025; no se afirma una cifra de 2026." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "MI-2", "MI-4" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "MI-2", "MI-4" ] }, "married_both": { "income": null, "assets": 3000, "income_basis": "countable", "asset_basis": "couple_combined", "income_note": { "en": "Current income budgeting must be confirmed with MDHHS.", "es": "MDHHS debe confirmar el cálculo vigente de ingresos." }, "asset_note": { "en": "Combined countable resources where this couple rule applies.", "es": "Recursos computables conjuntos cuando corresponde esta regla de pareja." }, "source_ids": [ "MI-2", "MI-4" ] }, "note": { "en": "SSI-related standards are not the Healthy Michigan MAGI standards.", "es": "Los estándares vinculados a SSI no son los MAGI de Healthy Michigan." } } }, "summary": { "en": "Michigan uses several Medicaid eligibility categories, and the care setting alone does not identify the correct financial test. MI Choice provides a specific home-and-community-based route with a 2026 gross monthly income reference of $2,982. Nursing-facility coverage may involve other SSI-related categories and a separate patient-pay calculation. AD-Care is another community pathway. The available AD-Care reference table retrieved for this review still carried 2025 figures, so this guide does not silently relabel them as 2026. A blank income cell signals a verification limit, not a denial of coverage.", "es": "Míchigan utiliza varias categorías Medicaid, y el lugar de atención no identifica por sí solo la prueba económica adecuada. MI Choice ofrece una vía domiciliaria y comunitaria con referencia mensual bruta de $2.982 para 2026. La cobertura residencial puede utilizar otras categorías vinculadas a SSI y una aportación posterior del paciente. AD-Care es otra vía comunitaria. La tabla AD-Care recuperada todavía mostraba cifras de 2025; esta guía no las presenta como si fueran de 2026. Una celda vacía señala falta de verificación, no denegación de cobertura." }, "excess_income_solution": { "en": "Ask MDHHS to identify the eligibility group before discussing excess income. Michigan’s Group 2 framework can involve a deductible, while MI Choice has its own enrollment-income rules. The state’s comparison chart distinguishes these pathways; a deductible in one category is not automatic permission to enroll in another. Likewise, a nursing-home patient-pay amount is the result of post-eligibility budgeting, not an advertised income cap. Request the calculation showing countable income, allowed deductions and the resulting responsibility. Do not assume a Miller trust used in a different state is Michigan’s standard solution.", "es": "Pide a MDHHS que identifique la categoría antes de analizar exceso de ingresos. Group 2 puede implicar un deducible, mientras MI Choice tiene reglas propias de inscripción. La tabla comparativa estatal distingue ambas vías: un deducible en una categoría no permite automáticamente entrar en otra. La aportación de un residente también resulta de un cálculo posterior, no de un tope publicitario de ingresos. Solicita el desglose de ingreso computable, deducciones y responsabilidad final. No supongas que un fideicomiso Miller usado en otro estado es la solución habitual de Míchigan." }, "exempt_assets_notes": { "en": "The November 2026 BEM 400 manual distinguishes available countable property from excluded resources. For the SSI-related categories represented here, its ordinary references include $2,000 for one person and $3,000 for a two-person asset group. Those are not the rules for every Medicaid program. A home can require both an exclusion analysis and a long-term-care equity review, with a 2026 reference of $752,000. Identify mortgages, joint ownership and residents of the property. Do not subtract an assumed home exemption from investments or cash accounts.", "es": "El manual BEM 400 de noviembre de 2026 distingue bienes disponibles computables y recursos excluidos. Para las categorías vinculadas a SSI aquí representadas incluye referencias ordinarias de $2.000 por persona y $3.000 para un grupo patrimonial de dos. No son reglas universales de Medicaid. Una vivienda puede requerir análisis de exclusión y revisión del patrimonio neto para cuidados prolongados, con referencia de $752.000 en 2026. Identifica hipotecas, copropiedad y residentes. No descuentes una supuesta exención inmobiliaria de inversiones o efectivo." }, "spousal_notes": { "en": "Michigan’s BEM 402 calls for an initial asset assessment in relevant married long-term-care and waiver cases. The protected spousal amount uses a formula and may also reflect a hearing or court decision. The 2026 published maximum reference is $162,660. This does not mean the applicant can keep that amount personally, nor that all remaining marital property is compared without exclusions to $2,000. Ask for the assessment date and the separate applicant-resource calculation. When both spouses receive care, the household arrangement needs its own determination.", "es": "BEM 402 exige una evaluación patrimonial inicial en determinados casos matrimoniales de cuidados prolongados o waiver. La cantidad conyugal protegida utiliza una fórmula y puede reflejar una resolución administrativa o judicial. La referencia máxima publicada para 2026 es $162.660. No significa que el solicitante pueda conservar personalmente esa suma ni que todo el patrimonio restante se compare, sin exclusiones, con $2.000. Solicita fecha de evaluación y cálculo separado del solicitante. Si ambos reciben cuidados, debe determinarse específicamente la situación del hogar." }, "lookback_rules": { "en": "Michigan describes transfers for less than fair value as divestment. Its manual uses a baseline date and a 60-month look-back, then asks whether the person is in a situation where a payment restriction applies. The review does not label every historical withdrawal a prohibited gift. Explain what was purchased, who received payment and whether an exception is being claimed. Keep existing supporting records, including property-sale documents and care-payment evidence. A tax gift exclusion does not by itself establish that Medicaid will disregard a transfer.", "es": "Míchigan denomina divestment a determinadas transmisiones por debajo de su valor. El manual utiliza una fecha de referencia y revisión de 60 meses, y comprueba si corresponde restringir el pago. No convierte toda retirada antigua en una donación prohibida. Explica qué se compró, quién recibió el pago y si se alega una excepción. Conserva justificantes existentes, incluidas ventas inmobiliarias y pagos por cuidados. Una exclusión fiscal de donaciones no establece por sí misma que Medicaid ignore una transmisión." }, "estate_recovery_merp": { "en": "MDHHS has an estate-recovery process for qualifying Medicaid long-term-care benefits. Its information distinguishes ordinary probate-estate recovery from special partnership-insurance treatment and explains hardship requests. A home excluded during eligibility may still need review after death; exclusion and recovery are separate legal questions. The state sends information to the estate representative or heirs when it learns of a death. Review the notice, covered services and response instructions rather than assuming an heir is personally responsible for every dollar Medicaid paid.", "es": "MDHHS dispone de recuperación sucesoria para determinados beneficios Medicaid de cuidados prolongados. Su información distingue recuperación ordinaria sobre bienes sucesorios y tratamiento especial de seguros Partnership, y explica solicitudes por dificultad. Una vivienda excluida al evaluar elegibilidad puede requerir revisión tras fallecer: exclusión y recuperación son cuestiones distintas. El estado envía información al representante o herederos cuando conoce el fallecimiento. Revisa notificación, servicios reclamados e instrucciones, sin suponer que un heredero responde personalmente de todo lo pagado." }, "document_notes": { "en": "For financial eligibility, use the MDHHS application route and retain the written requests from the assigned worker. For MI Choice, also contact the relevant waiver agency about screening and service access. Prepare income notices, account ownership details and property information; a facility’s intake form does not replace the Medicaid determination. Ask which month and which historical period each request covers. Keep the financial decision, any deductible notice and the later patient-pay explanation together, with a short record of questions still awaiting an answer. Ask the waiver agency which services have actually been authorized, because an eligibility letter and a completed service plan answer different questions.", "es": "Para elegibilidad económica utiliza la vía MDHHS y conserva las peticiones del trabajador asignado. Para MI Choice contacta también con la agencia del waiver sobre evaluación y acceso. Prepara avisos de ingresos, titularidad de cuentas e información inmobiliaria; el formulario de admisión residencial no sustituye la decisión Medicaid. Pregunta qué mes y qué período histórico cubre cada solicitud. Guarda juntas resolución económica, eventual deducible y explicación posterior de aportación, junto con las dudas pendientes. Pregunta a la agencia qué servicios están realmente autorizados: una carta de elegibilidad y un plan de servicios terminado responden a preguntas diferentes." }, "faqs": [ { "q": { "en": "Is MI Choice’s $2,982 cap universal?", "es": "¿El tope MI Choice de $2.982 es universal?" }, "a": { "en": "No. It is a specific 2026 waiver reference, not every Michigan Medicaid income test.", "es": "No. Es una referencia concreta del waiver para 2026, no cualquier prueba Medicaid." } }, { "q": { "en": "Why is AD-Care income blank?", "es": "¿Por qué falta el ingreso AD-Care?" }, "a": { "en": "The official PDF retrieved still showed 2025 figures; current budgeting needs confirmation.", "es": "El PDF oficial recuperado aún mostraba 2025; hay que confirmar el cálculo vigente." } }, { "q": { "en": "Is patient pay an eligibility ceiling?", "es": "¿La aportación del paciente es un tope de elegibilidad?" }, "a": { "en": "No. It calculates a contribution after the applicable eligibility determination.", "es": "No. Calcula una contribución posterior a determinar la elegibilidad aplicable." } }, { "q": { "en": "Does financial screening guarantee MI Choice services?", "es": "¿El examen económico garantiza servicios MI Choice?" }, "a": { "en": "No. Assessment and waiver enrollment, including available service access, remain separate.", "es": "No. Evaluación e inscripción en el waiver, incluido acceso disponible, son independientes." } } ] }, { "code": "MN", "state": "Minnesota", "state_es": "Minnesota", "slug_en": "minnesota-medicaid-income-asset-limits", "slug_es": "minnesota-limites-ingresos-bienes-medicaid", "medicaid_name": "Medical Assistance (MA)", "agency_url": "https://mn.gov/dhs/health-care/medical-assistance/", "reviewed": "2026-11-16", "income_rule_type": "medically_needy_spenddown", "single_income_limit_ltc": null, "single_asset_limit_ltc": 3000, "csra_max_spouse_assets": 162660, "home_equity_limit": 752000, "lookback_months": 60, "personal_needs_allowance": 132, "sources": [ { "id": "MN-1", "title": "Medical Assistance Treatment of Assets and Income, September 2026", "url": "https://www.house.mn.gov/hrd/pubs/MAasset.pdf", "accessed": "2026-11-16", "method": "pdf", "supports": "2026 regularMA income 1330/1803.33; resources 3000/6000 plus dependents; CSRA162660; LTC income contribution and exclusions." }, { "id": "MN-2", "title": "Eligibility Policy Manual AppendixF", "url": "https://hcopub.dhs.state.mn.us/epm/appendix_f.htm", "accessed": "2026-11-16", "method": "page", "supports": "2026 EW special income 2982; PNA132; EW maintenance 1353 fromJuly; home 752000; spousal allowances." }, { "id": "MN-3", "title": "Elderly Waiver and Alternative Care provider guidance", "url": "https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=ID_056766", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "EW obligation vs spenddown aboveSIS; county/Tribal financial review and MnCHOICES; Alternative Care distinction." }, { "id": "MN-4", "title": "Minnesota Statutes 2026 section 256S.05", "url": "https://www.revisor.mn.gov/statutes/2026/cite/256S.05", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "EW functional eligibility, maintenance needs and spousal rules." }, { "id": "MN-5", "title": "Medical Assistance estate recovery and liens", "url": "https://mn.gov/dhs/health-care/medical-assistance/estate-recovery/", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Recovery at 55+ forLTSS, permanent institutionalization scope, spouse/child delay and children not personally liable." }, { "id": "MN-6", "title": "MA-LTC lookback period and transfer date", "url": "https://hcopub.dhs.state.mn.us/epm/2_4_1_3_1.htm", "accessed": "2026-11-16", "method": "page", "supports": "60-month baseline review and new lookback after qualifying break inLTC; transfer dates." }, { "id": "MN-7", "title": "Asset assessment for planning purposes", "url": "https://hcopub.dhs.state.mn.us/epm/2_4_2_1_1.htm", "accessed": "2026-11-16", "method": "page", "supports": "County/Tribal planning assessment beforeapplication, ownership documentation; notapproval." }, { "id": "MN-8", "title": "MA income limits", "url": "https://hcopub.dhs.state.mn.us/epm/2_1_3_2.htm", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "MAABD countableincome methodology and 100%FPG categories, not gross threshold." }, { "id": "MN-9", "title": "Medical Assistance official overview", "url": "https://mn.gov/dhs/health-care/medical-assistance/", "accessed": "2026-11-16", "method": "page", "supports": "Official entry route; older adults and disability applicants may use a different application route from MNsure; countable assets, spenddown and renewals." } ], "programs": { "nursing_home": { "name": { "en": "MA payment for nursing-facility long-term care", "es": "MA: pago de cuidados prolongados en centro de enfermería" }, "income_rule_type": "medically_needy_spenddown", "single": { "income": null, "assets": 3000, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "No single universal gross-income cap is shown; MA-LTC income, deductions and care-cost contribution need review.", "es": "No se publica un tope bruto universal; deben revisarse ingresos MA-LTC, deducciones y contribución al coste." }, "asset_note": { "en": "Countable resources after exclusions.", "es": "Recursos computables después de las exclusiones." }, "source_ids": [ "MN-1", "MN-2" ] }, "married_one": { "income": null, "assets": 3000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "No single universal gross-income cap is shown; MA-LTC income, deductions and care-cost contribution need review. This is the applicant’s reference, not combined marital income.", "es": "No se publica un tope bruto universal; deben revisarse ingresos MA-LTC, deducciones y contribución al coste. Es la referencia del solicitante, no los ingresos conjuntos del matrimonio." }, "asset_note": { "en": "Applicant-side resources after the spousal assessment; not a ceiling on all marital property.", "es": "Recursos atribuidos al solicitante después de evaluar al matrimonio; no es un tope para todos sus bienes." }, "source_ids": [ "MN-1", "MN-2" ] }, "married_both": { "income": null, "assets": null, "income_basis": "unknown", "asset_basis": "unknown", "income_note": { "en": "No verified combined-couple threshold is published here; each spouse needs a separate eligibility review.", "es": "No publicamos un límite conjunto verificado; cada cónyuge necesita su propia evaluación." }, "asset_note": { "en": "Do not double the single-person limit or apply a community-spouse allowance when both receive institutional care.", "es": "No duplique el límite individual ni aplique una reserva para cónyuge comunitario cuando ambos reciben atención institucional." }, "source_ids": [ "MN-1", "MN-2" ] }, "note": { "en": "The clothing/personal-needs allowance is not the income eligibility limit.", "es": "La asignación para ropa y necesidades personales no es el límite de elegibilidad económica." } }, "hcbs_waiver": { "name": { "en": "Elderly Waiver (EW), special-income-standard route", "es": "Elderly Waiver (EW): vía del estándar especial de ingresos" }, "income_rule_type": "medically_needy_spenddown", "single": { "income": 2982, "assets": 3000, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "EW Special Income Standard; above-standard income may be evaluated with an MA spenddown.", "es": "Estándar Especial de Ingresos de EW; por encima puede evaluarse un deducible por gastos médicos de MA." }, "asset_note": { "en": "Countable resources after exclusions.", "es": "Recursos computables después de las exclusiones." }, "source_ids": [ "MN-1", "MN-2", "MN-3", "MN-4" ] }, "married_one": { "income": 2982, "assets": 3000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "EW Special Income Standard; above-standard income may be evaluated with an MA spenddown. This is the applicant’s reference, not combined marital income.", "es": "Estándar Especial de Ingresos de EW; por encima puede evaluarse un deducible por gastos médicos de MA. Es la referencia del solicitante, no los ingresos conjuntos del matrimonio." }, "asset_note": { "en": "Applicant-side resources after the spousal assessment; not a ceiling on all marital property.", "es": "Recursos atribuidos al solicitante después de evaluar al matrimonio; no es un tope para todos sus bienes." }, "source_ids": [ "MN-1", "MN-2", "MN-3", "MN-4" ] }, "married_both": { "income": null, "assets": null, "income_basis": "unknown", "asset_basis": "unknown", "income_note": { "en": "No verified combined-couple threshold is published here; each spouse needs a separate eligibility review.", "es": "No publicamos un límite conjunto verificado; cada cónyuge necesita su propia evaluación." }, "asset_note": { "en": "Do not double the single-person limit or apply a community-spouse allowance when both receive institutional care.", "es": "No duplique el límite individual ni aplique una reserva para cónyuge comunitario cuando ambos reciben atención institucional." }, "source_ids": [ "MN-1", "MN-2", "MN-3", "MN-4" ] }, "note": { "en": "A waiver obligation below the SIS differs from an MA spenddown above it.", "es": "La contribución de exención por debajo del SIS difiere del deducible médico por encima." } }, "abd_regular": { "name": { "en": "MA for age 65+, blindness or disability", "es": "MA para mayores de 65 años, ceguera o discapacidad" }, "income_rule_type": "medically_needy_spenddown", "single": { "income": 1330, "assets": 3000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "Countable-income reference; higher income can require spenddown. Additional dependent rules can change household resources.", "es": "Referencia de ingresos computables; ingresos superiores pueden requerir deducible. Los dependientes pueden modificar los recursos del hogar." }, "asset_note": { "en": "Individual countable resources.", "es": "Recursos computables individuales." }, "source_ids": [ "MN-1", "MN-8" ] }, "married_one": { "income": 1803.33, "assets": null, "income_basis": "countable", "asset_basis": "unknown", "income_note": { "en": "Couple/household reference where spouses are included together; exclusions and deeming require agency review. Countable-income reference; higher income can require spenddown. Additional dependent rules can change household resources.", "es": "Referencia de pareja u hogar cuando los cónyuges se incluyen juntos; la agencia debe revisar exclusiones y atribución de ingresos. Referencia de ingresos computables; ingresos superiores pueden requerir deducible. Los dependientes pueden modificar los recursos del hogar." }, "asset_note": { "en": "The couple resource reference is 6,000 dollars combined, not an applicant-only allowance.", "es": "La referencia patrimonial de la pareja es de 6,000 dólares en conjunto, no una reserva individual." }, "source_ids": [ "MN-1", "MN-8" ] }, "married_both": { "income": 1803.33, "assets": 6000, "income_basis": "countable", "asset_basis": "couple_combined", "income_note": { "en": "Combined couple countable-income reference, not a gross-income ceiling. Countable-income reference; higher income can require spenddown. Additional dependent rules can change household resources.", "es": "Referencia de ingresos computables conjuntos, no un límite de ingresos brutos. Referencia de ingresos computables; ingresos superiores pueden requerir deducible. Los dependientes pueden modificar los recursos del hogar." }, "asset_note": { "en": "Combined countable resources for the two-person assistance unit.", "es": "Recursos computables conjuntos de la unidad de dos personas." }, "source_ids": [ "MN-1", "MN-8" ] }, "note": { "en": "This is MA-ABD, not MinnesotaCare or the working-disabled MA-EPD program.", "es": "Corresponde a MA-ABD, no a MinnesotaCare ni al programa MA-EPD para trabajadores con discapacidad." } } }, "summary": { "en": "Minnesota calls its Medicaid program Medical Assistance. For older adults seeking help at home, Elderly Waiver adds services to MA after the required care assessment. County or Tribal Nation financial workers determine financial eligibility, while a lead agency organizes assessment and support planning. A nursing-facility case uses an income calculation tied to long-term-care obligations rather than a simple universal gross cap. The table therefore leaves that cap blank. Keep the general MA category, Elderly Waiver service eligibility and the amount payable toward care as three separate questions when speaking with the agency.", "es": "Minnesota denomina Medical Assistance a Medicaid. Para personas mayores que necesitan apoyo en casa, Elderly Waiver añade servicios a MA tras la evaluación de cuidados requerida. Trabajadores económicos del condado o de la nación tribal determinan la elegibilidad, y la agencia responsable organiza la evaluación y planificación. Un expediente institucional utiliza un cálculo relacionado con la contribución a cuidados, no un tope bruto universal. Por eso esa casilla queda vacía. Distinga al hablar con la oficina tres cuestiones: categoría general MA, acceso a Elderly Waiver y cantidad que debe aportar a los cuidados." }, "excess_income_solution": { "en": "Elderly Waiver’s special income standard divides two financial approaches. At or below it, a participant may have a waiver obligation after the maintenance-needs allowance and other deductions. Above it, the person may still qualify through an MA spenddown. These are not equivalent to an automatic denial above the displayed reference. Regular MA for older adults also permits spenddown evaluation. Ask the county or Tribal financial unit to identify the relevant period, allowable expenses and contribution notice. The calculator cannot decide which bills are usable or calculate an individual obligation from income alone.", "es": "El estándar especial de Elderly Waiver separa dos enfoques económicos. Hasta ese importe, el participante puede tener una contribución tras descontar necesidades de mantenimiento y otras deducciones. Por encima, aún puede reunir requisitos mediante un deducible de MA cubierto con gastos médicos. No equivale a un rechazo automático al superar la referencia. MA ordinario para mayores también contempla esta evaluación. Pregunte a la unidad económica del condado o nación tribal por el período, gastos admitidos y notificación correspondiente. La calculadora no decide qué facturas sirven ni calcula obligaciones personales solo con los ingresos." }, "exempt_assets_notes": { "en": "Minnesota’s individual MA resource reference is different from the 2,000-dollar figure common elsewhere. Exclusions can apply to a homestead, vehicle, personal property and qualifying arrangements, so list assets by type and ownership rather than treating every item as savings. The state publishes a separate 2026 home-equity limit for particular long-term-care circumstances. Ask whether the limit applies, whether a spouse or qualifying child changes the rule, and whether hardship review is relevant. An exemption for current eligibility does not automatically determine the outcome of a future estate-recovery case.", "es": "La referencia patrimonial individual de MA en Minnesota difiere de los 2.000 dólares habituales en otros estados. Puede haber exclusiones para vivienda, vehículo, bienes personales y determinados contratos; clasifique por tipo y titularidad en lugar de considerarlo todo ahorro. El estado publica otro límite de patrimonio neto de vivienda para determinadas circunstancias de cuidados prolongados en 2026. Pregunte si se aplica, si un cónyuge o hijo que reúna los requisitos modifica la norma y si procede evaluar dificultades excepcionales. Una exclusión actual no determina automáticamente una recuperación patrimonial futura." }, "spousal_notes": { "en": "When one spouse receives qualifying long-term care and the other remains in the community, the resource assessment differs from a regular two-person MA household. Minnesota’s state publication confirms the 2026 maximum community-spouse resource allowance, but the worker must apply the rules to actual countable assets. Income retained by the community spouse and any allocation from the care recipient are separate. Couples can request an informational asset assessment before filing for MA-LTC when the stated conditions apply. That assessment helps organize the facts; it is not a Medicaid approval or an instruction to transfer property.", "es": "Cuando un cónyuge recibe cuidados prolongados cubiertos y el otro permanece en la comunidad, la evaluación patrimonial difiere de un hogar ordinario MA de dos personas. La publicación estatal confirma el máximo de 2026 para el cónyuge comunitario, pero deben aplicarse las reglas a los bienes computables reales. Los ingresos propios de ese cónyuge y una posible asignación desde el beneficiario son cuestiones separadas. La pareja puede pedir una evaluación patrimonial informativa previa a la solicitud cuando proceda. Ayuda a organizar los hechos, pero no aprueba Medicaid ni indica que se transfieran bienes." }, "lookback_rules": { "en": "Minnesota’s current eligibility manual describes a 60-month lookback measured from a baseline date linked to the request for MA-LTC and the necessary institutional or waiver circumstances. Following a qualifying break in long-term-care services, a new request can establish a new lookback. The worker evaluates whether a transaction lacked adequate compensation and whether a penalty applies. Keep records showing when checks cleared or property delivery occurred, not only when a document was drafted. A review of transfers is distinct from checking whether today’s balance is below the resource standard.", "es": "El manual vigente describe una revisión retrospectiva de 60 meses desde una fecha vinculada a la solicitud MA-LTC y a las circunstancias institucionales o de exención necesarias. Tras una interrupción pertinente de servicios, una nueva solicitud puede establecer otro período. El trabajador evalúa si una operación carecía de contraprestación adecuada y si corresponde penalización. Conserve pruebas de cuándo se cobraron cheques o se entregaron bienes, no solo cuándo se redactaron documentos. Revisar transferencias es distinto de comprobar si el saldo actual está por debajo del estándar patrimonial." }, "estate_recovery_merp": { "en": "Minnesota explains that recovery generally concerns LTSS received at age 55 or older, with a separate rule for permanent institutionalization at any age. Claims are against the relevant estate; children do not have to reimburse a parent’s MA from their own assets simply because they are children. A surviving spouse or qualifying child can delay recovery, and later recovery from a spouse’s estate can require review. MinnesotaCare is a different program. Retain service records and ask about the actual claim and available protections rather than assuming all health coverage creates the same estate obligation.", "es": "Minnesota explica que la recuperación suele afectar a cuidados prolongados recibidos desde los 55 años, con otra regla para institucionalización permanente a cualquier edad. Se reclama a la herencia pertinente; los hijos no tienen que pagar MA de sus padres con bienes propios por el mero parentesco. Un cónyuge superviviente o hijo que reúna los requisitos puede aplazarla, y una reclamación posterior a la herencia del cónyuge requiere revisión. MinnesotaCare es otro programa. Guarde registros y pregunte por la reclamación y protecciones concretas, sin asumir iguales obligaciones para toda cobertura sanitaria." }, "document_notes": { "en": "Request the MA application appropriate for older adults or long-term-care services from the county or Tribal office, and arrange the MnCHOICES assessment when applicable. Collect pension and Social Security details, account ownership, insurance premiums, medical bills and current property information. Married applicants should distinguish documents for a planning asset assessment from a live application’s verification requests. Keep the waiver-obligation or spenddown notice with the approval letter. If the assessed need, living arrangement or coverage route changes, ask whether both the service plan and financial calculation need to be updated.", "es": "Solicite al condado u oficina tribal el formulario MA correspondiente a mayores o cuidados prolongados y organice MnCHOICES cuando proceda. Reúna pensiones, Seguridad Social, titulares bancarios, primas, facturas médicas e información inmobiliaria actual. Las personas casadas deben distinguir la documentación de una evaluación informativa de los requisitos de una solicitud real. Guarde la notificación de contribución o deducible con la aprobación. Si cambian las necesidades, convivencia o vía de cobertura, pregunte si deben actualizarse tanto el plan de servicios como el cálculo económico." }, "faqs": [ { "q": { "en": "Is Alternative Care the same as Elderly Waiver?", "es": "¿Alternative Care equivale a Elderly Waiver?" }, "a": { "en": "No. EW requires MA eligibility. Alternative Care is a separate route for qualifying older people who are not yet eligible for MA or choose not to have it.", "es": "No. EW exige elegibilidad MA. Alternative Care es otra vía para mayores que cumplen sus requisitos y aún no reúnen los de MA o no la eligen." } }, { "q": { "en": "Does income above the EW standard end the application?", "es": "¿Superar el estándar EW termina la solicitud?" }, "a": { "en": "No. State guidance specifically allows consideration with an MA spenddown above the special income standard. The county determines the individual obligation.", "es": "No. La orientación estatal contempla un deducible MA por encima del estándar especial. El condado determina la obligación individual." } }, { "q": { "en": "Can both spouses use the community-spouse allowance?", "es": "¿Ambos cónyuges pueden usar la reserva comunitaria?" }, "a": { "en": "Do not assume so. The protection addresses a spouse remaining in the community while the other receives qualifying care; two applicants require separate analysis.", "es": "No debe suponerse. Protege a quien permanece en la comunidad mientras el otro recibe cuidados cubiertos; dos solicitantes requieren otro análisis." } }, { "q": { "en": "Can I request an asset assessment before applying?", "es": "¿Puedo pedir una evaluación patrimonial antes de solicitar?" }, "a": { "en": "Yes, under the manual’s planning-assessment conditions. The county or Tribal agency reviews documented assets, but the result does not enroll anyone in MA.", "es": "Sí, bajo las condiciones del manual. El condado o agencia tribal revisa bienes documentados, pero el resultado no inscribe a nadie en MA." } } ] }, { "code": "NJ", "state": "New Jersey", "state_es": "Nueva Jersey", "slug_en": "new-jersey-medicaid-income-asset-limits", "slug_es": "new-jersey-limites-ingresos-bienes-medicaid", "medicaid_name": "NJ FamilyCare / Medicaid", "agency_url": "https://nj.gov/humanservices/dmahs/individuals-families/familycare/aged-disabled/", "reviewed": "2026-11-16", "income_rule_type": "income_cap_qit", "single_income_limit_ltc": 2982, "single_asset_limit_ltc": 2000, "csra_max_spouse_assets": 162660, "home_equity_limit": 1130000, "lookback_months": 60, "personal_needs_allowance": null, "sources": [ { "id": "NJ-1", "title": "DMAHS 2026 income standards", "url": "https://nj.gov/humanservices/dmahs/documents/providers-stakeholders/resources/medicaid/2026/26-03_Income_Eligibility_Standards_Effective_January-1-2026.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "2026 MLTSS cap, home-equity and spouse maxima; NJ Care income and asset standards." }, { "id": "NJ-2", "title": "Medicaid Communication 26-01", "url": "https://www.nj.gov/humanservices/dmahs/documents/providers-stakeholders/resources/medicaid/2026/26-01_Medicaid_Only_Income_and_Resources_Standards.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Institutional cap explicitly uses gross income before exclusions; regular Medicaid Only differs." }, { "id": "NJ-3", "title": "MLTSS application guidance, 2026", "url": "https://www.nj.gov/humanservices/dmahs/documents/about/NJFC-ABD-MLTSS-BRO-E-2026_Web.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "County financial review, first-of-month resources, spouse assessment, look-back and documentation." }, { "id": "NJ-4", "title": "Qualified Income Trusts", "url": "https://www.nj.gov/humanservices/dmahs/individuals-families/mtrusts.shtml", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "QIT scope, restrictions, approval and post-eligibility payments; resource test remains." }, { "id": "NJ-5", "title": "NJ FamilyCare ABD programs", "url": "https://nj.gov/humanservices/dmahs/individuals-families/familycare/aged-disabled/", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Distinct ABD pathways, spouse consideration and estate recovery after age 55." }, { "id": "NJ-6", "title": "NJ FamilyCare ABD brochure, 2026", "url": "https://www.nj.gov/humanservices/dmahs/documents/individuals-families/medicaid/NJFC_ABD_BRO-E.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Program-specific application and 2026 income trust guidance." } ], "programs": { "nursing_home": { "name": { "en": "MLTSS nursing-facility eligibility", "es": "Elegibilidad MLTSS para residencia de enfermería" }, "income_rule_type": "income_cap_qit", "single": { "income": 2982, "assets": 2000, "income_basis": "gross", "asset_basis": "individual", "income_note": { "en": "Institutional/MLTSS gross monthly cap before income exclusions.", "es": "Tope mensual bruto institucional/MLTSS antes de exclusiones." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "NJ-1", "NJ-2", "NJ-3" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "Applicant-side MLTSS reference; county must determine attributed income.", "es": "Referencia MLTSS del solicitante; el condado debe atribuir los ingresos." }, "asset_note": { "en": "Applicant-side limit after the applicable spousal assessment; not total marital assets.", "es": "Límite del solicitante tras la evaluación conyugal; no representa todos los bienes matrimoniales." }, "source_ids": [ "NJ-1", "NJ-3" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "NJ-1", "NJ-2", "NJ-3" ] }, "note": { "en": "Clinical and county financial approvals are separate.", "es": "La aprobación clínica y la económica del condado son independientes." } }, "hcbs_waiver": { "name": { "en": "MLTSS home and community-based services", "es": "Servicios domiciliarios y comunitarios MLTSS" }, "income_rule_type": "income_cap_qit", "single": { "income": 2982, "assets": 2000, "income_basis": "gross", "asset_basis": "individual", "income_note": { "en": "Institutional/MLTSS gross monthly cap before income exclusions.", "es": "Tope mensual bruto institucional/MLTSS antes de exclusiones." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "NJ-1", "NJ-2", "NJ-3" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "Applicant-side MLTSS reference; county must determine attributed income.", "es": "Referencia MLTSS del solicitante; el condado debe atribuir los ingresos." }, "asset_note": { "en": "Applicant-side limit after the applicable spousal assessment; not total marital assets.", "es": "Límite del solicitante tras la evaluación conyugal; no representa todos los bienes matrimoniales." }, "source_ids": [ "NJ-1", "NJ-3" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "NJ-1", "NJ-2", "NJ-3" ] }, "note": { "en": "This row is MLTSS; it does not describe every NJ FamilyCare home service.", "es": "Esta fila corresponde a MLTSS, no a cualquier servicio domiciliario de NJ FamilyCare." } }, "abd_regular": { "name": { "en": "NJ Care Special Medicaid, aged/blind/disabled", "es": "NJ Care Special Medicaid para mayores, ciegos o personas con discapacidad" }, "income_rule_type": "program_specific", "single": { "income": 1330, "assets": 4000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "NJ Care 100% FPL monthly standard, subject to program income exclusions.", "es": "Estándar mensual NJ Care del 100% del FPL, sujeto a exclusiones." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "NJ-1", "NJ-5" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "NJ-1", "NJ-5" ] }, "married_both": { "income": 1804, "assets": 6000, "income_basis": "countable", "asset_basis": "couple_combined", "income_note": { "en": "Two-person NJ Care standard; fiscal group and exclusions must be confirmed.", "es": "Estándar NJ Care de dos personas; confirmar grupo económico y exclusiones." }, "asset_note": { "en": "Combined countable resources where this couple rule applies.", "es": "Recursos computables conjuntos cuando corresponde esta regla de pareja." }, "source_ids": [ "NJ-1", "NJ-5" ] }, "note": { "en": "NJ Care differs from Medicaid Only/SSI and the Medically Needy category.", "es": "NJ Care difiere de Medicaid Only/SSI y de la categoría Medically Needy." } } }, "summary": { "en": "New Jersey’s Managed Long Term Services and Supports program, MLTSS, connects clinical eligibility with a separate financial review by the County Social Service Agency. For 2026 the institutional income cap is $2,982 per month, explicitly measured before income exclusions. The MLTSS applicant resource reference is $2,000, subject to exclusions and marital protections. Regular coverage is not one interchangeable category: NJ Care, Medicaid Only and Medically Needy appear in different columns of the state standards. This guide names NJ Care in its regular ABD row so those resource limits are not confused with MLTSS.", "es": "Managed Long Term Services and Supports, MLTSS, combina en Nueva Jersey elegibilidad clínica y una revisión económica independiente de la agencia de servicios sociales del condado. Para 2026, el tope institucional es $2.982 mensuales, medido expresamente antes de exclusiones. La referencia patrimonial del solicitante MLTSS es $2.000, con exclusiones y protección matrimonial. La cobertura ordinaria tampoco es una categoría única: NJ Care, Medicaid Only y Medically Needy ocupan columnas distintas. Esta guía identifica NJ Care en la fila ABD para no confundir sus límites patrimoniales con MLTSS." }, "excess_income_solution": { "en": "New Jersey permits a Qualified Income Trust for eligible people needing institutional-level care, including people served at home. The trust addresses specified income treatment; it does not turn savings into exempt income or replace the clinical assessment. The eligibility agency must approve the arrangement and review its administration. Income directed through a QIT remains subject to the permitted cost-of-care rules. Someone above a regular NJ Care standard should therefore ask about the relevant coverage category instead of assuming the MLTSS trust route applies to every medical application.", "es": "Nueva Jersey permite un Qualified Income Trust para personas elegibles que necesitan cuidados de nivel institucional, incluso atendidas en casa. El fideicomiso modifica un tratamiento concreto de ingresos; no transforma ahorros en ingresos exentos ni sustituye la evaluación clínica. La agencia debe aprobarlo y revisar su administración. Los ingresos canalizados siguen sujetos a las reglas de aportación al coste. Quien supera el estándar ordinario NJ Care debe consultar su categoría de cobertura, sin suponer que la vía fiduciaria MLTSS sirve para cualquier solicitud médica." }, "exempt_assets_notes": { "en": "The MLTSS application guide explains that the occupied home and a vehicle used by the applicant can be excluded from the ordinary resource total. That summary does not erase the separate home-equity restriction: the 2026 state table lists $1,130,000. Ask how occupancy, ownership and a spouse’s residence affect the assessment. Resources are evaluated at the beginning of the month under the MLTSS guidance, so the date on a statement matters. A single balance printed later in the month may not answer the county’s question.", "es": "La guía MLTSS explica que la vivienda ocupada y un vehículo utilizado por el solicitante pueden excluirse del total ordinario. Ese resumen no elimina la restricción inmobiliaria independiente: la tabla estatal de 2026 indica $1.130.000. Pregunta cómo influyen ocupación, propiedad y residencia del cónyuge. La guía evalúa los recursos al principio del mes, por lo que importa la fecha del extracto. Un saldo impreso más tarde puede no responder a lo que necesita comprobar el condado." }, "spousal_notes": { "en": "When only one spouse needs MLTSS, the county evaluates the couple’s resources and the amount protected for the spouse remaining in the community. The published maximum for 2026 is $162,660, not a guaranteed extra allowance for every married applicant. Income maintenance for that spouse is a separate calculation from protected assets. Where both spouses apply for long-term care, do not double the one-applicant figure or assume a community spouse exists. Ask for the household-specific budget and the explanation of which income belongs to which spouse.", "es": "Si solo un cónyuge necesita MLTSS, el condado evalúa los recursos matrimoniales y la cantidad protegida para quien permanece en la comunidad. El máximo publicado de 2026 es $162.660, no una franquicia adicional garantizada para toda persona casada. El mantenimiento de ingresos del cónyuge es un cálculo separado de los bienes protegidos. Si ambos solicitan cuidados prolongados, no dupliques la cifra individual ni supongas que existe cónyuge comunitario. Solicita el presupuesto concreto y la atribución de ingresos entre ambos." }, "lookback_rules": { "en": "MLTSS guidance describes a five-year review of financial history. The county may ask about sales, gifts, withdrawals and payments to relatives to determine whether fair value was received. A documented purchase is not automatically the same as a gift, and a transfer penalty is different from ordinary excess resources. Preserve existing care agreements, payment records and explanations for unusual transactions. Do not create a new transfer merely because an online calculator shows excess assets; the county must evaluate the transaction and any applicable exception.", "es": "MLTSS describe una revisión de cinco años de historial económico. El condado puede preguntar por ventas, regalos, retiradas y pagos a familiares para comprobar si hubo contraprestación adecuada. Una compra documentada no equivale automáticamente a una donación, y una penalización por transmisión difiere del exceso ordinario de bienes. Conserva acuerdos de cuidados existentes, registros y explicaciones de operaciones inusuales. No realices nuevas transmisiones porque una calculadora indique exceso: el condado debe evaluar la operación y cualquier excepción aplicable." }, "estate_recovery_merp": { "en": "DMAHS describes estate recovery for Medicaid payments associated with services received from age 55 onward. This is a later estate process, distinct from the financial test used during life. The QIT guidance expressly warns that recovery rules remain relevant; using a trust does not promise an inheritance will be protected. If an estate receives a notice, its representative should ask the agency about the covered payments, any surviving-family protections and available review procedures. Keep eligibility and trust records accessible for that purpose.", "es": "DMAHS describe recuperación sucesoria de pagos Medicaid por servicios recibidos desde los 55 años. Es un procedimiento posterior sobre la herencia, distinto del examen económico durante la vida. Las instrucciones QIT advierten que la recuperación sigue siendo relevante: utilizar un fideicomiso no promete proteger una herencia. Si llega una notificación, el representante debe preguntar por los pagos reclamados, las protecciones familiares y los procedimientos de revisión. Conserva accesibles los documentos de elegibilidad y del fideicomiso para ese fin." }, "document_notes": { "en": "Contact the county agency for the financial application and identify who is arranging the clinical screening. Prepare current award letters, ownership records and the statements the caseworker requests. Explain whether an account is joint rather than reporting only a personal estimate of your share. Keep copies of documents submitted and a list of outstanding questions. The 2026 guidance offers a possible simplified self-attestation route for some applicants, so ask whether it applies instead of assuming everyone must assemble the same historical packet. When supplying an account balance, label the statement date clearly; the MLTSS guidance emphasizes the first day of the month.", "es": "Contacta con el condado para la solicitud económica e identifica quién organiza la evaluación clínica. Prepara cartas de prestaciones, documentos de titularidad y extractos solicitados. Explica si una cuenta es conjunta, sin comunicar únicamente una estimación personal de tu parte. Conserva copias y una lista de dudas pendientes. La guía de 2026 contempla una posible declaración simplificada para ciertos solicitantes; pregunta si corresponde en lugar de suponer que todos deben reunir idéntico expediente histórico. Al presentar un saldo bancario, indica claramente la fecha del extracto; las instrucciones MLTSS destacan el primer día del mes." }, "faqs": [ { "q": { "en": "Does NJ Care use the MLTSS asset limit?", "es": "¿NJ Care utiliza el límite patrimonial MLTSS?" }, "a": { "en": "No. The 2026 table gives NJ Care its own $4,000 individual resource standard.", "es": "No. La tabla de 2026 atribuye a NJ Care un estándar individual de $4.000." } }, { "q": { "en": "Is the $2,982 cap take-home income?", "es": "¿El tope de $2.982 corresponde al ingreso neto?" }, "a": { "en": "No. The institutional standard explicitly uses gross income before exclusions.", "es": "No. El estándar institucional usa expresamente ingresos brutos antes de exclusiones." } }, { "q": { "en": "Will a QIT solve excess savings?", "es": "¿Un QIT resuelve el exceso de ahorros?" }, "a": { "en": "No. Its permitted contents and purpose concern income, while the resource test remains.", "es": "No. Su contenido y finalidad se refieren a ingresos; la prueba patrimonial permanece." } }, { "q": { "en": "Who makes the financial decision?", "es": "¿Quién decide la elegibilidad económica?" }, "a": { "en": "The County Social Service Agency reviews finances; clinical eligibility has a separate route.", "es": "La agencia social del condado revisa las finanzas; la elegibilidad clínica tiene otra vía." } } ] }, { "code": "NY", "state": "New York", "state_es": "Nueva York", "slug_en": "new-york-medicaid-income-asset-limits", "slug_es": "nueva-york-limites-ingresos-bienes-medicaid", "medicaid_name": "New York Medicaid", "agency_url": "https://www.health.ny.gov/health_care/medicaid/", "reviewed": "2026-11-16", "income_rule_type": "medically_needy_spenddown", "single_income_limit_ltc": null, "single_asset_limit_ltc": 33038, "csra_max_spouse_assets": 162660, "home_equity_limit": null, "lookback_months": 60, "personal_needs_allowance": 50, "sources": [ { "id": "NY-1", "title": "NYS DOH:2026 full Medicaid financial levels", "url": "https://www.health.ny.gov/health_care/medicaid/program/update/savingsprogram/medicaresavingsprogram", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Community income 1836/2489 and assets 33038/44796; deductions" }, { "id": "NY-2", "title": "NYS DOH:2026 spousal impoverishment update", "url": "https://www.health.ny.gov/health_care/medicaid/program/update/2026/no04_2026-03.htm", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "CSRA 162660; institutional income after deductions compared with care cost" }, { "id": "NY-3", "title": "NYS Partnership:2026 resource and income allowances", "url": "https://nyspltc.health.ny.gov/medicaid/index.htm", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Nursing applicant assets 33038 and PNA 50; special Partnership exceptions distinguished" }, { "id": "NY-4", "title": "NYS Office for Aging:2026 HIICAP Medicaid module", "url": "https://aging.ny.gov/system/files/documents/2026/04/hiicap-notebook-2026-module-14-medicaid.pdf", "accessed": "2026-11-16", "method": "pdf", "supports": "Nursing 60-month lookback; community 30-month policy described as not yet implemented in 2026 module" }, { "id": "NY-5", "title": "NYS DOH: Excess Income Program", "url": "https://www.health.ny.gov/health_care/medicaid/excess_income", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Medical-expense spenddown mechanics" }, { "id": "NY-6", "title": "NYS OMIG: estate recovery", "url": "https://omig.ny.gov/casualty-estate-recovery-estate-recovery", "accessed": "2026-11-16", "method": "page", "supports": "Recoverable services, capitation, protected survivors and hardship" } ], "programs": { "nursing_home": { "name": { "en": "Medicaid nursing-facility chronic-care budgeting", "es": "Presupuesto institucional Medicaid para residencia" }, "income_rule_type": "medically_needy_spenddown", "single": { "income": null, "assets": 33038, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "Chronic-care budgeting compares available income after deductions with care costs; the personal-needs allowance is not an income cap.", "es": "El presupuesto institucional compara ingresos disponibles tras deducciones con costes asistenciales; la asignación personal no es un tope de ingresos." }, "asset_note": { "en": "2026 individual countable-resource allowance.", "es": "Asignación individual de recursos computables 2026." }, "source_ids": [ "NY-2", "NY-3" ] }, "married_one": { "income": null, "assets": 33038, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "Chronic-care budgeting compares available income after deductions with care costs; the personal-needs allowance is not an income cap.", "es": "El presupuesto institucional compara ingresos disponibles tras deducciones con costes asistenciales; la asignación personal no es un tope de ingresos." }, "asset_note": { "en": "Applicant resources; community-spouse protections apply separately.", "es": "Recursos del solicitante; protección conyugal separada." }, "source_ids": [ "NY-2", "NY-3" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Chronic-care budgeting compares available income after deductions with care costs; the personal-needs allowance is not an income cap.", "es": "El presupuesto institucional compara ingresos disponibles tras deducciones con costes asistenciales; la asignación personal no es un tope de ingresos." }, "asset_note": { "en": "The verified community couple standard is not substituted for two institutional cases.", "es": "La referencia comunitaria de pareja no sustituye dos casos institucionales." }, "source_ids": [ "NY-2", "NY-3" ] }, "note": { "en": "A $50 personal-needs amount concerns income retained after eligibility, not maximum gross income.", "es": "Los $50 personales corresponden a ingresos conservados tras elegibilidad, no al máximo bruto." } }, "hcbs_waiver": { "name": { "en": "Community long-term care; waiver or MLTC budgeting must be identified", "es": "Cuidados comunitarios; debe identificarse presupuesto de exención o MLTC" }, "income_rule_type": "program_specific", "single": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "The district must identify the waiver, MLTC or other coverage category before applying community standards.", "es": "El distrito debe identificar exención, MLTC u otra categoría antes de aplicar referencias comunitarias." }, "asset_note": { "en": "No universal waiver asset limit is inferred from the community Medicaid table.", "es": "No se deduce un límite universal de exenciones de la tabla comunitaria." }, "source_ids": [ "NY-1", "NY-2" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Some community LTC routes use spousal-impoverishment budgeting; request the relevant calculation.", "es": "Algunas vías comunitarias utilizan protección conyugal; solicita el cálculo correspondiente." }, "asset_note": { "en": "Do not compare all marital assets to one individual limit.", "es": "No compares todo el patrimonio matrimonial con un límite individual." }, "source_ids": [ "NY-2" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Each person’s service and budgeting category require review.", "es": "Deben revisarse servicio y categoría presupuestaria de cada persona." }, "asset_note": { "en": "Combined eligibility cannot be inferred from two separate individual allowances.", "es": "No se deduce elegibilidad conjunta sumando dos asignaciones individuales." }, "source_ids": [ "NY-1", "NY-2" ] }, "note": { "en": "This row deliberately leaves figures open where the precise community program has not been selected.", "es": "Se dejan cifras abiertas cuando no se ha seleccionado el programa comunitario preciso." } }, "abd_regular": { "name": { "en": "Full community Medicaid for aged, blind or disabled people", "es": "Medicaid comunitario completo para mayores, personas ciegas o con discapacidad" }, "income_rule_type": "medically_needy_spenddown", "single": { "income": 1836, "assets": 33038, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "2026 monthly net/countable reference before case-specific deductions; not gross income.", "es": "Referencia mensual neta/computable 2026; no equivale a ingresos brutos." }, "asset_note": { "en": "Individual countable resources.", "es": "Recursos computables individuales." }, "source_ids": [ "NY-1" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Spousal deeming and the applicable budget determine the relevant income amount.", "es": "La imputación conyugal y presupuesto determinan el importe aplicable." }, "asset_note": { "en": "A one-applicant married case needs its own household assessment.", "es": "Un matrimonio con un solicitante necesita evaluación propia." }, "source_ids": [ "NY-1", "NY-2" ] }, "married_both": { "income": 2489, "assets": 44796, "income_basis": "countable", "asset_basis": "couple_combined", "income_note": { "en": "Combined community couple reference, not this amount per spouse.", "es": "Referencia conjunta de pareja comunitaria, no por cónyuge." }, "asset_note": { "en": "Combined community couple resources.", "es": "Recursos conjuntos de la pareja comunitaria." }, "source_ids": [ "NY-1" ] }, "note": { "en": "The $20 general disregard and other deductions must be applied by the district; the calculator does not assess them.", "es": "El distrito aplica la exclusión general de $20 y otras deducciones; la calculadora no las determina." } } }, "summary": { "en": "New York separates community Medicaid budgeting from the financial rules for a permanent nursing-home stay. In 2026, the state publishes community references of $1,836 monthly countable income and $33,038 countable resources for one person. Those amounts should not be relabeled as a nursing-home gross-income cap. Local social services districts, including New York City HRA, determine the applicable budget. Someone asking for home care must also identify the service route: ordinary community coverage, managed long-term care and a particular waiver can involve different assessments and spouse protections.", "es": "Nueva York separa el presupuesto Medicaid comunitario de las reglas para una estancia residencial permanente. En 2026 publica referencias comunitarias de $1,836 mensuales de ingresos computables y $33,038 de recursos para una persona. No deben presentarse como un tope bruto residencial. Los distritos de servicios sociales, incluida HRA en Nueva York, determinan el presupuesto aplicable. Quien solicita atención domiciliaria debe identificar la vía: cobertura comunitaria ordinaria, atención de larga duración administrada y una exención concreta pueden tener distintas evaluaciones y protecciones conyugales." }, "excess_income_solution": { "en": "The Excess Income Program, often called spenddown or surplus income, can recognize qualifying medical expenses when income exceeds the relevant standard. The district explains which bills count and the period they cover. This is different from an asset limit and from buying services without an authorization. Nursing-home chronic-care budgeting considers income after permitted deductions against care costs, then determines the contribution toward care. A $50 personal-needs allowance describes money retained by an eligible resident; it does not mean that earning more than $50 makes the person ineligible.", "es": "El programa de exceso de ingresos, llamado spenddown o surplus income, puede reconocer gastos médicos admisibles cuando se supera la referencia. El distrito explica qué facturas cuentan y su periodo. Es distinto del límite patrimonial y de contratar servicios sin autorización. El presupuesto institucional compara ingresos tras deducciones permitidas con costes y determina la aportación a la atención. La asignación personal de $50 describe dinero que conserva un residente elegible; no significa que recibir más de $50 impida acceder a Medicaid." }, "exempt_assets_notes": { "en": "A resource total requires classification, not just addition. Ask how the district treats the home, a vehicle, retirement arrangements, insurance and jointly owned accounts. An account containing a relative’s money may require ownership evidence rather than an informal explanation. The home’s treatment depends on the coverage and household circumstances. This table does not insert an unverified statewide home-equity number. Keep eligibility exemptions separate from the later estate-recovery question, and do not treat a balance transferred into another name as automatically unavailable to Medicaid.", "es": "El total de recursos exige clasificar, no solo sumar. Pregunta cómo trata el distrito vivienda, vehículo, jubilación, seguros y cuentas conjuntas. Una cuenta con dinero de un familiar puede exigir prueba de titularidad, no una explicación informal. La vivienda depende de cobertura y circunstancias del hogar. Esta tabla no introduce un límite inmobiliario estatal sin verificar. Separa las exclusiones de elegibilidad de la recuperación sucesoria posterior y no supongas que cambiar el titular de un saldo lo vuelve automáticamente indisponible para Medicaid." }, "spousal_notes": { "en": "New York’s 2026 spousal notice identifies a maximum community-spouse resource allowance of $162,660 and explains that protection can also matter for certain waiver and managed long-term-care services. The amount is not an unconditional cash payment or an automatic resource allowance for every married couple. Ask the district for a resource assessment and its income-allocation calculation. A couple living together on ordinary community Medicaid has a different published combined reference. When both spouses receive institutional care, do not double the community-spouse allowance or apply a household chart without confirming the budget.", "es": "La notificación conyugal de 2026 identifica un máximo protegido de $162,660 y explica que la protección también puede importar en ciertas exenciones y atención administrada. No es un pago ni una asignación automática para todo matrimonio. Solicita evaluación patrimonial y cálculo de distribución de ingresos. Una pareja con Medicaid comunitario ordinario tiene otra referencia conjunta publicada. Si ambos reciben atención institucional, no dupliques la asignación del cónyuge comunitario ni apliques una tabla doméstica sin confirmar el presupuesto correspondiente." }, "lookback_rules": { "en": "The nursing-home transfer lookback is 60 months. Community long-term care requires particular caution: the state’s 2026 HIICAP module still describes the proposed 30-month transfer rule as conditional on approval and implementation. This guide therefore does not present 30 months as an active blanket HCBS rule. Ask the district for current written guidance for the service and application date. Transfers can have exceptions and require individual analysis; the fact that a transaction is recent does not establish its penalty. Retain records of ownership, consideration received and the reason for the transaction.", "es": "La revisión de transferencias para residencia abarca 60 meses. En atención comunitaria hay que ser preciso: el módulo estatal HIICAP 2026 todavía describe la regla propuesta de 30 meses como condicionada a aprobación e implementación. Por eso no se presenta como norma activa universal HCBS. Solicita al distrito instrucciones vigentes para servicio y fecha de solicitud. Las transferencias pueden tener excepciones y requieren análisis individual; que una operación sea reciente no determina su sanción. Conserva titularidad, contraprestación recibida y motivo de la operación." }, "estate_recovery_merp": { "en": "New York OMIG describes recovery of certain Medicaid expenditures from an eligible deceased recipient’s estate, including managed-care capitation payments. A capitation amount can differ from the value of services the family remembers receiving. Survivor protections, deferrals and hardship rules must be considered before a claim is resolved. Estate recovery is not an automatic demand that children pay their parent’s care bills from personal savings. The estate representative should obtain the claim details, coverage dates and instructions for submitting information about protected survivors or hardship.", "es": "OMIG describe recuperación de determinados gastos Medicaid del patrimonio sucesorio, incluidos pagos por afiliación a planes administrados. Esos pagos pueden diferir de los servicios que la familia recuerda. Deben examinarse protecciones de supervivientes, aplazamientos y dificultades antes de resolver la reclamación. No equivale a exigir automáticamente que los hijos paguen con sus ahorros las facturas parentales. El representante sucesorio debe pedir detalle, fechas de cobertura e instrucciones para aportar información sobre familiares protegidos o dificultades." }, "document_notes": { "en": "Prepare current Social Security and pension statements, bank records, ownership documents and medical-expense evidence relevant to a spenddown. Keep nursing admission dates or home-care assessment requests with the financial file. Ask the district which supplement and historical records are needed for this application; community and institutional requests are not interchangeable. Save copies of submissions and any written budget. If a figure seems wrong, ask which income source or resource produced it and use the review instructions on the notice rather than relying on a national chart.", "es": "Prepara justificantes actuales de Seguro Social, pensiones, cuentas, titularidad y gastos médicos relevantes para spenddown. Guarda fechas de ingreso residencial o solicitudes de evaluación domiciliaria junto al expediente económico. Pregunta qué suplemento y registros históricos exige ese caso; solicitudes comunitarias e institucionales no son intercambiables. Conserva copias y presupuesto escrito. Si una cifra parece incorrecta, pregunta qué ingreso o recurso la produjo y utiliza las instrucciones de revisión de la notificación en vez de una tabla nacional." }, "faqs": [ { "q": { "en": "Is $1,836 a nursing-home income cap?", "es": "¿ $1,836 es un tope residencial?" }, "a": { "en": "No. It is a 2026 community income reference; institutional chronic-care budgeting works differently.", "es": "No. Es una referencia comunitaria 2026; el presupuesto institucional funciona de otra manera." } }, { "q": { "en": "Is the 30-month community lookback confirmed active here?", "es": "¿Se confirma activa la revisión comunitaria de 30 meses?" }, "a": { "en": "No. The reviewed 2026 state material describes implementation as pending; verify current service-specific instructions.", "es": "No. El material estatal 2026 revisado describe implementación pendiente; confirma instrucciones actuales del servicio." } }, { "q": { "en": "Can medical bills affect an income result?", "es": "¿Las facturas médicas pueden afectar el resultado?" }, "a": { "en": "Qualifying bills may count through the Excess Income Program; the district determines the amount and period.", "es": "Facturas admisibles pueden contar en el programa de exceso; el distrito determina importe y periodo. El distrito también debe confirmar qué deducciones reconoce." } }, { "q": { "en": "Is $50 the amount I may earn?", "es": "¿ $50 es lo que puedo ingresar?" }, "a": { "en": "No. It is the published nursing-home personal-needs allowance, not a general earnings limit.", "es": "No. Es la asignación personal residencial publicada, no un límite general de ingresos." } } ] }, { "code": "NC", "state": "North Carolina", "state_es": "Carolina del Norte", "slug_en": "north-carolina-medicaid-income-asset-limits", "slug_es": "carolina-del-norte-limites-ingresos-bienes-medicaid", "medicaid_name": "NC Medicaid", "agency_url": "https://medicaid.ncdhhs.gov/beneficiaries/long-term-services-and-supports/community-alternatives-program-disabled-adults", "reviewed": "2026-11-16", "income_rule_type": "program_specific", "single_income_limit_ltc": null, "single_asset_limit_ltc": 2000, "csra_max_spouse_assets": null, "home_equity_limit": 752000, "lookback_months": 60, "personal_needs_allowance": 70, "sources": [ { "id": "NC-1", "title": "MA-2252 Non-MAGI income/reserve limits, April 2026", "url": "https://policies.ncdhhs.gov/wp-content/uploads/MA-2252-Non-MAGI-Income-1.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "MAABD-N1330/1804; MAABD resources 2000/3000; medically-needy standards distinct." }, { "id": "NC-2", "title": "Basic Medicaid eligibility requirements, April 2026 income/resource columns", "url": "https://policies.ncdhhs.gov/wp-content/uploads/Basic-Medicaid-Eligibility-8.pdf", "accessed": "2026-11-16", "method": "pdf", "supports": "MAABD household references; nursing income contribution and 70PNA. Spousal sidebar retains 2025 figures and is not used as 2026 source." }, { "id": "NC-3", "title": "CAP/DA beneficiary eligibility", "url": "https://medicaid.ncdhhs.gov/beneficiaries/long-term-services-and-supports/community-alternatives-program-disabled-adults", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "AdultCAP/DA level ofcare, underlyingMAA/MAB/MAD/HCWD, Medicaid Direct, possible deductible." }, { "id": "NC-4", "title": "MA-2280 CAP Medicaid eligibility", "url": "https://policies.ncdhhs.gov/wp-content/uploads/ma-2280-CAP.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Applicant-only income starting CAP approval; oneperson resource reference after marriedasset/spousalprotection review; monthlydeductibles." }, { "id": "NC-5", "title": "MA-2242 Home equity and institutional services", "url": "https://policies.ncdhhs.gov/wp-content/uploads/ma-2242-Home-Equity-Value-For-Evaluating-Instititional-Services.pdf", "accessed": "2026-11-16", "method": "pdf", "supports": "2026 home 752000; institutional scope, exceptions and distinction from in-home health supplies." }, { "id": "NC-6", "title": "MA-2240 Transfers of assets, June 2026", "url": "https://policies.ncdhhs.gov/wp-content/uploads/MA-2240-Transfer-of-Assets-3.pdf", "accessed": "2026-11-16", "method": "pdf", "supports": "Transfer review,60-month lookback, records requests and exceptions." }, { "id": "NC-7", "title": "NC Medicaid estate recovery statute", "url": "https://www3.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_108A/GS_108A-70.5.html", "accessed": "2026-11-16", "method": "page", "supports": "Recovery scope, surviving spouse/child protections and hardship process." }, { "id": "NC-8", "title": "MA-2250 Income", "url": "https://policies.ncdhhs.gov/wp-content/uploads/ma-2250-Income.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Available and countable income, financialresponsibility and institutional spouse income attribution." } ], "programs": { "nursing_home": { "name": { "en": "NC Medicaid nursing-facility long-term-care budgeting", "es": "NC Medicaid: cálculo de cuidados prolongados en centro de enfermería" }, "income_rule_type": "program_specific", "single": { "income": null, "assets": 2000, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "No universal fixed gross-income cap is verified here. LTC budgeting considers income, allowable deductions and care costs.", "es": "No se verifica aquí un tope bruto fijo universal. El cálculo considera ingresos, deducciones permitidas y costes de cuidados." }, "asset_note": { "en": "Countable resources after exclusions.", "es": "Recursos computables después de las exclusiones." }, "source_ids": [ "NC-1", "NC-2", "NC-8" ] }, "married_one": { "income": null, "assets": 2000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "No universal fixed gross-income cap is verified here. LTC budgeting considers income, allowable deductions and care costs. This is the applicant’s reference, not combined marital income.", "es": "No se verifica aquí un tope bruto fijo universal. El cálculo considera ingresos, deducciones permitidas y costes de cuidados. Es la referencia del solicitante, no los ingresos conjuntos del matrimonio." }, "asset_note": { "en": "Applicant-side resources after the spousal assessment; not a ceiling on all marital property.", "es": "Recursos atribuidos al solicitante después de evaluar al matrimonio; no es un tope para todos sus bienes." }, "source_ids": [ "NC-1", "NC-2", "NC-8" ] }, "married_both": { "income": null, "assets": null, "income_basis": "unknown", "asset_basis": "unknown", "income_note": { "en": "No verified combined-couple threshold is published here; each spouse needs a separate eligibility review.", "es": "No publicamos un límite conjunto verificado; cada cónyuge necesita su propia evaluación." }, "asset_note": { "en": "Do not double the single-person limit or apply a community-spouse allowance when both receive institutional care.", "es": "No duplique el límite individual ni aplique una reserva para cónyuge comunitario cuando ambos reciben atención institucional." }, "source_ids": [ "NC-1", "NC-2", "NC-8" ] }, "note": { "en": "The 70-dollar personal allowance is an institutional cost-of-care deduction, not an income eligibility ceiling.", "es": "La asignación personal de 70 dólares es una deducción institucional del coste, no el límite de elegibilidad económica." } }, "hcbs_waiver": { "name": { "en": "CAP/DA through the MAABD-N financial route", "es": "CAP/DA mediante la vía económica MAABD-N" }, "income_rule_type": "medically_needy_spenddown", "single": { "income": 1330, "assets": 2000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "MAABD-N reference for the applicant; CAP can involve a monthly deductible or another underlying category.", "es": "Referencia MAABD-N del solicitante; CAP puede implicar un deducible mensual u otra categoría de cobertura." }, "asset_note": { "en": "Countable resources after exclusions.", "es": "Recursos computables después de las exclusiones." }, "source_ids": [ "NC-1", "NC-3", "NC-4", "NC-8" ] }, "married_one": { "income": 1330, "assets": 2000, "income_basis": "countable", "asset_basis": "applicant_only", "income_note": { "en": "MAABD-N reference for the applicant; CAP can involve a monthly deductible or another underlying category. This is the applicant’s reference, not combined marital income.", "es": "Referencia MAABD-N del solicitante; CAP puede implicar un deducible mensual u otra categoría de cobertura. Es la referencia del solicitante, no los ingresos conjuntos del matrimonio." }, "asset_note": { "en": "Applicant-side resources after the spousal assessment; not a ceiling on all marital property.", "es": "Recursos atribuidos al solicitante después de evaluar al matrimonio; no es un tope para todos sus bienes." }, "source_ids": [ "NC-1", "NC-3", "NC-4", "NC-8" ] }, "married_both": { "income": null, "assets": null, "income_basis": "unknown", "asset_basis": "unknown", "income_note": { "en": "No verified combined-couple threshold is published here; each spouse needs a separate eligibility review.", "es": "No publicamos un límite conjunto verificado; cada cónyuge necesita su propia evaluación." }, "asset_note": { "en": "Do not double the single-person limit or apply a community-spouse allowance when both receive institutional care.", "es": "No duplique el límite individual ni aplique una reserva para cónyuge comunitario cuando ambos reciben atención institucional." }, "source_ids": [ "NC-1", "NC-3", "NC-4", "NC-8" ] }, "note": { "en": "Not a universal CAP ceiling: HCWD and other underlying eligibility pathways differ. Applicant-only income treatment begins with CAP approval.", "es": "No es un máximo universal CAP: HCWD y otras vías difieren. El tratamiento individual de ingresos comienza con la aprobación CAP." } }, "abd_regular": { "name": { "en": "MAA/MAB/MAD categorically-needy community coverage", "es": "Cobertura comunitaria MAA/MAB/MAD de necesidad categórica" }, "income_rule_type": "medically_needy_spenddown", "single": { "income": 1330, "assets": 2000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "MAABD-N countable-income reference effective April 1,2026. Deductible and reduced-standard rules require separate review.", "es": "Referencia computable MAABD-N vigente desde abril de 2026. El deducible y los estándares reducidos requieren otra revisión." }, "asset_note": { "en": "Individual countable resources.", "es": "Recursos computables individuales." }, "source_ids": [ "NC-1", "NC-2", "NC-8" ] }, "married_one": { "income": 1804, "assets": null, "income_basis": "countable", "asset_basis": "unknown", "income_note": { "en": "Couple/household reference where spouses are included together; exclusions and deeming require agency review. MAABD-N countable-income reference effective April 1,2026. Deductible and reduced-standard rules require separate review.", "es": "Referencia de pareja u hogar cuando los cónyuges se incluyen juntos; la agencia debe revisar exclusiones y atribución de ingresos. Referencia computable MAABD-N vigente desde abril de 2026. El deducible y los estándares reducidos requieren otra revisión." }, "asset_note": { "en": "The couple resource reference is 3,000 dollars combined, not an applicant-only allowance.", "es": "La referencia patrimonial de la pareja es de 3,000 dólares en conjunto, no una reserva individual." }, "source_ids": [ "NC-1", "NC-2", "NC-8" ] }, "married_both": { "income": 1804, "assets": 3000, "income_basis": "countable", "asset_basis": "couple_combined", "income_note": { "en": "Combined couple countable-income reference, not a gross-income ceiling. MAABD-N countable-income reference effective April 1,2026. Deductible and reduced-standard rules require separate review.", "es": "Referencia de ingresos computables conjuntos, no un límite de ingresos brutos. Referencia computable MAABD-N vigente desde abril de 2026. El deducible y los estándares reducidos requieren otra revisión." }, "asset_note": { "en": "Combined countable resources for the two-person assistance unit.", "es": "Recursos computables conjuntos de la unidad de dos personas." }, "source_ids": [ "NC-1", "NC-2", "NC-8" ] }, "note": { "en": "For spouses living together, financial responsibility can apply even when only one applies; CAP has a distinct rule.", "es": "Con cónyuges convivientes puede existir responsabilidad económica aunque solo uno solicite; CAP tiene una regla distinta." } } }, "summary": { "en": "North Carolina’s county Department of Social Services determines Medicaid financial eligibility, while long-term-care services need their own clinical and program review. Regular Medicaid for the aged, blind or disabled uses MAABD categories. CAP/DA provides home-and-community-based services for qualifying adults and requires an appropriate underlying Medicaid category. Nursing-facility budgeting is another calculation. Do not substitute Medicaid expansion figures for a senior’s application. The state’s current income chart and the person’s living arrangement are needed together, especially when a spouse remains at home or the application moves from ordinary coverage into CAP.", "es": "El Departamento de Servicios Sociales del condado determina la elegibilidad económica de Medicaid en Carolina del Norte, mientras que los cuidados prolongados necesitan revisión clínica y del programa. Medicaid ordinario para mayores, personas ciegas o con discapacidad utiliza categorías MAABD. CAP/DA ofrece servicios domiciliarios y comunitarios para adultos que reúnen requisitos y exige una categoría Medicaid adecuada. Los centros de enfermería utilizan otro cálculo. No sustituya los importes de ampliación Medicaid por los de una solicitud de mayores. Deben combinarse la tabla vigente y la convivencia, especialmente cuando queda un cónyuge en casa o se pasa de cobertura ordinaria a CAP." }, "excess_income_solution": { "en": "NC Medicaid describes a deductible route for some people whose countable income exceeds the applicable MAABD standard. CAP policy calculates its deductibles monthly, which differs from assuming that every program has the same budget period. A nursing-facility resident generally contributes income after permitted allowances and expenses under LTC budgeting. Ask the county to name the coverage category and show the calculation before treating a high pension as a final denial. Approved medical costs, their dates and responsibility for payment matter; simply spending money on ordinary purchases does not create a medical deductible.", "es": "NC Medicaid describe una vía de deducible para algunas personas cuyos ingresos computables superan el estándar MAABD correspondiente. CAP calcula sus deducibles mensualmente; no debe suponerse un período idéntico en todos los programas. Un residente institucional normalmente aporta ingresos después de las asignaciones y gastos permitidos mediante el cálculo LTC. Pida al condado la categoría y su cálculo antes de interpretar una pensión elevada como rechazo definitivo. Importan los costes médicos admitidos, sus fechas y quién debe pagarlos; gastar en compras ordinarias no crea un deducible médico." }, "exempt_assets_notes": { "en": "The resource standard concerns countable property, not the total value of every household possession. Home equity receives a separate review under MA-2242 for the institutional services covered by that rule. The 2026 figure is verified, but it must be read with the rule’s exceptions and scope. The policy expressly distinguishes institutional services from applications for certain in-home health services and supplies. Give the worker mortgage information, ownership shares and household occupancy. A house that is not counted in the ordinary resource total may still need another review before a particular long-term-care benefit is payable.", "es": "El estándar patrimonial se refiere a bienes computables, no al valor de todas las posesiones familiares. MA-2242 revisa por separado el patrimonio neto de vivienda para los servicios institucionales incluidos en esa norma. La cifra de 2026 está verificada, pero debe leerse con sus excepciones y alcance. La política distingue expresamente servicios institucionales de ciertas solicitudes de atención sanitaria y suministros domiciliarios. Entregue información hipotecaria, participaciones y ocupantes. Aunque una vivienda no figure en el total patrimonial ordinario, puede necesitar otra evaluación antes de que Medicaid pague determinado servicio prolongado." }, "spousal_notes": { "en": "CAP’s financial rules are a useful example of why household status matters. Starting with CAP approval, the policy considers the applicant’s income rather than imposing ordinary spouse-for-spouse income responsibility. Resources still require review of the married couple’s assets and any applicable spousal protection. This is different from regular MAABD coverage for spouses living together. The general 2026 chart contains a spousal sidebar with older figures, so this guide does not reuse those numbers as current allowances. Ask the county for the current resource-protection determination and the effective month of any change in budgeting.", "es": "CAP demuestra por qué importa la situación familiar. Desde su aprobación, la política considera los ingresos del solicitante en lugar de imponer la responsabilidad ordinaria de un cónyuge por el otro. Los bienes siguen requiriendo revisión conjunta y cualquier protección matrimonial aplicable. Difiere de MAABD ordinario con cónyuges convivientes. La tabla general de 2026 conserva una columna matrimonial con cifras antiguas, por lo que esta guía no las reutiliza como asignaciones vigentes. Solicite al condado la determinación actual de recursos protegidos y el mes efectivo de cualquier cambio en el cálculo." }, "lookback_rules": { "en": "MA-2240 requires transfer evaluation for the covered long-term-care circumstances and uses a 60-month lookback. The starting point can depend on institutional services and CAP facts; it is not always just the day a family visits an office. Current policy can require substantial historical financial records, so ask the county for the specific period and account list. Explain transfers with documents showing value and compensation. The agency must consider applicable exceptions and hardship procedures. A penalty concerns payment under the relevant rules; it should not be described as automatic lifetime loss of all Medicaid.", "es": "MA-2240 exige revisar transferencias en las situaciones cubiertas de cuidados prolongados y utiliza 60 meses retrospectivos. El punto inicial depende de los servicios institucionales y circunstancias CAP; no siempre es el día de acudir a una oficina. La política vigente puede exigir abundantes registros históricos: pida el período y cuentas concretos. Explique las operaciones con pruebas de valor y contraprestación. La agencia debe considerar excepciones y procedimientos por dificultades excepcionales. Una penalización afecta al pago conforme a sus reglas; no debe describirse como pérdida automática y permanente de todo Medicaid." }, "estate_recovery_merp": { "en": "North Carolina’s estate-recovery law identifies certain institutional cases and services received at age 55 or older, including covered home-and-community-based care. The state’s claim is addressed through the estate after death, with statutory protections involving a surviving spouse or qualifying child and provisions for hardship review. This is different from a transfer penalty during an application. A home can be excluded for eligibility yet remain part of the later estate analysis. Keep Medicaid and service notices so the representative can establish what was received and respond to the actual claim.", "es": "La ley de recuperación de Carolina del Norte identifica ciertos casos institucionales y servicios recibidos desde los 55 años, incluidos cuidados domiciliarios y comunitarios cubiertos. La reclamación se tramita contra la herencia después del fallecimiento, con protecciones legales relativas al cónyuge superviviente o determinados hijos y revisión de dificultades excepcionales. Difiere de penalizar una transferencia durante la solicitud. Una vivienda puede excluirse para elegibilidad y seguir siendo relevante en la herencia. Conserve resoluciones Medicaid y de servicios para identificar lo recibido y responder a la reclamación real." }, "document_notes": { "en": "Tell county DSS whether you are requesting ordinary MAABD, nursing-facility coverage or CAP/DA. For CAP/DA, coordinate the program referral and medical review as well as the financial application; Medicaid Direct enrollment is part of the published program conditions. Prepare award letters, account records, insurance expenses, property information and relevant medical bills. Identify the date services are expected to begin, because budgeting can change with approval. Request a written deductible or patient-liability explanation. If a notice seems to use the wrong marital category, raise that specific issue promptly using its contact and review instructions.", "es": "Indique al DSS del condado si solicita MAABD ordinario, cobertura institucional o CAP/DA. En CAP/DA coordine derivación y evaluación médica además de la solicitud económica; la inscripción en Medicaid Direct forma parte de las condiciones publicadas. Prepare cartas de prestaciones, registros bancarios, seguros, inmuebles y facturas médicas pertinentes. Identifique cuándo deberían comenzar los servicios, porque el cálculo puede cambiar con la aprobación. Pida por escrito el deducible o responsabilidad de pago. Si una resolución parece utilizar otra categoría matrimonial, señale ese problema siguiendo sus instrucciones de contacto y revisión." }, "faqs": [ { "q": { "en": "Does CAP/DA use my spouse’s pension?", "es": "¿CAP/DA utiliza la pensión de mi cónyuge?" }, "a": { "en": "MA-2280 removes spouse-for-spouse income responsibility from the month of CAP approval. This does not eliminate the separate married-resource assessment.", "es": "MA-2280 elimina esa responsabilidad de ingresos desde el mes de aprobación CAP. No elimina la evaluación independiente de los recursos matrimoniales." } }, { "q": { "en": "Is the CAP deductible always six months of bills?", "es": "¿El deducible CAP siempre son seis meses de facturas?" }, "a": { "en": "No. CAP policy says deductibles are calculated monthly even though its medically-needy certification period can cover six months. Ask for the written monthly calculation.", "es": "No. CAP indica cálculo mensual aunque la certificación de necesidad médica pueda abarcar seis meses. Pida el cálculo mensual por escrito." } }, { "q": { "en": "Why is the nursing-home income cap blank?", "es": "¿Por qué falta el tope de ingresos institucional?" }, "a": { "en": "A fixed universal gross cap was not verified. Nursing-facility budgeting includes income contributions and permitted deductions rather than the simple regular-MAABD comparison alone.", "es": "No se verificó un tope bruto universal. El cálculo institucional incluye contribuciones y deducciones permitidas, no solo la comparación sencilla de MAABD ordinario." } }, { "q": { "en": "Does aCAP referral itself approve Medicaid?", "es": "¿Una derivación CAP aprueba Medicaid?" }, "a": { "en": "No. The person must meet the underlying Medicaid category, program level-of-care rules and service requirements. Financial and clinical decisions are separate.", "es": "No. Deben cumplirse la categoría Medicaid, nivel de cuidados y servicios requeridos. Las decisiones económicas y clínicas son independientes." } } ] }, { "code": "OH", "state": "Ohio", "state_es": "Ohio", "slug_en": "ohio-medicaid-income-asset-limits", "slug_es": "ohio-limites-ingresos-bienes-medicaid", "medicaid_name": "Ohio Medicaid", "agency_url": "https://medicaid.ohio.gov/families-and-individuals/coverage/who-qualifies", "reviewed": "2026-11-16", "income_rule_type": "income_cap_qit", "single_income_limit_ltc": 2982, "single_asset_limit_ltc": 2000, "csra_max_spouse_assets": 162660, "home_equity_limit": 752000, "lookback_months": 60, "personal_needs_allowance": null, "sources": [ { "id": "OH-1", "title": "Ohio 2026 Medicaid standards help sheet", "url": "https://dam.assets.ohio.gov/image/upload/benefits.ohio.gov/2026_Medicaid_Standards_Help_Sheet.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "2026 SIL $2,982; ABD need $994/$1,491; resources $2,000/$3,000; spouse and home maxima." }, { "id": "OH-2", "title": "Ohio 2026 cost-of-living standards letter", "url": "https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/About%20Us/PoliciesGuidelines/MEPL/MEPL_191_-_2026_COLA.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Institutional/HCBS SIL and community need standards; maintenance allowances differ from eligibility." }, { "id": "OH-3", "title": "Ohio special income level rule", "url": "https://codes.ohio.gov/ohio-administrative-code/rule-5160:1-6-03.1", "accessed": "2026-11-16", "method": "page", "supports": "SIL budgeting excludes spousal income and specified income types; separate patient liability." }, { "id": "OH-4", "title": "Ohio QIT rule, effective October 2026", "url": "https://codes.ohio.gov/ohio-administrative-code/rule-5160:1-6-03.2", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Current QIT requirements and restriction to applicable long-term-care cases." }, { "id": "OH-5", "title": "Ohio spousal resources rule", "url": "https://codes.ohio.gov/ohio-administrative-code/rule-5160:1-6-04", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Community-spouse assessment, income attribution and applicant resource remainder." }, { "id": "OH-6", "title": "Ohio transfer-of-assets rule", "url": "https://codes.ohio.gov/ohio-administrative-code/rule-5160:1-6-06", "accessed": "2026-11-16", "method": "page", "supports": "60-month review, HCBS SIL scope, rebuttal and documented exceptions." }, { "id": "OH-7", "title": "Ohio Medicaid common questions", "url": "https://medicaid.ohio.gov/families-and-individuals/support/", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Application through Ohio Benefits/county JFS and recovery through Attorney General including non-probate property." }, { "id": "OH-8", "title": "Ohio ABD income rules, July 2026", "url": "https://codes.ohio.gov/ohio-administrative-code/rule-5160:1-3-03.1", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "ABD countable-income methodology, distinct from gross amount received." }, { "id": "OH-9", "title": "PASSPORT eligibility", "url": "https://aging.ohio.gov/care-and-living/get-help/home-and-community-care/passport-eligibility-1", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "PASSPORT age and clinical requirements; indexed official page, direct URL returned 404." } ], "programs": { "nursing_home": { "name": { "en": "Institutional Medicaid special income level", "es": "Nivel especial de ingresos de Medicaid institucional" }, "income_rule_type": "income_cap_qit", "single": { "income": 2982, "assets": 2000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "SIL starts with individual gross income and excludes specified income types under rule 5160:1-6-03.1.", "es": "SIL parte del ingreso bruto individual y excluye tipos concretos según norma 5160:1-6-03.1." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "OH-1", "OH-3" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "countable", "asset_basis": "applicant_only", "income_note": { "en": "Individual SIL computation excludes spouse income; attribution and other requirements still apply.", "es": "El cálculo SIL individual excluye ingresos conyugales; siguen aplicándose atribución y demás requisitos." }, "asset_note": { "en": "Applicant-side limit after the applicable spousal assessment; not total marital assets.", "es": "Límite del solicitante tras la evaluación conyugal; no representa todos los bienes matrimoniales." }, "source_ids": [ "OH-1", "OH-3", "OH-5" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "OH-1", "OH-3", "OH-5" ] }, "note": { "en": "SIL is one eligibility route; clinical requirements and patient liability are separate.", "es": "SIL es una vía; requisitos clínicos y aportación del paciente son independientes." } }, "hcbs_waiver": { "name": { "en": "PASSPORT / HCBS special income level route", "es": "Vía de nivel especial de ingresos PASSPORT / HCBS" }, "income_rule_type": "income_cap_qit", "single": { "income": 2982, "assets": 2000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "SIL starts with individual gross income and excludes specified income types under rule 5160:1-6-03.1.", "es": "SIL parte del ingreso bruto individual y excluye tipos concretos según norma 5160:1-6-03.1." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "OH-1", "OH-3" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "countable", "asset_basis": "applicant_only", "income_note": { "en": "Individual SIL computation excludes spouse income; attribution and other requirements still apply.", "es": "El cálculo SIL individual excluye ingresos conyugales; siguen aplicándose atribución y demás requisitos." }, "asset_note": { "en": "Applicant-side limit after the applicable spousal assessment; not total marital assets.", "es": "Límite del solicitante tras la evaluación conyugal; no representa todos los bienes matrimoniales." }, "source_ids": [ "OH-1", "OH-3", "OH-5" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "OH-1", "OH-3", "OH-5" ] }, "note": { "en": "The named waiver must accept the applicant; a financial reference does not authorize services.", "es": "El waiver debe admitir al solicitante; una referencia económica no autoriza servicios." } }, "abd_regular": { "name": { "en": "Aged, blind or disabled Medicaid, own household", "es": "Medicaid para mayores, ciegos o personas con discapacidad en su hogar" }, "income_rule_type": "program_specific", "single": { "income": 994, "assets": 2000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "2026 own-household need standard after applicable income exclusions.", "es": "Estándar de necesidad en hogar propio de 2026 tras exclusiones aplicables." }, "asset_note": { "en": "Individual countable resources; exclusions apply.", "es": "Recursos computables individuales; existen exclusiones." }, "source_ids": [ "OH-1", "OH-2", "OH-8" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined threshold; agency budgeting is required.", "es": "Sin umbral conjunto verificado; la agencia debe realizar el cálculo." }, "asset_note": { "en": "Classification and ownership require agency review.", "es": "La agencia debe revisar clasificación y titularidad." }, "source_ids": [ "OH-1", "OH-8" ] }, "married_both": { "income": 1491, "assets": 3000, "income_basis": "countable", "asset_basis": "couple_combined", "income_note": { "en": "Couple own-household need standard; not gross income before exclusions.", "es": "Estándar de necesidad de pareja en hogar propio; no es ingreso bruto antes de exclusiones." }, "asset_note": { "en": "Combined countable resources where this couple rule applies.", "es": "Recursos computables conjuntos cuando corresponde esta regla de pareja." }, "source_ids": [ "OH-1", "OH-2", "OH-8" ] }, "note": { "en": "Other living arrangements and eligibility groups have different standards.", "es": "Otros alojamientos y categorías tienen estándares distintos." } } }, "summary": { "en": "Ohio publishes separate 2026 references for ordinary aged, blind or disabled Medicaid and the special income level used in qualifying long-term-care cases. The state help sheet lists $2,982 for the institutional and HCBS special income level, while the own-household ABD need standards are $994 for an individual and $1,491 for a couple. These are different tests, not competing versions of the same limit. Ohio’s SIL rule starts with individual gross income but excludes specified payment types. The table therefore labels the result as countable rather than automatically comparing all gross receipts.", "es": "Ohio publica referencias distintas para Medicaid ordinario de mayores, ciegos o personas con discapacidad y para el nivel especial utilizado en determinados cuidados prolongados. La hoja estatal de 2026 indica $2.982 para el nivel institucional y HCBS, mientras los estándares ABD en hogar propio son $994 individuales y $1.491 de pareja. Son pruebas diferentes, no versiones contradictorias de un límite. La norma SIL parte de ingresos brutos individuales, pero excluye pagos específicos. Por eso la tabla utiliza ingreso computable, evitando comparar automáticamente todos los cobros brutos." }, "excess_income_solution": { "en": "The QIT rule effective October 12, 2026 permits a qualifying income trust only within the specified long-term-care framework. It does not waive the resource test, establish nursing-facility level of care or create an ordinary ABD spend-down option. The trust has ongoing requirements, and permitted distributions interact with the patient-liability calculation. Ask the county worker which eligibility route was evaluated and whether a QIT is relevant before seeking individualized legal help. This page explains the distinction without offering instructions for drafting, funding or administering a trust.", "es": "La norma QIT vigente desde el 12 de octubre de 2026 permite el fideicomiso de ingresos únicamente dentro del marco especificado de cuidados prolongados. No elimina la prueba patrimonial, establece necesidad clínica ni crea una vía ordinaria ABD mediante spend-down. Exige cumplimiento continuado y sus desembolsos interactúan con la aportación del paciente. Pregunta al trabajador del condado qué vía evaluó y si procede QIT antes de buscar asesoramiento jurídico individual. Esta página explica la distinción sin instrucciones para redactar, financiar o administrar fideicomisos." }, "exempt_assets_notes": { "en": "Ohio’s 2026 help sheet gives ordinary Medicaid resource references of $2,000 for one person and $3,000 for a couple, but married long-term-care cases may require the spousal assessment instead. Resource classification matters before any comparison: a home, household property, vehicle or insurance policy does not necessarily receive the same treatment as a checking account. The home-equity reference is $752,000, subject to applicable exceptions. Record ownership shares and secured debt. Do not assume that an asset excluded during life is outside the state’s later estate-recovery definition.", "es": "La hoja de 2026 publica referencias patrimoniales ordinarias de $2.000 individuales y $3.000 de pareja, pero los cuidados prolongados matrimoniales pueden requerir evaluación conyugal. Antes de comparar hay que clasificar: vivienda, efectos domésticos, vehículo o seguro no reciben necesariamente el tratamiento de una cuenta corriente. La referencia inmobiliaria es $752.000, sujeta a excepciones. Anota participaciones y deuda garantizada. No supongas que un bien excluido durante la vida queda fuera de la definición sucesoria utilizada posteriormente por el estado." }, "spousal_notes": { "en": "For the long-term-care rules represented here, a community spouse’s income is not simply added to the applicant’s SIL income. Joint payments still require attribution, and resources require a separate assessment. The 2026 maximum protected-resource reference is $162,660. The rule evaluates the couple’s countable resources after the protected amount, with an applicant-side remainder of up to $2,000 under that test. It is not a $2,000 cap on the whole marriage. Request the written assessment and any maintenance allowance rather than trying to reconstruct the decision from one bank balance.", "es": "En las reglas prolongadas aquí representadas no se suman sin más los ingresos del cónyuge comunitario al SIL del solicitante. Los pagos conjuntos requieren atribución y los bienes otra evaluación. La referencia máxima protegida de 2026 es $162.660. La norma examina recursos computables matrimoniales después de la protección, con remanente del solicitante de hasta $2.000 bajo esa prueba. No limita todo el matrimonio a $2.000. Solicita evaluación escrita y mantenimiento conyugal, sin reconstruir la decisión a partir de un único saldo." }, "lookback_rules": { "en": "Ohio’s transfer rule uses a 60-month look-back and a program-specific baseline date. For HCBS waiver requests, the rule expressly ties its transfer provisions to eligibility using the special income level. It also lists recognized exceptions and a process for explaining why a questioned transaction was not improper. Those details matter more than a blanket instruction to avoid every family transaction. Keep existing evidence about value, purpose and recipient, and ask the agency which provision applies. The review period and a restricted coverage period are not the same duration.", "es": "La norma de transmisiones utiliza 60 meses y una fecha de referencia según programa. Para solicitudes HCBS vincula expresamente esas disposiciones a la elegibilidad mediante nivel especial de ingresos. También enumera excepciones y un procedimiento para explicar por qué una operación cuestionada no fue indebida. Esos detalles importan más que prohibir indiscriminadamente toda operación familiar. Conserva pruebas existentes sobre valor, finalidad y destinatario, y pregunta qué disposición corresponde. El período revisado y el período de cobertura restringida no duran necesariamente lo mismo." }, "estate_recovery_merp": { "en": "Ohio Medicaid’s public guidance describes recovery after the death of certain members, including people who received qualifying services from age 55 and people permanently institutionalized. The Attorney General’s office handles estate notices. Ohio’s description of an estate can include property passing outside probate, so a statement about probate-only recovery from another state should not be reused here. Ask what services, dates and property support the claim and what protections may apply. An estate notice is not proof that every heir personally owes the stated amount.", "es": "La información pública describe recuperación tras fallecer determinados miembros, incluidas personas con servicios pertinentes desde los 55 años y personas institucionalizadas permanentemente. La oficina del Fiscal General gestiona avisos. La definición de herencia de Ohio puede incluir bienes ajenos al procedimiento sucesorio ordinario; no reutilices explicaciones de otro estado limitadas a probate. Pregunta qué servicios, fechas y bienes respaldan la reclamación y qué protecciones corresponden. Un aviso sucesorio no prueba que cada heredero deba personalmente la cantidad indicada." }, "document_notes": { "en": "Apply through Ohio Benefits or the County Department of Job and Family Services, and identify the separate PASSPORT assessment contact when seeking that waiver. Bring award letters showing gross payments and deductions, financial statements, ownership records and any documents requested for the spouse. Keep income eligibility, resource eligibility and patient liability as separate questions in your notes. Ohio publishes different personal and maintenance allowances for care settings; none should be substituted for the SIL. Retain notices and use their instructions if the calculation appears incorrect. For example, the SIL rule identifies veterans’ aid-and-attendance payments among excluded types; preserve documentation of the payment rather than relying on its bank-deposit description.", "es": "Solicita mediante Ohio Benefits o el Departamento de Empleo y Servicios Familiares del condado, e identifica el contacto independiente de evaluación PASSPORT si pides ese waiver. Presenta cartas con pagos brutos y deducciones, extractos, titularidad y documentos conyugales solicitados. Anota por separado elegibilidad de ingresos, patrimonial y aportación. Ohio publica asignaciones personales y de mantenimiento distintas según alojamiento; ninguna sustituye SIL. Conserva notificaciones y sigue sus instrucciones si detectas un cálculo incorrecto. Por ejemplo, la norma SIL identifica pagos de ayuda y asistencia a veteranos entre los tipos excluidos; conserva documentación de la prestación, no solo el concepto del abono." }, "faqs": [ { "q": { "en": "Is $994 Ohio’s long-term-care cap?", "es": "¿$994 es el tope de cuidados prolongados?" }, "a": { "en": "No. It is the individual ABD own-household need standard; SIL is a different route.", "es": "No. Es el estándar ABD individual en hogar propio; SIL es otra vía." } }, { "q": { "en": "Does a QIT eliminate patient liability?", "es": "¿QIT elimina la aportación del paciente?" }, "a": { "en": "No. The current rule works alongside the required contribution calculation.", "es": "No. La norma vigente funciona junto al cálculo de contribución exigida." } }, { "q": { "en": "Must all spouse income be added to SIL?", "es": "¿Debe sumarse todo ingreso conyugal a SIL?" }, "a": { "en": "No. The cited SIL rule excludes spouse income, while attribution rules still matter.", "es": "No. La norma SIL excluye ingreso conyugal, aunque importan las reglas de atribución." } }, { "q": { "en": "Is Ohio recovery limited to probate property?", "es": "¿La recuperación se limita a bienes en probate?" }, "a": { "en": "No. Ohio’s public guidance includes property that passes outside probate.", "es": "No. La información de Ohio incluye bienes que pasan fuera del procedimiento ordinario." } } ] }, { "code": "OR", "state": "Oregon", "state_es": "Oregón", "slug_en": "oregon-medicaid-income-asset-limits", "slug_es": "oregon-limites-ingresos-bienes-medicaid", "medicaid_name": "Oregon Supplemental Income Program Medical (OSIPM)", "agency_url": "https://www.oregon.gov/odhs/home-care-consumers/Pages/default.aspx", "reviewed": "2026-11-16", "income_rule_type": "income_cap_qit", "single_income_limit_ltc": 2982, "single_asset_limit_ltc": 2000, "csra_max_spouse_assets": 162660, "home_equity_limit": null, "lookback_months": 60, "personal_needs_allowance": null, "sources": [ { "id": "OR-1", "title": "ODHS/OHA combined standards 2026", "url": "https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/de5530.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "OSIPM standard 994/1491 and resources 2000/3000; 300%SSI2982 with 2000 resources;2026 figures from indexed official chart." }, { "id": "OR-2", "title": "Oregon Programs Eligibility Notebook", "url": "https://www.oregon.gov/odhs/benefits/open/open-2024-01.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "OSIPM LTC financial route includes nursing facilities and authorized HCBS/Independent Choices; countable income and Income Cap Trust review. Older handbook used for structure, not 2026 amounts." }, { "id": "OR-3", "title": "OAR461-160-0580 community spouse resources", "url": "https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=329896", "accessed": "2026-11-16", "method": "page", "supports": "Effective Jan 2026 CSRA minimum 32532 and usual maximum 162660; countable couple assessment and applicant resource standard." }, { "id": "OR-4", "title": "Oregon Money Management Program", "url": "https://www.oregon.gov/odhs/providers-partners/community-services-supports/Pages/money-management.aspx", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Income Cap Trust assistance and local-provider limitations; ADRC referral." }, { "id": "OR-5", "title": "Oregon estate recovery guidance", "url": "https://www.oregon.gov/odhs/financial-recovery/Pages/estate-recovery.aspx", "accessed": "2026-11-16", "method": "page", "supports": "Estate claims, surviving spouse and child protections, Request for Notice distinct from lien, ICT remaining funds." }, { "id": "OR-6", "title": "OAR461-140 resource transfer exceptions", "url": "https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=336073", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Resource transfer review, transfers more than 60 months before request and applicable exceptions." }, { "id": "OR-7", "title": "OPI-M2026 program standards memorandum", "url": "https://www.oregon.gov/odhs/transmittals/APDTransmittals/im26009.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "OPI-M uses separate income and resource standards; not interchangeable with traditional OSIPM LTC." }, { "id": "OR-8", "title": "Home care services and MedicaidLTSS entry", "url": "https://www.oregon.gov/odhs/home-care-consumers/Pages/default.aspx", "accessed": "2026-11-16", "method": "page", "supports": "APD/AAA application entry; OPI/OPI-M distinct routes and eligibility reviews." } ], "programs": { "nursing_home": { "name": { "en": "OSIPM nursing-facility long-term care", "es": "OSIPM: cuidados prolongados en centro de enfermería" }, "income_rule_type": "income_cap_qit", "single": { "income": 2982, "assets": 2000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "300% SSI reference using the OSIPM income rules; income-cap-trust review may apply above it.", "es": "Referencia de 300% de SSI según las reglas de ingresos OSIPM; superar el estándar puede requerir revisión de un fideicomiso de ingresos." }, "asset_note": { "en": "Countable resources after exclusions.", "es": "Recursos computables después de las exclusiones." }, "source_ids": [ "OR-1", "OR-2", "OR-3" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "countable", "asset_basis": "applicant_only", "income_note": { "en": "300% SSI reference using the OSIPM income rules; income-cap-trust review may apply above it. This is the applicant’s reference, not combined marital income.", "es": "Referencia de 300% de SSI según las reglas de ingresos OSIPM; superar el estándar puede requerir revisión de un fideicomiso de ingresos. Es la referencia del solicitante, no los ingresos conjuntos del matrimonio." }, "asset_note": { "en": "Applicant-side resources after the spousal assessment; not a ceiling on all marital property.", "es": "Recursos atribuidos al solicitante después de evaluar al matrimonio; no es un tope para todos sus bienes." }, "source_ids": [ "OR-1", "OR-2", "OR-3" ] }, "married_both": { "income": null, "assets": null, "income_basis": "unknown", "asset_basis": "unknown", "income_note": { "en": "No verified combined-couple threshold is published here; each spouse needs a separate eligibility review.", "es": "No publicamos un límite conjunto verificado; cada cónyuge necesita su propia evaluación." }, "asset_note": { "en": "Do not double the single-person limit or apply a community-spouse allowance when both receive institutional care.", "es": "No duplique el límite individual ni aplique una reserva para cónyuge comunitario cuando ambos reciben atención institucional." }, "source_ids": [ "OR-1", "OR-2", "OR-3" ] }, "note": { "en": "Traditional OSIPM LTC route; OPI-M, behavioral-health and employed-person programs have separate financial rules.", "es": "Vía tradicional de cuidados OSIPM; OPI-M, salud conductual y el programa para trabajadores tienen otras reglas económicas." } }, "hcbs_waiver": { "name": { "en": "OSIPM authorized home and community-based long-term care", "es": "OSIPM: cuidados prolongados domiciliarios y comunitarios autorizados" }, "income_rule_type": "income_cap_qit", "single": { "income": 2982, "assets": 2000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "300% SSI reference using the OSIPM income rules; income-cap-trust review may apply above it.", "es": "Referencia de 300% de SSI según las reglas de ingresos OSIPM; superar el estándar puede requerir revisión de un fideicomiso de ingresos." }, "asset_note": { "en": "Countable resources after exclusions.", "es": "Recursos computables después de las exclusiones." }, "source_ids": [ "OR-1", "OR-2", "OR-3" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "countable", "asset_basis": "applicant_only", "income_note": { "en": "300% SSI reference using the OSIPM income rules; income-cap-trust review may apply above it. This is the applicant’s reference, not combined marital income.", "es": "Referencia de 300% de SSI según las reglas de ingresos OSIPM; superar el estándar puede requerir revisión de un fideicomiso de ingresos. Es la referencia del solicitante, no los ingresos conjuntos del matrimonio." }, "asset_note": { "en": "Applicant-side resources after the spousal assessment; not a ceiling on all marital property.", "es": "Recursos atribuidos al solicitante después de evaluar al matrimonio; no es un tope para todos sus bienes." }, "source_ids": [ "OR-1", "OR-2", "OR-3" ] }, "married_both": { "income": null, "assets": null, "income_basis": "unknown", "asset_basis": "unknown", "income_note": { "en": "No verified combined-couple threshold is published here; each spouse needs a separate eligibility review.", "es": "No publicamos un límite conjunto verificado; cada cónyuge necesita su propia evaluación." }, "asset_note": { "en": "Do not double the single-person limit or apply a community-spouse allowance when both receive institutional care.", "es": "No duplique el límite individual ni aplique una reserva para cónyuge comunitario cuando ambos reciben atención institucional." }, "source_ids": [ "OR-1", "OR-2", "OR-3" ] }, "note": { "en": "Traditional OSIPM LTC route; OPI-M, behavioral-health and employed-person programs have separate financial rules.", "es": "Vía tradicional de cuidados OSIPM; OPI-M, salud conductual y el programa para trabajadores tienen otras reglas económicas." } }, "abd_regular": { "name": { "en": "Non-SSI OSIPM regular coverage", "es": "Cobertura ordinaria OSIPM para quienes no reciben SSI" }, "income_rule_type": "program_specific", "single": { "income": 994, "assets": 2000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "Countable-income reference for non-SSI OSIPM, not the separate OSIPM-EPD employment program.", "es": "Referencia de ingresos computables de OSIPM sin SSI; no corresponde al programa laboral separado OSIPM-EPD." }, "asset_note": { "en": "Individual countable resources.", "es": "Recursos computables individuales." }, "source_ids": [ "OR-1" ] }, "married_one": { "income": 1491, "assets": null, "income_basis": "countable", "asset_basis": "unknown", "income_note": { "en": "Couple/household reference where spouses are included together; exclusions and deeming require agency review. Countable-income reference for non-SSI OSIPM, not the separate OSIPM-EPD employment program.", "es": "Referencia de pareja u hogar cuando los cónyuges se incluyen juntos; la agencia debe revisar exclusiones y atribución de ingresos. Referencia de ingresos computables de OSIPM sin SSI; no corresponde al programa laboral separado OSIPM-EPD." }, "asset_note": { "en": "The couple resource reference is 3,000 dollars combined, not an applicant-only allowance.", "es": "La referencia patrimonial de la pareja es de 3,000 dólares en conjunto, no una reserva individual." }, "source_ids": [ "OR-1" ] }, "married_both": { "income": 1491, "assets": 3000, "income_basis": "countable", "asset_basis": "couple_combined", "income_note": { "en": "Combined couple countable-income reference, not a gross-income ceiling. Countable-income reference for non-SSI OSIPM, not the separate OSIPM-EPD employment program.", "es": "Referencia de ingresos computables conjuntos, no un límite de ingresos brutos. Referencia de ingresos computables de OSIPM sin SSI; no corresponde al programa laboral separado OSIPM-EPD." }, "asset_note": { "en": "Combined countable resources for the two-person assistance unit.", "es": "Recursos computables conjuntos de la unidad de dos personas." }, "source_ids": [ "OR-1" ] }, "note": { "en": "SSI recipients follow deemed-eligibility rules. A two-person need group must be confirmed.", "es": "Quienes reciben SSI siguen reglas de elegibilidad reconocida. Debe confirmarse la unidad de necesidades de dos personas." } } }, "summary": { "en": "Oregon’s senior long-term-care financial pathway is generally discussed as OSIPM, the Oregon Supplemental Income Program Medical. It should not be confused with every Oregon Health Plan category. The state’s combined standards distinguish traditional long-term care, regular non-SSI OSIPM, employed-person coverage and other categories. A local Aging and People with Disabilities office or participating Area Agency on Aging can connect the financial review with a service assessment. Explain whether the person seeks nursing-facility placement or support at home. Financial eligibility alone does not authorize a particular provider or number of care hours.", "es": "La vía económica de cuidados prolongados para personas mayores de Oregón suele identificarse como OSIPM, Oregon Supplemental Income Program Medical. No equivale a todas las categorías de Oregon Health Plan. Los estándares estatales distinguen cuidados prolongados tradicionales, OSIPM ordinario sin SSI, cobertura para trabajadores y otras categorías. Una oficina local de Aging and People with Disabilities o una Area Agency on Aging participante puede coordinar la revisión económica y la evaluación de servicios. Indique si se solicita un centro de enfermería o apoyo domiciliario. La elegibilidad económica no autoriza por sí sola un proveedor ni unas horas de cuidado." }, "excess_income_solution": { "en": "Oregon recognizes Income Cap Trusts for certain people needing Medicaid long-term care whose income exceeds the applicable cap. This is a specific legal and administrative arrangement, not a deduction created by paying an ordinary household bill. The Oregon Money Management Program describes trustee assistance, but availability varies among local providers. Ask the eligibility worker whether this route applies, and obtain qualified advice about obligations before signing documents. A trust does not remove the service assessment or all cost-sharing requirements. Its remaining funds can also carry repayment obligations after death.", "es": "Oregón reconoce los Income Cap Trusts para ciertas personas que necesitan cuidados prolongados de Medicaid y superan el tope de ingresos correspondiente. Es una figura jurídica y administrativa concreta, no una deducción que aparezca por pagar una factura doméstica. Oregon Money Management Program describe asistencia de fiduciarios, cuya disponibilidad varía según el proveedor local. Pregunte al trabajador de elegibilidad si corresponde esta vía y obtenga asesoramiento sobre sus obligaciones antes de firmar. El fideicomiso no elimina la evaluación de servicios ni toda contribución económica. Los fondos restantes también pueden tener obligaciones de reembolso al fallecer." }, "exempt_assets_notes": { "en": "The traditional OSIPM resource test is applied after examining ownership and exclusions. A family should distinguish a bank balance from a home interest, vehicle, burial arrangement or other property requiring a separate rule. This review did not confirm a current statewide home-equity figure from a sufficiently direct source, so that numeric field remains blank. That does not mean homes are ignored or unlimited. Request a written explanation of whether the home is excluded, whether a separate equity restriction applies and how an absent or resident spouse affects that decision.", "es": "El examen patrimonial de OSIPM tradicional se aplica después de revisar titularidad y exclusiones. Conviene distinguir un saldo bancario de la participación en una vivienda, un vehículo, un contrato funerario u otros bienes sujetos a reglas específicas. Esta revisión no confirmó un importe estatal vigente de patrimonio neto de vivienda mediante una fuente suficientemente directa; por eso queda vacío. No significa que las viviendas se ignoren o no tengan restricciones. Solicite una explicación escrita de la exclusión, del posible límite de patrimonio neto y del efecto de un cónyuge residente o ausente." }, "spousal_notes": { "en": "The 2026 Oregon community-spouse rule begins with an assessment of the couple’s countable resources. It then determines a protected share using the rule’s alternatives, including minimum, ordinary maximum and qualifying adjustment provisions. Only after that analysis are the remaining resources compared with the applicant’s standard. The maximum shown here is therefore not automatically awarded to every spouse. A later marriage during service eligibility also has rules. Keep evidence of the relevant care-start date, marriage date and account ownership so the worker can identify the correct assessment period.", "es": "La regla de Oregón de 2026 comienza evaluando los recursos computables conjuntos del matrimonio. Después determina una parte protegida mediante las alternativas previstas, que incluyen un mínimo, un máximo ordinario y disposiciones de ajuste cuando proceden. Solo entonces se comparan los recursos restantes con el estándar del solicitante. El máximo publicado no se concede automáticamente a todos los cónyuges. También existen reglas para matrimonios celebrados después de empezar los servicios. Conserve pruebas del inicio de cuidados, fecha matrimonial y titularidad de cuentas para identificar el período correcto de evaluación." }, "lookback_rules": { "en": "Resource transfers can affect OSIPM payment for nursing-facility and home-and-community-based care. The rules examine the timing and character of transfers, including the 60-month period and specified exceptions. An ordinary tax rule about gifts does not establish a Medicaid exception. Document transactions rather than moving property to satisfy an online calculator. If the agency questions a transfer, ask which rule applies, what evidence of compensation is needed and whether an exception is being considered. A transfer issue and an income-cap issue require different reviews.", "es": "Las transferencias patrimoniales pueden afectar al pago OSIPM de cuidados institucionales, domiciliarios y comunitarios. Las reglas examinan fechas y características, incluido el período de 60 meses y las excepciones previstas. Una regla fiscal sobre donaciones no establece una excepción de Medicaid. Documente las operaciones en lugar de cambiar la titularidad para satisfacer una calculadora. Si la agencia cuestiona una transferencia, pregunte qué norma aplica, qué prueba de contraprestación necesita y si examina alguna excepción. Una transferencia y un exceso de ingresos requieren revisiones diferentes." }, "estate_recovery_merp": { "en": "Oregon’s Estate Administration Unit may present claims after a recipient dies. The official guidance distinguishes a Request for Notice recorded against property from a lien: the notice asks to be informed of a transaction. A home can nevertheless be part of an estate from which an appropriate claim is paid. Surviving spouses and qualifying children can affect recovery. Income Cap Trust balances have their own repayment duties. Families should preserve the death-date financial records and discuss the claim before distributing estate property; exclusion during eligibility is not a permanent exemption from recovery.", "es": "La Estate Administration Unit de Oregón puede presentar reclamaciones después del fallecimiento. La orientación oficial distingue una Request for Notice anotada sobre un inmueble de un gravamen: esa anotación solicita información sobre operaciones posteriores. Aun así, la vivienda puede integrar la herencia de la que se pague una reclamación válida. El cónyuge superviviente y determinados hijos pueden afectar a la recuperación. Los saldos de Income Cap Trust tienen obligaciones propias. Conserve los registros económicos del fallecimiento y consulte antes de distribuir bienes; una exclusión al solicitar Medicaid no implica protección permanente frente a la recuperación." }, "document_notes": { "en": "Prepare an organized folder for APD or the local aging office: current income awards, account statements, health-insurance costs, property ownership and existing trust documents. Include the current care arrangement and practical help needed with daily activities. If applying with a community spouse, ask what historical balance date the resource assessment uses. Record the category and effective date on each notice. Oregon’s 2026 OPI-M memorandum describes a different program with broader financial standards; ask about it separately rather than substituting its figures into a traditional OSIPM application.", "es": "Prepare una carpeta para APD o la oficina local de mayores: cartas de ingresos actuales, extractos, gastos de seguro, titularidad de bienes y documentos de fideicomisos existentes. Incluya la atención actual y la ayuda necesaria en actividades diarias. Si existe un cónyuge comunitario, pregunte qué fecha histórica utiliza la evaluación patrimonial. Anote categoría y fecha de vigencia de cada resolución. El memorando OPI-M de 2026 describe otro programa con estándares económicos más amplios; pregunte por él por separado, sin sustituir las cifras de una solicitud OSIPM tradicional." }, "faqs": [ { "q": { "en": "Does the OPI-M income limit apply to nursing homes?", "es": "¿El límite de OPI-M se aplica a residencias?" }, "a": { "en": "Do not assume so. OPI-M is a separate program. The table identifies traditional OSIPM long-term care and should not be replaced with OPI-M standards.", "es": "No debe suponerse. OPI-M es otro programa. La tabla identifica cuidados prolongados OSIPM tradicionales; sus estándares no deben sustituirse por los de OPI-M." } }, { "q": { "en": "Does an Income Cap Trust solve excess assets?", "es": "¿Un Income Cap Trust resuelve el exceso de bienes?" }, "a": { "en": "Not automatically. It addresses a particular income eligibility issue. Resource eligibility, service need and the trust’s administration are separate matters.", "es": "No automáticamente. Atiende un problema concreto de ingresos. La elegibilidad patrimonial, necesidad de cuidados y administración del fideicomiso son cuestiones independientes." } }, { "q": { "en": "Is the spouse maximum a guaranteed allowance?", "es": "¿El máximo matrimonial es una reserva garantizada?" }, "a": { "en": "No. Oregon calculates the protected share under OAR461-160-0580, including the assessment date and applicable alternatives. Ask for the actual approved calculation.", "es": "No. Oregón calcula la parte protegida mediante OAR461-160-0580, con la fecha de evaluación y alternativas aplicables. Pida el cálculo realmente aprobado." } }, { "q": { "en": "Is a Request for Notice an estate-recovery lien?", "es": "¿Una Request for Notice es un gravamen de recuperación?" }, "a": { "en": "Oregon says the Request for Notice is not a lien. It does not prevent a later valid estate claim involving the recipient’s property interest.", "es": "Oregón indica que esa solicitud de aviso no es un gravamen. No impide una reclamación posterior válida sobre la participación patrimonial del beneficiario." } } ] }, { "code": "PA", "state": "Pennsylvania", "state_es": "Pensilvania", "slug_en": "pennsylvania-medicaid-income-asset-limits", "slug_es": "pensilvania-limites-ingresos-bienes-medicaid", "medicaid_name": "Pennsylvania Medical Assistance", "agency_url": "https://www.pa.gov/agencies/dhs/resources/aging-physical-disabilities/medicaid-payment-long-term-care", "reviewed": "2026-11-16", "income_rule_type": "medically_needy_spenddown", "single_income_limit_ltc": 2982, "single_asset_limit_ltc": null, "csra_max_spouse_assets": 162660, "home_equity_limit": 752000, "lookback_months": 60, "personal_needs_allowance": null, "sources": [ { "id": "PA-1", "title": "Pennsylvania DHS: Medical Assistance payment of long-term care", "url": "https://www.pa.gov/agencies/dhs/resources/aging-physical-disabilities/medicaid-payment-long-term-care", "accessed": "2026-11-16", "method": "page", "supports": "2026 NMP 2982; resources 2000+6000 disregard or 2400 above NMP; HCBS distinctions; spouses; home equity 752000;60 months" }, { "id": "PA-2", "title": "Pennsylvania DHS: Estate Recovery Program", "url": "https://www.pa.gov/agencies/dhs/resources/for-residents/estate-recovery", "accessed": "2026-11-16", "method": "page", "supports": "LTC and HCBS recovery after 55; hardship and claim contacts" }, { "id": "PA-3", "title": "Pennsylvania DHS: Estate Recovery brochure", "url": "https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/docs/documents/ma-response-forms/Estate%20Recovery%20Program.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Home ownership, surviving spouse and claim exceptions" }, { "id": "PA-4", "title": "Pennsylvania DHS: Community HealthChoices", "url": "https://www.pa.gov/agencies/dhs/resources/medicaid/chc", "accessed": "2026-11-16", "method": "page", "supports": "Adult CHC managed-care and LTSS eligibility distinctions" }, { "id": "PA-5", "title": "Pennsylvania DHS: Federal Poverty Income Guidelines", "url": "https://www.pa.gov/agencies/dhs/resources/data-reports/federal-poverty-income-guidelines", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Multiple Medical Assistance household/income categories; not a universal LTC standard" } ], "programs": { "nursing_home": { "name": { "en": "Medical Assistance nursing-facility: NMP or medically needy", "es": "Residencia Medical Assistance: NMP o necesidad médica" }, "income_rule_type": "medically_needy_spenddown", "single": { "income": 2982, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "NMP category reference, not a universal denial threshold. The county must determine the financial route.", "es": "Referencia NMP, no umbral universal de denegación. El condado determina la vía económica." }, "asset_note": { "en": "DHS lists $2,000 plus a $6,000 disregard at or below the 300%FBR income standard; above it, the listed resource limit is $2,400. No single amount is safely comparable here.", "es": "DHS indica $2,000 más exclusión de $6,000 con ingresos hasta 300%FBR; por encima, la referencia es $2,400. No hay un único importe comparable aquí." }, "source_ids": [ "PA-1" ] }, "married_one": { "income": 2982, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "NMP category reference, not a universal denial threshold. The county must determine the financial route.", "es": "Referencia NMP, no umbral universal de denegación. El condado determina la vía económica." }, "asset_note": { "en": "DHS lists $2,000 plus a $6,000 disregard at or below the 300%FBR income standard; above it, the listed resource limit is $2,400. No single amount is safely comparable here. Spousal allocation must be assessed separately.", "es": "DHS indica $2,000 más exclusión de $6,000 con ingresos hasta 300%FBR; por encima, la referencia es $2,400. No hay un único importe comparable aquí. La asignación conyugal requiere evaluación separada." }, "source_ids": [ "PA-1" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Reference for the NMP route; other income budgeting may apply. Both-applicant aggregation must be confirmed.", "es": "Referencia de la vía NMP; pueden aplicarse otros presupuestos. Debe confirmarse agregación de ambos solicitantes." }, "asset_note": { "en": "DHS lists $2,000 plus a $6,000 disregard at or below the 300%FBR income standard; above it, the listed resource limit is $2,400. No single amount is safely comparable here.", "es": "DHS indica $2,000 más exclusión de $6,000 con ingresos hasta 300%FBR; por encima, la referencia es $2,400. No hay un único importe comparable aquí." }, "source_ids": [ "PA-1" ] }, "note": { "en": "Anticipated facility costs may be deductible in a medically-needy six-month budget; do not treat 2982 as the only possible route.", "es": "Los costes residenciales previstos pueden deducirse en un presupuesto semestral por necesidad médica;2982 no es la única vía." } }, "hcbs_waiver": { "name": { "en": "Community HealthChoices HCBS: county financial review", "es": "Community HealthChoices HCBS: revisión económica del condado" }, "income_rule_type": "program_specific", "single": { "income": 2982, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "NMP category reference, not a universal denial threshold. The county must determine the financial route.", "es": "Referencia NMP, no umbral universal de denegación. El condado determina la vía económica." }, "asset_note": { "en": "DHS lists $2,000 plus a $6,000 disregard at or below the 300%FBR income standard; above it, the listed resource limit is $2,400. No single amount is safely comparable here.", "es": "DHS indica $2,000 más exclusión de $6,000 con ingresos hasta 300%FBR; por encima, la referencia es $2,400. No hay un único importe comparable aquí." }, "source_ids": [ "PA-1" ] }, "married_one": { "income": 2982, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "NMP category reference, not a universal denial threshold. The county must determine the financial route.", "es": "Referencia NMP, no umbral universal de denegación. El condado determina la vía económica." }, "asset_note": { "en": "DHS lists $2,000 plus a $6,000 disregard at or below the 300%FBR income standard; above it, the listed resource limit is $2,400. No single amount is safely comparable here. Spousal allocation must be assessed separately.", "es": "DHS indica $2,000 más exclusión de $6,000 con ingresos hasta 300%FBR; por encima, la referencia es $2,400. No hay un único importe comparable aquí. La asignación conyugal requiere evaluación separada." }, "source_ids": [ "PA-1" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Reference for the NMP route; other income budgeting may apply. Both-applicant aggregation must be confirmed.", "es": "Referencia de la vía NMP; pueden aplicarse otros presupuestos. Debe confirmarse agregación de ambos solicitantes." }, "asset_note": { "en": "DHS lists $2,000 plus a $6,000 disregard at or below the 300%FBR income standard; above it, the listed resource limit is $2,400. No single amount is safely comparable here.", "es": "DHS indica $2,000 más exclusión de $6,000 con ingresos hasta 300%FBR; por encima, la referencia es $2,400. No hay un único importe comparable aquí." }, "source_ids": [ "PA-1" ] }, "note": { "en": "DHS discusses HCBS alongside LTC, but its anticipated nursing-facility expense deduction must not automatically be applied to home care.", "es": "DHS incluye HCBS junto a LTC, pero no debe trasladarse automáticamente la deducción por gastos residenciales previstos." } }, "abd_regular": { "name": { "en": "Aged, blind or disabled community Medical Assistance categories", "es": "Categorías comunitarias Medical Assistance para mayores, personas ciegas o con discapacidad" }, "income_rule_type": "program_specific", "single": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "The applicable community category and deductions need confirmation; the LTC 300%reference is not imported.", "es": "Deben confirmarse categoría comunitaria y deducciones; no se traslada la referencia LTC 300%." }, "asset_note": { "en": "No universal community resource threshold verified for this broad category.", "es": "No se verifica un umbral patrimonial comunitario universal para esta categoría amplia." }, "source_ids": [ "PA-5" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Household budgeting and spouse income treatment need county review.", "es": "El condado debe revisar presupuesto del hogar e ingresos conyugales." }, "asset_note": { "en": "No applicant-only asset amount inferred from a couple category.", "es": "No se deduce un importe individual de una categoría de pareja." }, "source_ids": [ "PA-5" ] }, "married_both": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "No verified combined figure for all community aged/disabled categories.", "es": "No hay cifra conjunta verificada para todas las categorías comunitarias." }, "asset_note": { "en": "County must identify the coverage group and combined treatment.", "es": "El condado debe identificar categoría y tratamiento conjunto." }, "source_ids": [ "PA-5" ] }, "note": { "en": "Healthy Horizons and other community pathways have their own rules; financial eligibility is not established by the LTC table.", "es": "Healthy Horizons y otras vías comunitarias tienen reglas propias; la tabla LTC no determina elegibilidad." } } }, "summary": { "en": "Pennsylvania’s long-term-care financial rules cannot be reduced to one income figure and one asset figure. The Department of Human Services publishes a 2026 non-money-payment reference of $2,982 monthly income, but the resource treatment changes with the financial route. Nursing-facility services and Community HealthChoices HCBS also require care-related eligibility. Start with the county assistance office for the financial case and identify the service program separately. A person may be enrolled in CHC for coordination without automatically qualifying for every long-term-care benefit or a paid family attendant.", "es": "Las reglas económicas de cuidados prolongados de Pensilvania no se reducen a un ingreso y un patrimonio únicos. Department of Human Services publica una referencia 2026 NMP de $2,982 mensuales, pero el tratamiento patrimonial cambia según la vía económica. Residencia y HCBS de Community HealthChoices también requieren elegibilidad asistencial. Empieza en la oficina de asistencia del condado para el expediente económico e identifica por separado el servicio. Tener CHC para coordinación no concede automáticamente todas las prestaciones de larga duración ni un asistente familiar remunerado." }, "excess_income_solution": { "en": "For nursing-facility applicants above the NMP income reference, DHS explains a medically-needy route using a six-month net-income budget and allowable medical expenses, including anticipated facility costs. This is not the same as Florida’s QIT model. It also should not be copied into an HCBS result without confirming that the deduction applies to that program. Ask the county which budget period, deductions and category it used. The final contribution toward care may be different from both the eligibility reference and the amount of income initially reported.", "es": "Para solicitantes residenciales por encima de la referencia NMP, DHS explica una vía por necesidad médica con presupuesto neto semestral y gastos admisibles, incluidos costes residenciales previstos. No equivale al modelo QIT de Florida. Tampoco debe copiarse al resultado HCBS sin confirmar que esa deducción corresponde al programa. Pregunta al condado qué periodo, deducciones y categoría utilizó. La aportación final a cuidados puede diferir tanto de la referencia de elegibilidad como de los ingresos inicialmente declarados por la persona solicitante." }, "exempt_assets_notes": { "en": "DHS lists a $2,000 resource limit plus a $6,000 disregard when income is at or below the 300%FBR reference. Above that income level, its published resource limit is $2,400. That is why the calculator leaves the comparable asset amount blank instead of displaying an unconditional $8,000. The home may be excluded under specified occupancy and equity conditions; a vehicle and certain burial arrangements also receive exclusions. Ask the county to show which items were counted and which were disregarded, especially if an account has more than one owner.", "es": "DHS indica límite de $2,000 más exclusión de $6,000 si los ingresos no superan 300%FBR. Por encima, publica límite patrimonial de $2,400. Por eso la calculadora deja vacío el importe comparable, en vez de mostrar $8,000 incondicionales. La vivienda puede excluirse según ocupación y patrimonio; un vehículo y ciertos acuerdos funerarios también reciben exclusiones. Solicita al condado qué partidas contó y cuáles excluyó, especialmente si una cuenta tiene varios titulares o la familia utiliza una cifra antigua de internet." }, "spousal_notes": { "en": "A community spouse can have resources protected through a formal assessment. Pennsylvania describes a share based on the couple’s resources, bounded by the 2026 minimum and maximum, with $162,660 as the published maximum. Form PA 1572 is the resource-assessment route identified by DHS. A possible income allowance is a separate calculation involving the spouse’s income and shelter costs. Do not compare total marital savings with the applicant’s individual resource test. If both spouses require care, ask for the applicable both-applicant treatment rather than assuming two community-spouse allowances.", "es": "Un cónyuge comunitario puede proteger recursos mediante evaluación formal. Pensilvania describe una participación basada en recursos conjuntos, con mínimo y máximo 2026; el máximo publicado es $162,660. DHS identifica el formulario PA 1572 para evaluar patrimonio. La posible asignación de ingresos se calcula por separado, considerando ingresos y vivienda del cónyuge. No compares ahorros matrimoniales totales con la prueba individual. Si ambos necesitan atención, pide el tratamiento de dos solicitantes en vez de suponer dos asignaciones de cónyuge comunitario." }, "lookback_rules": { "en": "Pennsylvania reviews transfers within 60 months when a person applies for Medical Assistance long-term care. Its description covers both facility care and relevant HCBS, with the triggering dates connected to admission or assessed service eligibility and the application. The office reviews compensation, ownership and any applicable exception; the lookback is not an automatic five-year denial. Save explanations and documents for significant transactions. A current bank balance below a resource reference does not answer whether an earlier gift or ownership change affects payment for the requested long-term services.", "es": "Pensilvania revisa transferencias de 60 meses cuando se solicita Medical Assistance para cuidados prolongados. Su descripción incluye residencia y HCBS pertinentes, con fechas relacionadas con ingreso o evaluación asistencial y solicitud. La oficina examina contraprestación, titularidad y excepciones; la revisión no significa denegación automática durante cinco años. Guarda explicaciones y documentos de operaciones importantes. Un saldo actual inferior a la referencia patrimonial no resuelve si una donación o cambio de titular anterior afecta al pago de los servicios solicitados." }, "estate_recovery_merp": { "en": "Pennsylvania’s estate-recovery program concerns specified long-term-care Medical Assistance, including HCBS and related services, received from age 55. DHS provides claim contacts and hardship-request forms. The treatment of a home depends on ownership and surviving family circumstances; a home excluded during the application is not automatically exempt from every later claim. The estate representative should obtain a statement of the actual claim and explain any protected survivor or hardship circumstances. This process should be distinguished from a facility asking a family member to personally guarantee bills during life.", "es": "La recuperación sucesoria de Pensilvania afecta a determinados servicios Medical Assistance de larga duración, incluidos HCBS y servicios relacionados, recibidos desde los 55 años. DHS ofrece contactos y formularios por dificultades. La vivienda depende de titularidad y supervivientes; excluirla durante la solicitud no la exime automáticamente de toda reclamación posterior. El representante debe solicitar el importe real y explicar familiares protegidos o dificultades. Este proceso es diferente de que una residencia pida a un familiar garantizar personalmente facturas durante la vida del beneficiario." }, "document_notes": { "en": "Use COMPASS or the county’s long-term-care financial application route. Prepare income verification, ownership records, balances and medical bills that may support the relevant budget. Married applicants should also keep spouse income and shelter information for the separate allowance assessment. Add the functional-assessment or CHC correspondence without assuming it replaces financial evidence. Ask for a written request specifying dates and missing items, keep proof of delivery and check the decision notice for the budget actually used. A generic internet checklist cannot determine the county’s evidence needs.", "es": "Utiliza COMPASS o la solicitud económica de larga duración del condado. Prepara pruebas de ingresos, titularidad, saldos y facturas médicas pertinentes. Si hay matrimonio, conserva ingresos y gastos de vivienda del cónyuge para la evaluación separada de asignaciones. Añade evaluación funcional o comunicaciones CHC sin suponer que sustituyen pruebas económicas. Pide una solicitud escrita con fechas y documentos pendientes, guarda comprobantes y revisa qué presupuesto utilizó la decisión. Una lista genérica de internet no determina la documentación necesaria para ese caso." }, "faqs": [ { "q": { "en": "Is $8,000 always the Pennsylvania resource limit?", "es": "¿ $8,000 es siempre el límite patrimonial?" }, "a": { "en": "No. DHS ties the $6,000 disregard to the income category; above the NMP reference, it publishes a different $2,400 limit.", "es": "No. DHS vincula la exclusión de $6,000 a la categoría; por encima de NMP publica otro límite de $2,400." } }, { "q": { "en": "Does income over $2,982 automatically rule out nursing care?", "es": "¿Superar $2,982 descarta automáticamente residencia?" }, "a": { "en": "No. A medically-needy facility budget may be relevant; the county must evaluate the case.", "es": "No. Puede corresponder presupuesto residencial por necesidad médica; el condado debe evaluarlo." } }, { "q": { "en": "Can I copy that facility deduction into HCBS?", "es": "¿Puedo copiar esa deducción residencial a HCBS?" }, "a": { "en": "Do not assume so. Ask which financial pathway and deductions apply to the named waiver service.", "es": "No lo supongas. Pregunta qué vía y deducciones corresponden al servicio concreto." } }, { "q": { "en": "Which office assesses spouse resources?", "es": "¿Qué oficina evalúa recursos conyugales?" }, "a": { "en": "DHS identifies the county assistance office and PA 1572 resource assessment; request the calculation for your case.", "es": "DHS identifica la oficina del condado y evaluación PA 1572; solicita el cálculo de tu caso. Conserva la respuesta escrita." } } ] }, { "code": "TX", "state": "Texas", "state_es": "Texas", "slug_en": "texas-medicaid-income-asset-limits", "slug_es": "texas-limites-ingresos-bienes-medicaid", "medicaid_name": "Texas Medicaid for the Elderly and People with Disabilities", "agency_url": "https://fhb.hhs.texas.gov/handbooks/medicaid-elderly-people-disabilities-handbook/appendix-xxxi-budget-reference-chart", "reviewed": "2026-11-16", "income_rule_type": "income_cap_qit", "single_income_limit_ltc": 2982, "single_asset_limit_ltc": 2000, "csra_max_spouse_assets": 162660, "home_equity_limit": 752000, "lookback_months": 60, "personal_needs_allowance": 75, "sources": [ { "id": "TX-1", "title": "Texas HHSC:2026 Budget Reference Chart", "url": "https://fhb.hhs.texas.gov/handbooks/medicaid-elderly-people-disabilities-handbook/appendix-xxxi-budget-reference-chart", "accessed": "2026-11-16", "method": "page", "supports": "Institutional and HCBS 2982/5964, countable resources 2000/3000; CSRA; home equity; PNA 75; specified community SSI categories" }, { "id": "TX-2", "title": "Texas HHSC: F-6800 Qualified Income Trust", "url": "https://fhb.hhs.texas.gov/handbooks/medicaid-elderly-people-disabilities-handbook/f-6800-qualified-income-trust", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "QIT institutional/waiver uses; not CAS; legal review; copayment retains income" }, { "id": "TX-3", "title": "Texas HHSC: documentation and verification guide", "url": "https://fhb.hhs.texas.gov/handbooks/medicaid-elderly-people-disabilities-handbook/appendix-xvi-documentation-verification-guide", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Evidence guidance and transfer documentation; not uniform 60-month bank request" }, { "id": "TX-4", "title": "Texas HHSC: Medicaid estate recovery guide", "url": "https://hhs.texas.gov/regulations/legal-information/your-guide-medicaid-estate-recovery-program", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Estate recovery, exceptions and 60-month transfer review" }, { "id": "TX-5", "title": "Texas approved SPA 26-0003", "url": "https://www.hhs.texas.gov/sites/default/files/documents/cms-26-0003-approval.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "MERP update effective July 2,2026; do not use outdated minimum-estate threshold" }, { "id": "TX-6", "title": "Texas HHSC: STAR+PLUS HCBS eligibility", "url": "https://fhb.hhs.texas.gov/handbooks/starplus-program-support-unit-operational-procedures-handbook/1200-starplus-hcbs-program-eligibility", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Separate HCBS service eligibility and entry routes" } ], "programs": { "nursing_home": { "name": { "en": "MEPD nursing-facility institutional standard", "es": "Estándar institucional MEPD para residencia" }, "income_rule_type": "income_cap_qit", "single": { "income": 2982, "assets": 2000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "HHSC labels this total countable income under its special institutional standard; not assessed from gross input alone.", "es": "HHSC lo denomina ingresos computables bajo su estándar institucional; no se evalúa solo con el bruto." }, "asset_note": { "en": "Individual countable resources.", "es": "Recursos computables individuales." }, "source_ids": [ "TX-1" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "countable", "asset_basis": "applicant_only", "income_note": { "en": "Applicant income under institutional rules; spouse attribution requires HHSC review.", "es": "Ingresos del solicitante según reglas institucionales; HHSC revisa atribución conyugal." }, "asset_note": { "en": "Applicant-only resources following the spousal assessment.", "es": "Recursos del solicitante tras evaluación conyugal." }, "source_ids": [ "TX-1" ] }, "married_both": { "income": 5964, "assets": 3000, "income_basis": "countable", "asset_basis": "couple_combined", "income_note": { "en": "Published combined institutional couple standard, not 5964 for each applicant.", "es": "Referencia institucional conjunta, no 5964 por solicitante." }, "asset_note": { "en": "Combined institutional couple resources.", "es": "Recursos institucionales conjuntos de pareja." }, "source_ids": [ "TX-1" ] }, "note": { "en": "QIT review can matter above the applicable income standard; this does not determine functional eligibility.", "es": "La revisión QIT puede importar por encima del estándar; no determina elegibilidad funcional." } }, "hcbs_waiver": { "name": { "en": "STAR+PLUS HCBS: special institutional financial category", "es": "STAR+PLUS HCBS: categoría económica institucional especial" }, "income_rule_type": "income_cap_qit", "single": { "income": 2982, "assets": 2000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "HHSC labels this total countable income under its special institutional standard; not assessed from gross input alone.", "es": "HHSC lo denomina ingresos computables bajo su estándar institucional; no se evalúa solo con el bruto." }, "asset_note": { "en": "Individual countable resources.", "es": "Recursos computables individuales." }, "source_ids": [ "TX-1" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "countable", "asset_basis": "applicant_only", "income_note": { "en": "Applicant income under institutional rules; spouse attribution requires HHSC review.", "es": "Ingresos del solicitante según reglas institucionales; HHSC revisa atribución conyugal." }, "asset_note": { "en": "Applicant-only resources following the spousal assessment.", "es": "Recursos del solicitante tras evaluación conyugal." }, "source_ids": [ "TX-1" ] }, "married_both": { "income": 5964, "assets": 3000, "income_basis": "countable", "asset_basis": "couple_combined", "income_note": { "en": "Published combined institutional couple standard, not 5964 for each applicant.", "es": "Referencia institucional conjunta, no 5964 por solicitante." }, "asset_note": { "en": "Combined institutional couple resources.", "es": "Recursos institucionales conjuntos de pareja." }, "source_ids": [ "TX-1" ] }, "note": { "en": "QIT review can matter above the applicable income standard; this does not determine functional eligibility.", "es": "La revisión QIT puede importar por encima del estándar; no determina elegibilidad funcional." } }, "abd_regular": { "name": { "en": "Specified community SSI-related MEPD categories", "es": "Categorías comunitarias MEPD concretas vinculadas a SSI" }, "income_rule_type": "program_specific", "single": { "income": 994, "assets": 2000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "SSI-reference category requires countable income below 994; special Social Security increase exclusions apply.", "es": "La categoría SSI exige ingresos computables inferiores a 994; se aplican exclusiones especiales de incrementos." }, "asset_note": { "en": "Individual resource standard for the listed SSI-related categories.", "es": "Referencia individual para las categorías SSI indicadas." }, "source_ids": [ "TX-1" ] }, "married_one": { "income": null, "assets": null, "income_basis": "contextual", "asset_basis": "unknown", "income_note": { "en": "Spouse deeming and protected coverage category must be established.", "es": "Debe determinarse imputación conyugal y categoría protegida." }, "asset_note": { "en": "Married one-applicant treatment is not inferred from the couple table.", "es": "No se deduce el tratamiento de un solicitante casado de la tabla de pareja." }, "source_ids": [ "TX-1" ] }, "married_both": { "income": 1491, "assets": 3000, "income_basis": "countable", "asset_basis": "couple_combined", "income_note": { "en": "Countable couple income must be below 1491 in the specified SSI-reference categories.", "es": "Ingresos computables conjuntos inferiores a 1491 en las categorías SSI especificadas." }, "asset_note": { "en": "Combined couple resource standard.", "es": "Referencia conjunta de recursos." }, "source_ids": [ "TX-1" ] }, "note": { "en": "These figures describe listed DAC, Pickle and widow/widower categories; not every community benefit or Medicare Savings Program.", "es": "Estas cifras describen categorías DAC, Pickle y viudedad indicadas; no todos los beneficios comunitarios ni programas de ahorro Medicare." } } }, "summary": { "en": "Texas uses the Medicaid for the Elderly and People with Disabilities framework for many long-term-care financial decisions. Its 2026 budget chart distinguishes institutional and HCBS waiver budgets from specified community SSI-related categories. The institutional reference is $2,982 for one person and $5,964 for an applicable couple budget. HHSC describes the amounts as countable income, so this site does not compare them directly with a gross pension entry. For STAR+PLUS HCBS, ask both the eligibility office and service coordinator which financial category and service-entry route apply.", "es": "Texas utiliza Medicaid for the Elderly and People with Disabilities para muchas decisiones económicas de cuidados prolongados. La tabla 2026 distingue presupuestos institucionales y de exenciones HCBS de determinadas categorías comunitarias SSI. La referencia institucional es $2,982 individual y $5,964 para el presupuesto de pareja correspondiente. HHSC describe ingresos computables; por eso esta web no los compara directamente con una pensión bruta. En STAR+PLUS HCBS, pregunta a la oficina económica y al coordinador qué categoría financiera y vía de servicios corresponden." }, "excess_income_solution": { "en": "Texas recognizes Qualified Income Trusts for qualifying institutional or HCBS waiver cases above the special income standard. The handbook expressly distinguishes Community Attendant Services: the QIT route is not available there merely because income is too high. A trust must receive the required legal review, and income remains relevant to the care copayment. This is why choosing the exact program matters more than a general label such as home care. Ask for a written eligibility explanation before relying on a trust or an advertised spenddown solution from another state.", "es": "Texas reconoce Qualified Income Trusts para casos institucionales o de exención HCBS admisibles por encima del estándar especial. El manual distingue Community Attendant Services: allí no se admite QIT simplemente porque los ingresos sean demasiado altos. El fideicomiso requiere revisión jurídica y los ingresos siguen influyendo en la aportación asistencial. Elegir el programa exacto importa más que una etiqueta general como atención domiciliaria. Solicita explicación escrita de elegibilidad antes de basarte en un fideicomiso o una solución spenddown anunciada para otro estado." }, "exempt_assets_notes": { "en": "The institutional resource chart lists $2,000 for an individual and $3,000 for an applicable couple, while home equity has a separate $752,000 reference. These numbers concern countable resources after the relevant rules, not the resale price of all possessions. Give HHSC clear information about ownership and access to accounts, real estate, insurance and retirement arrangements. A home may be treated differently because of occupants or other exceptions. Avoid treating an excluded resource, a protected spouse allocation and an asset held by someone else as interchangeable concepts.", "es": "La tabla institucional incluye $2,000 individuales y $3,000 para la pareja correspondiente, mientras el patrimonio de vivienda tiene referencia separada de $752,000. Son recursos computables tras aplicar reglas, no el precio de venta de todas las pertenencias. Facilita información clara de titularidad y acceso a cuentas, inmuebles, seguros y jubilación. La vivienda puede recibir otro tratamiento por ocupantes o excepciones. Un recurso excluido, una asignación conyugal protegida y un bien perteneciente a otra persona son conceptos diferentes y no deben mezclarse." }, "spousal_notes": { "en": "HHSC calculates a spousal protected resource amount using the couple’s countable resources and the applicable minimum and maximum. The 2026 chart lists a maximum of $162,660, but that maximum is not automatically assigned to every community spouse. A separate income allocation can affect the applicant’s care copayment. Request the assessment date, resources included and the final protected amount. A married applicant’s $2,000 resource line is not a rule requiring both spouses together to own no more than $2,000. Both-applicant cases need a different budget.", "es": "HHSC calcula la protección conyugal con recursos computables conjuntos y mínimos y máximos aplicables. La tabla 2026 muestra máximo de $162,660, pero no se asigna automáticamente a todo cónyuge comunitario. Otra asignación de ingresos puede afectar al copago asistencial. Solicita fecha de evaluación, recursos incluidos y cantidad finalmente protegida. La línea de $2,000 del solicitante casado no exige que ambos cónyuges juntos posean como máximo $2,000. Los casos donde solicitan ambos requieren un presupuesto distinto y deben identificarse desde el inicio." }, "lookback_rules": { "en": "The Texas estate-recovery guide also explains the separate 60-month transfer review for nursing-facility and waiver applications. HHSC can examine gifts, ownership changes and compensation received. Exceptions and the individual facts determine whether a penalty applies. Its documentation guide describes different verification requests, including additional historical statements when transfers require investigation; it does not support a claim that every applicant must initially upload exactly 60 months of every account. Keep records available and obtain the actual request from the eligibility worker rather than guessing its scope.", "es": "La guía de Texas también explica la revisión separada de 60 meses para solicitudes residenciales y de exenciones. HHSC puede examinar regalos, cambios de titular y contraprestaciones. Las excepciones y hechos individuales determinan posibles sanciones. La guía documental contempla distintas peticiones, incluidos extractos históricos adicionales cuando deben investigarse transferencias; no justifica afirmar que todo solicitante deba subir inicialmente exactamente 60 meses de cada cuenta. Conserva registros disponibles y pide la solicitud concreta al trabajador de elegibilidad en lugar de adivinar su alcance." }, "estate_recovery_merp": { "en": "Texas MERP can seek repayment for covered long-term services from certain estates, subject to exclusions and hardship provisions. The state updated its approved plan in July 2026, including recovery criteria and the minimum estate amount, so an older dollar threshold should not be repeated as current. Eligibility treatment of a home and a later estate claim are separate issues. Obtain the actual recovery notice and instructions if one arrives. A family’s responsibility to respond as estate representative is not the same as personal responsibility for all Medicaid payments.", "es": "MERP de Texas puede reclamar determinados servicios prolongados a ciertas herencias, con exclusiones y procedimientos por dificultades. El plan aprobado se actualizó en julio 2026, incluidos criterios y patrimonio mínimo; no debe repetirse un umbral monetario antiguo como vigente. El tratamiento de la vivienda durante elegibilidad y una reclamación sucesoria posterior son cuestiones distintas. Si llega una notificación, solicita detalle e instrucciones. Responder como representante de la herencia no equivale a responsabilidad personal por todos los pagos Medicaid del familiar fallecido." }, "document_notes": { "en": "Organize income award letters, current account statements, property ownership and any existing trust documents before contacting HHSC. For STAR+PLUS HCBS, add the service coordinator’s correspondence and assessment information. Keep the financial application, service authorization and worker employment paperwork in separate sections; they answer different questions. Ask which deductions were used in the budget and retain the official copayment notice. The nursing-facility personal-needs allowance is $75 in the reviewed chart, but that is a retained-income calculation after eligibility, not a monthly earnings ceiling.", "es": "Organiza cartas de ingresos, extractos actuales, titularidad inmobiliaria y fideicomisos existentes antes de contactar HHSC. Para STAR+PLUS HCBS, añade comunicaciones del coordinador y evaluaciones. Separa solicitud económica, autorización asistencial y documentación laboral: responden a cuestiones diferentes. Pregunta qué deducciones se usaron y conserva el copago oficial. La asignación personal residencial es $75 en la tabla revisada, pero se calcula sobre ingresos conservados tras elegibilidad; no es un techo mensual de ingresos ni sustituye la revisión del programa concreto." }, "faqs": [ { "q": { "en": "Can a QIT solve excess income in every home-care program?", "es": "¿Un QIT resuelve exceso de ingresos en toda atención domiciliaria?" }, "a": { "en": "No. The Texas handbook specifically excludes the income-ineligible Community Attendant Services route from QIT use.", "es": "No. El manual excluye específicamente el uso QIT para Community Attendant Services cuando hay exceso de ingresos." } }, { "q": { "en": "Does the community spouse automatically keep $162,660?", "es": "¿El cónyuge conserva automáticamente $162,660?" }, "a": { "en": "No. It is the published maximum; the resource assessment determines the protected amount.", "es": "No. Es el máximo publicado; la evaluación determina la cantidad protegida." } }, { "q": { "en": "Are the $75 personal needs an application threshold?", "es": "¿Los $75 personales son un umbral de solicitud?" }, "a": { "en": "No. They concern income retained by an eligible nursing-facility resident.", "es": "No. Corresponden a ingresos conservados por un residente elegible." } }, { "q": { "en": "Must everyone submit five years of records immediately?", "es": "¿Todos deben entregar cinco años de registros inmediatamente?" }, "a": { "en": "Follow HHSC’s case-specific verification request; the transfer-review period and initial document request are different.", "es": "Sigue la petición concreta de HHSC; el periodo de revisión y la documentación inicial son diferentes." } } ] }, { "code": "VA", "state": "Virginia", "state_es": "Virginia", "slug_en": "virginia-medicaid-income-asset-limits", "slug_es": "virginia-limites-ingresos-bienes-medicaid", "medicaid_name": "Virginia Medicaid / Cardinal Care", "agency_url": "https://www.dmas.virginia.gov/for-applicants/applying-for-medicaid/", "reviewed": "2026-11-16", "income_rule_type": "medically_needy_spenddown", "single_income_limit_ltc": 2982, "single_asset_limit_ltc": 2000, "csra_max_spouse_assets": 162660, "home_equity_limit": 752000, "lookback_months": 60, "personal_needs_allowance": 40, "sources": [ { "id": "VA-1", "title": "ChapterM00 income charts, July 2026", "url": "https://www.dmas.virginia.gov/media/ff1bdyne/chapter-m00-appendix-income-charts-2026-07-01.pdf", "accessed": "2026-11-16", "method": "pdf", "supports": "2026 institutional 300%SSI2982; ABD80%FPL1064/1443; PNA40; spousemax 162660 andhome 752000. Downloaded officialPDF; all-income screen differs from ABDcountableincome." }, { "id": "VA-2", "title": "ChapterM11 ABD resources, January 2026", "url": "https://www.dmas.virginia.gov/media/sg5m1q3j/m11-abd-resources-1-1-26a.pdf", "accessed": "2026-11-16", "method": "pdf", "supports": "Individual 2000/couple 3000 standard; resource exclusions and household classification. OfficialPDF downloaded and extracted." }, { "id": "VA-3", "title": "ChapterM14 Long-term care, current linked edition", "url": "https://www.dmas.virginia.gov/media/hksogjdf/chapter-m14-long-term-care.pdf", "accessed": "2026-11-16", "method": "pdf", "supports": "Nursing/CBC300%SSI and medicallyneedy routes,2000 individual resources,60 monthlookback, homeequity, spousal andpatientpay rules. OfficialPDF downloaded and extracted." }, { "id": "VA-4", "title": "ChapterM13 spenddown", "url": "https://www.dmas.virginia.gov/media/eqyfiboa/m13-10-1-24.pdf", "accessed": "2026-11-16", "method": "pdf", "supports": "Virginia medically-needy spenddown structure; case andbudget period review." }, { "id": "VA-5", "title": "Medical Assistance Handbook, May 2025", "url": "https://cubrevirginia.dmas.virginia.gov/media/smtidzzo/medical-assistance-handbook_plan-first-revisions__humana-revisions_552025.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Estate recovery after 55, surviving spouse/child protections, reportingand recovery distinct from fraud." }, { "id": "VA-6", "title": "CCC Plus Waiver official overview", "url": "https://www.dmas.virginia.gov/for-members/benefits-and-services/waivers/ccc-plus-waiver", "accessed": "2026-11-16", "method": "page", "supports": "LTSSscreening,localDSS,hospitalroute,CommonHelp,AppendixD and separateMedicaideligibility." }, { "id": "VA-7", "title": "Applying for Medicaid", "url": "https://www.dmas.virginia.gov/for-applicants/applying-for-medicaid/", "accessed": "2026-11-16", "method": "page", "supports": "Official application routes, information preparation and response toverification requests." }, { "id": "VA-8", "title": "Estate recovery fact sheet", "url": "https://www.dmas.virginia.gov/media/5997/revised-estate-recovery-fact-sheet-08-24-2022.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Estate interest and excludedhome distinction, hardship and qualifyingfamily protections." } ], "programs": { "nursing_home": { "name": { "en": "Medicaid nursing-facility 300% SSI route", "es": "Medicaid institucional: vía de 300% de SSI" }, "income_rule_type": "medically_needy_spenddown", "single": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "300% SSI screening reference: the manual counts all income except items defined as not income. Medically-needy review may apply above it.", "es": "Referencia de 300% de SSI: el manual cuenta todos los ingresos salvo conceptos definidos como no ingresos. Por encima puede proceder necesidad médica." }, "asset_note": { "en": "Countable resources after exclusions.", "es": "Recursos computables después de las exclusiones." }, "source_ids": [ "VA-1", "VA-2", "VA-3" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "300% SSI screening reference: the manual counts all income except items defined as not income. Medically-needy review may apply above it. This is the applicant’s reference, not combined marital income.", "es": "Referencia de 300% de SSI: el manual cuenta todos los ingresos salvo conceptos definidos como no ingresos. Por encima puede proceder necesidad médica. Es la referencia del solicitante, no los ingresos conjuntos del matrimonio." }, "asset_note": { "en": "Applicant-side resources after the spousal assessment; not a ceiling on all marital property.", "es": "Recursos atribuidos al solicitante después de evaluar al matrimonio; no es un tope para todos sus bienes." }, "source_ids": [ "VA-1", "VA-2", "VA-3" ] }, "married_both": { "income": null, "assets": null, "income_basis": "unknown", "asset_basis": "unknown", "income_note": { "en": "No verified combined-couple threshold is published here; each spouse needs a separate eligibility review.", "es": "No publicamos un límite conjunto verificado; cada cónyuge necesita su propia evaluación." }, "asset_note": { "en": "Do not double the single-person limit or apply a community-spouse allowance when both receive institutional care.", "es": "No duplique el límite individual ni aplique una reserva para cónyuge comunitario cuando ambos reciben atención institucional." }, "source_ids": [ "VA-1", "VA-2", "VA-3" ] }, "note": { "en": "Do not substitute regular ABD disregards into the 300% screen. Eligibility andpatient pay calculations are separate.", "es": "No sustituya las exclusiones ABD ordinarias en la prueba de 300%. La elegibilidad y la responsabilidad de pago son cálculos separados." } }, "hcbs_waiver": { "name": { "en": "CCC Plus community-based waiver financial route", "es": "CCC Plus: vía económica de la exención comunitaria" }, "income_rule_type": "medically_needy_spenddown", "single": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "300% SSI screening reference: the manual counts all income except items defined as not income. Medically-needy review may apply above it.", "es": "Referencia de 300% de SSI: el manual cuenta todos los ingresos salvo conceptos definidos como no ingresos. Por encima puede proceder necesidad médica." }, "asset_note": { "en": "Countable resources after exclusions.", "es": "Recursos computables después de las exclusiones." }, "source_ids": [ "VA-1", "VA-2", "VA-3" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "300% SSI screening reference: the manual counts all income except items defined as not income. Medically-needy review may apply above it. This is the applicant’s reference, not combined marital income.", "es": "Referencia de 300% de SSI: el manual cuenta todos los ingresos salvo conceptos definidos como no ingresos. Por encima puede proceder necesidad médica. Es la referencia del solicitante, no los ingresos conjuntos del matrimonio." }, "asset_note": { "en": "Applicant-side resources after the spousal assessment; not a ceiling on all marital property.", "es": "Recursos atribuidos al solicitante después de evaluar al matrimonio; no es un tope para todos sus bienes." }, "source_ids": [ "VA-1", "VA-2", "VA-3" ] }, "married_both": { "income": null, "assets": null, "income_basis": "unknown", "asset_basis": "unknown", "income_note": { "en": "No verified combined-couple threshold is published here; each spouse needs a separate eligibility review.", "es": "No publicamos un límite conjunto verificado; cada cónyuge necesita su propia evaluación." }, "asset_note": { "en": "Do not double the single-person limit or apply a community-spouse allowance when both receive institutional care.", "es": "No duplique el límite individual ni aplique una reserva para cónyuge comunitario cuando ambos reciben atención institucional." }, "source_ids": [ "VA-1", "VA-2", "VA-3" ] }, "note": { "en": "Do not substitute regular ABD disregards into the 300% screen. Eligibility andpatient pay calculations are separate.", "es": "No sustituya las exclusiones ABD ordinarias en la prueba de 300%. La elegibilidad y la responsabilidad de pago son cálculos separados." } }, "abd_regular": { "name": { "en": "ABD community coverage at 80% federal poverty level", "es": "Cobertura comunitaria ABD al 80% del nivel federal de pobreza" }, "income_rule_type": "medically_needy_spenddown", "single": { "income": 1064, "assets": 2000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "Countable-income reference from Virginia’s 2026 rounded monthly chart; other protected categories and spenddown may apply.", "es": "Referencia computable de la tabla mensual redondeada de Virginia 2026; pueden proceder categorías protegidas y deducibles." }, "asset_note": { "en": "Individual countable resources.", "es": "Recursos computables individuales." }, "source_ids": [ "VA-1", "VA-2" ] }, "married_one": { "income": 1443, "assets": null, "income_basis": "countable", "asset_basis": "unknown", "income_note": { "en": "Couple/household reference where spouses are included together; exclusions and deeming require agency review. Countable-income reference from Virginia’s 2026 rounded monthly chart; other protected categories and spenddown may apply.", "es": "Referencia de pareja u hogar cuando los cónyuges se incluyen juntos; la agencia debe revisar exclusiones y atribución de ingresos. Referencia computable de la tabla mensual redondeada de Virginia 2026; pueden proceder categorías protegidas y deducibles." }, "asset_note": { "en": "The couple resource reference is 3,000 dollars combined, not an applicant-only allowance.", "es": "La referencia patrimonial de la pareja es de 3,000 dólares en conjunto, no una reserva individual." }, "source_ids": [ "VA-1", "VA-2" ] }, "married_both": { "income": 1443, "assets": 3000, "income_basis": "countable", "asset_basis": "couple_combined", "income_note": { "en": "Combined couple countable-income reference, not a gross-income ceiling. Countable-income reference from Virginia’s 2026 rounded monthly chart; other protected categories and spenddown may apply.", "es": "Referencia de ingresos computables conjuntos, no un límite de ingresos brutos. Referencia computable de la tabla mensual redondeada de Virginia 2026; pueden proceder categorías protegidas y deducibles." }, "asset_note": { "en": "Combined countable resources for the two-person assistance unit.", "es": "Recursos computables conjuntos de la unidad de dos personas." }, "source_ids": [ "VA-1", "VA-2" ] }, "note": { "en": "This is the ABD 80%FPL category, not the 300% SSI institutional screen or Medicaid Works.", "es": "Es la categoría ABD al 80% de pobreza, no la prueba institucional de 300% de SSI ni Medicaid Works." } } }, "summary": { "en": "Virginia’s Department of Medical Assistance Services publishes separate financial rules for regular aged, blind and disabled coverage and for long-term-care cases. Cardinal Care is the Medicaid umbrella, while CCC Plus is a particular home-and-community-based waiver. A person seeking that waiver needs Medicaid financial eligibility and an LTSS screening. The screening can be requested through local Social Services, with a hospital route available during discharge planning. Start by identifying which covered group the eligibility worker is using. The same pension can be evaluated differently under the regular ABD category and the institutional 300-percent SSI screen.", "es": "El Department of Medical Assistance Services de Virginia publica reglas económicas diferentes para cobertura ordinaria de mayores, ceguera y discapacidad, y para cuidados prolongados. Cardinal Care es el marco Medicaid, mientras que CCC Plus es una exención domiciliaria y comunitaria concreta. Quien la solicita necesita elegibilidad económica y evaluación LTSS. Esta puede pedirse a Servicios Sociales locales, con una vía hospitalaria durante la planificación del alta. Identifique primero qué categoría utiliza el trabajador. Una misma pensión puede evaluarse de forma distinta en ABD ordinario y en la prueba institucional de 300% de SSI." }, "excess_income_solution": { "en": "The 300-percent SSI figure is a screening reference, not a promise that everyone above it is excluded from Virginia long-term-care coverage. The manual also contains medically-needy income and spenddown procedures, including community-based care. Its initial 300-percent screen counts income differently from the ordinary ABD calculation, so a general income disregard should not simply be subtracted from every pension. Ask which covered groups were considered, what medical expenses are recognized and which budget period applies. The eventual patient-pay obligation is calculated separately and can remain significant even when financial eligibility is established.", "es": "La cifra de 300% de SSI es una referencia de evaluación, no significa que toda persona que la supere quede fuera de los cuidados prolongados de Virginia. El manual también contiene procedimientos de necesidad médica y deducibles, incluidos cuidados comunitarios. La prueba inicial cuenta ingresos de forma distinta al cálculo ABD ordinario; no debe restarse automáticamente una exclusión general de cualquier pensión. Pregunte qué categorías se examinaron, qué gastos médicos se reconocen y qué período corresponde. La responsabilidad final de pago se calcula aparte y puede ser considerable aunque exista elegibilidad económica." }, "exempt_assets_notes": { "en": "Virginia’s ABD resource chapter distinguishes countable resources from excluded property and provides separate household rules. A qualifying residence or other excluded item should not automatically be added to a cash savings total. For long-term-care payment, the manual also applies a home-equity restriction with specified family and other exceptions. Gather the deed, ownership percentage, mortgage information and occupancy details so the worker can review both tests. The statewide equity figure is not a guarantee that every property below it is excluded, nor does an eligibility exclusion automatically protect the property from later estate recovery.", "es": "El capítulo patrimonial ABD distingue recursos computables de bienes excluidos y establece reglas familiares. Una residencia u otro bien que reúna condiciones de exclusión no debe añadirse automáticamente al ahorro en efectivo. Para pagar cuidados prolongados también se aplica una restricción de patrimonio neto de vivienda, con excepciones familiares y de otro tipo. Reúna escritura, porcentaje de propiedad, hipoteca y ocupantes para revisar ambas pruebas. Estar por debajo del importe estatal no garantiza que toda propiedad quede excluida; tampoco una exclusión inicial protege automáticamente frente a recuperación patrimonial posterior." }, "spousal_notes": { "en": "The community-spouse resource protection applies through a marital assessment, not by comparing all joint savings with the applicant’s individual resource ceiling. Virginia’s 2026 chart gives the current spousal standards, and the long-term-care chapter explains the assessment and income-allocation rules. A protected resource share is distinct from a monthly maintenance allowance. If both spouses seek institutional care, the community-spouse assumptions may no longer fit. Request a worksheet that identifies each spouse’s role and the effective date, especially after a hospital admission, a change of residence or a spouse’s own application.", "es": "La protección patrimonial del cónyuge comunitario requiere evaluar el matrimonio, no comparar todo el ahorro conjunto con el límite individual del solicitante. La tabla de Virginia 2026 recoge estándares vigentes y el capítulo de cuidados explica evaluación y asignaciones. La parte patrimonial protegida difiere de una asignación mensual de mantenimiento. Si ambos solicitan cuidados institucionales, quizá no procedan las premisas del cónyuge comunitario. Pida una hoja que identifique el papel de cada persona y la fecha efectiva, especialmente tras una hospitalización, cambio de residencia o solicitud del otro cónyuge." }, "lookback_rules": { "en": "Virginia’s long-term-care chapter reviews transfers within 60 months of the relevant baseline and addresses transfers made afterward as well. The baseline depends on the person being an institutionalized individual under the rules and having applied for Medicaid. Transactions must be evaluated for adequate compensation and applicable exceptions; the result cannot be inferred from one bank balance. Keep agreements, statements and records of services or property involved in questioned payments. A family-care payment can raise documentation questions, so describe the actual arrangement accurately rather than relabeling past transactions to fit a desired outcome.", "es": "El capítulo de cuidados revisa transferencias de 60 meses anteriores a la fecha pertinente y también operaciones posteriores. Esa fecha depende de reunir la condición institucional según las reglas y haber solicitado Medicaid. Deben examinarse contraprestación suficiente y excepciones; el resultado no se deduce de un saldo bancario. Conserve acuerdos, extractos y registros de los servicios o bienes implicados. Un pago por cuidados familiares puede requerir documentación: describa lo sucedido con precisión en lugar de cambiar el nombre de operaciones pasadas para obtener un resultado deseado." }, "estate_recovery_merp": { "en": "DMAS guidance explains recovery from the estates of certain Medicaid members who received benefits after age 55. The recovery analysis considers the property interest left at death, applicable surviving-spouse and child protections, and hardship provisions. A residence excluded in the financial application can still be relevant to an estate claim. Recovery of correctly paid benefits after death is different from repayment demanded because of incorrect eligibility information. Keep the benefit notices and seek the specific claim basis. The existence of Medicaid coverage alone does not establish that a home must immediately be sold.", "es": "DMAS explica la recuperación contra herencias de determinados beneficiarios que recibieron prestaciones después de los 55 años. Se analiza la participación patrimonial al fallecer, protecciones del cónyuge superviviente y ciertos hijos, y disposiciones por dificultades excepcionales. Una residencia excluida en la solicitud puede ser relevante para la reclamación. Recuperar prestaciones correctamente pagadas después de la muerte difiere de exigir reembolso por información de elegibilidad incorrecta. Guarde resoluciones y solicite el fundamento concreto de la reclamación. Tener Medicaid no demuestra por sí solo que una vivienda deba venderse inmediatamente." }, "document_notes": { "en": "Apply through CommonHelp, Cover Virginia or local DSS using the official application options. For long-term services and supports, ask about AppendixD and the screening request rather than submitting only a general health-coverage application. Prepare identity information, income awards, account and property records, existing insurance and relevant medical expenses. A request for additional information should identify what is missing and where to send it. Keep copies and submission dates. Once approved, retain the financial notice, screening outcome and service authorization separately so a delay can be traced to the correct stage.", "es": "Solicite mediante CommonHelp, Cover Virginia o DSS local utilizando las opciones oficiales. Para cuidados prolongados pregunte por el ApéndiceD y la evaluación, en lugar de presentar únicamente una solicitud sanitaria general. Prepare identificación, cartas de ingresos, registros bancarios e inmobiliarios, seguros existentes y gastos médicos pertinentes. Una petición adicional debe indicar qué falta y dónde enviarlo. Guarde copias y fechas. Tras la aprobación conserve por separado resolución económica, resultado de evaluación y autorización de servicios para identificar qué fase explica una demora." }, "faqs": [ { "q": { "en": "Does CCC Plus approval replace the financial application?", "es": "¿La aprobación CCC Plus sustituye la solicitud económica?" }, "a": { "en": "No. Virginia requires Medicaid eligibility as well as the LTSS screening and waiver approval. Each step addresses a different part of coverage.", "es": "No. Virginia exige elegibilidad Medicaid además de evaluación LTSS y aprobación de la exención. Cada paso responde a una parte diferente de la cobertura." } }, { "q": { "en": "Is the 40-dollar allowance an income limit?", "es": "¿La asignación de 40 dólares es un límite de ingresos?" }, "a": { "en": "No. It is the nursing-facility personal-needs allowance used in post-eligibility budgeting. It is not the 300-percent SSI financial screening standard.", "es": "No. Es la asignación personal institucional del cálculo posterior a la aprobación. No es el estándar económico de 300% de SSI." } }, { "q": { "en": "Can I subtract regular ABD disregards from the LTC screen?", "es": "¿Puedo restar exclusiones ABD ordinarias en la prueba LTC?" }, "a": { "en": "Not automatically. The 2026 chart says the 300-percent SSI screen counts all income except items specifically defined as not income. Ask for the category-specific calculation.", "es": "No automáticamente. La tabla de 2026 cuenta todos los ingresos en esa prueba salvo conceptos definidos como no ingresos. Pida el cálculo de su categoría." } }, { "q": { "en": "Where do I request the CCC Plus screening?", "es": "¿Dónde solicito la evaluación CCC Plus?" }, "a": { "en": "Local Social Services can arrange a community screening. A hospital discharge planner can arrange screening during hospitalization; financial eligibility must still be determined.", "es": "Servicios Sociales locales pueden organizarla en la comunidad. Durante hospitalización puede gestionarla el equipo de alta; todavía debe determinarse la elegibilidad económica." } } ] }, { "code": "WA", "state": "Washington", "state_es": "Washington", "slug_en": "washington-medicaid-income-asset-limits", "slug_es": "washington-limites-ingresos-bienes-medicaid", "medicaid_name": "Washington Apple Health", "agency_url": "https://www.hca.wa.gov/free-or-low-cost-health-care", "reviewed": "2026-11-16", "income_rule_type": "program_specific", "single_income_limit_ltc": 2982, "single_asset_limit_ltc": 2000, "csra_max_spouse_assets": 162660, "home_equity_limit": 1130000, "lookback_months": 60, "personal_needs_allowance": 108.74, "sources": [ { "id": "WA-1", "title": "Apple Health income and resource standards, January 2026", "url": "https://www.hca.wa.gov/assets/free-or-low-cost/income-standards-20260101.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "2026 SIL2982; medically needy resources 2000/3000; home equity 1130000; federal spousal maximum 162660; PNA108.74 for all-other medical institutions; distinct waiver and cash PNAs." }, { "id": "WA-2", "title": "WAC182-515-1508 HCS waiver financial eligibility", "url": "https://app.leg.wa.gov/WAC/default.aspx?cite=182-515-1508", "accessed": "2026-11-16", "method": "page", "supports": "HCS waiver income aboveSIL can qualify through alternative net-income calculation; institutional resource rules; cost participation." }, { "id": "WA-3", "title": "Apple Health and LTSS for adults, DSHS22-619", "url": "https://www.dshs.wa.gov/media/592/download?inline=", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "HCS application and CARE assessment; financial eligibility, excluded resources and 60-month transfer review." }, { "id": "WA-4", "title": "Estate Recovery, DSHS14-454, March 2026", "url": "https://www.dshs.wa.gov/sites/default/files/2026-07/14-454.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Recovery scope including LTSS after 55, certain state-funded benefits, estate interests and exclusions." }, { "id": "WA-5", "title": "Application for ABD/long-term-care coverage", "url": "https://www.hca.wa.gov/assets/free-or-low-cost/18-005.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Application information; estate recovery surviving-spouse/child protections and institutional lien exceptions." }, { "id": "WA-6", "title": "WAC chapter 182-513 institutional medical rules", "url": "https://app.leg.wa.gov/WAC/default.aspx?cite=182-513&dispo=true&full=true", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Institutional categorically needy and medically needy financial routes; resources and medical-expense deductions." } ], "programs": { "nursing_home": { "name": { "en": "Apple Health nursing-facility LTSS", "es": "Apple Health: cuidados en centro de enfermería" }, "income_rule_type": "program_specific", "single": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "Special Income Level for an institutional pathway. Other medically needy rules can apply above it.", "es": "Nivel Especial de Ingresos de una vía institucional. Por encima pueden aplicarse otras reglas de necesidad médica." }, "asset_note": { "en": "Countable resources after exclusions.", "es": "Recursos computables después de las exclusiones." }, "source_ids": [ "WA-1", "WA-3", "WA-6" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "Special Income Level for an institutional pathway. Other medically needy rules can apply above it. This is the applicant’s reference, not combined marital income.", "es": "Nivel Especial de Ingresos de una vía institucional. Por encima pueden aplicarse otras reglas de necesidad médica. Es la referencia del solicitante, no los ingresos conjuntos del matrimonio." }, "asset_note": { "en": "Applicant-side resources after the spousal assessment; not a ceiling on all marital property.", "es": "Recursos atribuidos al solicitante después de evaluar al matrimonio; no es un tope para todos sus bienes." }, "source_ids": [ "WA-1", "WA-3", "WA-6" ] }, "married_both": { "income": null, "assets": null, "income_basis": "unknown", "asset_basis": "unknown", "income_note": { "en": "No verified combined-couple threshold is published here; each spouse needs a separate eligibility review.", "es": "No publicamos un límite conjunto verificado; cada cónyuge necesita su propia evaluación." }, "asset_note": { "en": "Do not double the single-person limit or apply a community-spouse allowance when both receive institutional care.", "es": "No duplique el límite individual ni aplique una reserva para cónyuge comunitario cuando ambos reciben atención institucional." }, "source_ids": [ "WA-1", "WA-3", "WA-6" ] }, "note": { "en": "The published PNA is the all-other-medical-institutions figure; cash assistance and certain veterans’ settings differ.", "es": "La asignación personal publicada corresponde a otras instituciones médicas; la asistencia monetaria y ciertos centros de veteranos difieren." } }, "hcbs_waiver": { "name": { "en": "COPES/HCS home and community-based waivers", "es": "Exenciones domiciliarias y comunitarias COPES/HCS" }, "income_rule_type": "program_specific", "single": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "SIL reference, not an absolute COPES income ceiling; WAC182-515-1508 includes an above-SIL route.", "es": "Referencia SIL, no un tope absoluto de COPES; WAC182-515-1508 contempla una vía por encima del SIL." }, "asset_note": { "en": "Countable resources after exclusions.", "es": "Recursos computables después de las exclusiones." }, "source_ids": [ "WA-1", "WA-2", "WA-3" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "SIL reference, not an absolute COPES income ceiling; WAC182-515-1508 includes an above-SIL route. This is the applicant’s reference, not combined marital income.", "es": "Referencia SIL, no un tope absoluto de COPES; WAC182-515-1508 contempla una vía por encima del SIL. Es la referencia del solicitante, no los ingresos conjuntos del matrimonio." }, "asset_note": { "en": "Applicant-side resources after the spousal assessment; not a ceiling on all marital property.", "es": "Recursos atribuidos al solicitante después de evaluar al matrimonio; no es un tope para todos sus bienes." }, "source_ids": [ "WA-1", "WA-2", "WA-3" ] }, "married_both": { "income": null, "assets": null, "income_basis": "unknown", "asset_basis": "unknown", "income_note": { "en": "No verified combined-couple threshold is published here; each spouse needs a separate eligibility review.", "es": "No publicamos un límite conjunto verificado; cada cónyuge necesita su propia evaluación." }, "asset_note": { "en": "Do not double the single-person limit or apply a community-spouse allowance when both receive institutional care.", "es": "No duplique el límite individual ni aplique una reserva para cónyuge comunitario cuando ambos reciben atención institucional." }, "source_ids": [ "WA-1", "WA-2", "WA-3" ] }, "note": { "en": "Assessment and an approved service plan are separate from income eligibility.", "es": "La evaluación funcional y el plan de servicios aprobado son independientes de la elegibilidad económica." } }, "abd_regular": { "name": { "en": "SSI-related Apple Health: category review needed", "es": "Apple Health vinculado a SSI: debe revisarse la categoría" }, "income_rule_type": "program_specific", "single": { "income": null, "assets": 2000, "income_basis": "unknown", "asset_basis": "individual", "income_note": { "en": "A complete 2026 categorically-needy income row was not verified; no gross limit is inferred from the medically-needy table.", "es": "No se verificó la fila completa de ingresos de necesidad categórica de 2026; no deducimos un límite bruto de la tabla de necesidad médica." }, "asset_note": { "en": "Individual countable resources.", "es": "Recursos computables individuales." }, "source_ids": [ "WA-1", "WA-5" ] }, "married_one": { "income": null, "assets": null, "income_basis": "unknown", "asset_basis": "unknown", "income_note": { "en": "Couple/household reference where spouses are included together; exclusions and deeming require agency review. A complete 2026 categorically-needy income row was not verified; no gross limit is inferred from the medically-needy table.", "es": "Referencia de pareja u hogar cuando los cónyuges se incluyen juntos; la agencia debe revisar exclusiones y atribución de ingresos. No se verificó la fila completa de ingresos de necesidad categórica de 2026; no deducimos un límite bruto de la tabla de necesidad médica." }, "asset_note": { "en": "The couple resource reference is 3,000 dollars combined, not an applicant-only allowance.", "es": "La referencia patrimonial de la pareja es de 3,000 dólares en conjunto, no una reserva individual." }, "source_ids": [ "WA-1", "WA-5" ] }, "married_both": { "income": null, "assets": 3000, "income_basis": "unknown", "asset_basis": "couple_combined", "income_note": { "en": "Combined couple countable-income reference, not a gross-income ceiling. A complete 2026 categorically-needy income row was not verified; no gross limit is inferred from the medically-needy table.", "es": "Referencia de ingresos computables conjuntos, no un límite de ingresos brutos. No se verificó la fila completa de ingresos de necesidad categórica de 2026; no deducimos un límite bruto de la tabla de necesidad médica." }, "asset_note": { "en": "Combined countable resources for the two-person assistance unit.", "es": "Recursos computables conjuntos de la unidad de dos personas." }, "source_ids": [ "WA-1", "WA-5" ] }, "note": { "en": "The resource figures are the verified SSI-related medically-needy references; another coverage category may differ.", "es": "Los recursos son referencias verificadas de necesidad médica vinculada a SSI; otra categoría puede diferir." } } }, "summary": { "en": "Washington uses Apple Health for Medicaid, but long-term services and supports require more than ordinary health coverage. Home and Community Services reviews financial eligibility while a CARE assessment establishes care needs. A nursing-facility application and a COPES request can therefore follow related financial rules without producing the same service package. The special income level in the table identifies one eligibility route. It does not establish an automatic approval or rejection. Start by identifying the requested setting, whether a spouse remains at home, and which agency is assessing the person who needs care.", "es": "Washington llama Apple Health a Medicaid, pero los servicios y apoyos de larga duración requieren más que la cobertura sanitaria ordinaria. Home and Community Services revisa la elegibilidad económica y la evaluación CARE determina las necesidades de cuidado. Una solicitud para un centro de enfermería y otra para COPES pueden utilizar reglas económicas relacionadas sin ofrecer los mismos servicios. El nivel especial de ingresos identifica una vía de acceso, no una aprobación o rechazo automático. Primero conviene identificar el lugar de atención, si queda un cónyuge en casa y qué oficina realiza la evaluación." }, "excess_income_solution": { "en": "Being above the special income level deserves a second review. For HCS waivers, Washington’s rule allows an alternative calculation involving available income, permitted disregards, the average state nursing-facility rate and specified medical expenses. Institutional medically needy rules are another distinct calculation. A web comparison cannot reproduce these assessments using a pension total alone. Ask the public benefits specialist which category was evaluated and request the income worksheet. Cost participation after approval is a separate question: qualifying does not necessarily mean retaining every dollar of income.", "es": "Superar el nivel especial de ingresos merece una segunda revisión. Para las exenciones HCS, la regla permite otro cálculo que considera ingresos disponibles, exclusiones autorizadas, la tarifa media estatal de centros de enfermería y determinados gastos médicos. La necesidad médica institucional utiliza otro procedimiento. Comparar únicamente una pensión en internet no reproduce estas evaluaciones. Solicite al especialista de prestaciones la categoría examinada y la hoja de cálculo de ingresos. La contribución al coste después de la aprobación es otra cuestión: reunir los requisitos no significa necesariamente conservar todos los ingresos." }, "exempt_assets_notes": { "en": "Countable resources are different from everything a person owns. A home, vehicle or other property can receive an exclusion when the applicable conditions are met. Washington separately publishes a long-term-care home-equity standard, so an excluded home still needs an equity review where that rule applies. Explain who owns the property, any mortgage balance and who lives there. A spouse or qualifying child can change the analysis. Selling an excluded item may change its treatment once the proceeds become cash; request a case-specific explanation before acting.", "es": "Los recursos computables no equivalen a todos los bienes de una persona. La vivienda, un vehículo u otros bienes pueden quedar excluidos cuando cumplen las condiciones aplicables. Washington publica además un estándar de patrimonio neto de vivienda para cuidados prolongados; una casa excluida puede necesitar esa revisión adicional. Explique quién es propietario, la hipoteca pendiente y quién reside allí. La presencia de un cónyuge o hijo que reúna los requisitos puede cambiar el análisis. Vender un bien excluido puede modificar su tratamiento al convertirse en dinero; pida una explicación antes de actuar." }, "spousal_notes": { "en": "Washington publishes both a state spousal resource standard and a federal spousal maximum. They should not be collapsed into a promise that every community spouse can keep the maximum. The setting and the applicable spousal assessment matter. Likewise, income allowances for a married waiver participant differ from those for some single participants. Bring both spouses’ financial information, even if only one requests services, and ask for separate written figures for applicant resources, the community spouse’s protected share, and any income allocation.", "es": "Washington publica un estándar patrimonial estatal para cónyuges y un máximo federal. No deben convertirse en la promesa de que toda persona cuyo cónyuge necesita cuidados conservará el máximo. Importan el lugar de atención y la evaluación matrimonial aplicable. También difieren las asignaciones de ingresos de algunos participantes casados y solteros en exenciones. Prepare la información económica de ambos aunque solo uno solicite servicios. Pida cifras separadas por escrito para los recursos del solicitante, la parte protegida del cónyuge y cualquier asignación de ingresos." }, "lookback_rules": { "en": "The DSHS adult LTSS brochure describes a 60-month review of transfers for institutional and home-and-community-based waiver applications. A gift or sale below fair market value may affect payment for LTSS, but the review must examine the transaction and any applicable exception. Keep evidence of dates, ownership, consideration received and the purpose of unusual transactions. The lookback period is not a universal instruction that every applicant must immediately upload five years of every document. Follow the specialist’s actual verification request and keep copies of what you submit.", "es": "El folleto de DSHS sobre cuidados prolongados describe una revisión de transferencias de 60 meses para solicitudes institucionales y de exenciones domiciliarias y comunitarias. Una donación o venta por debajo del valor de mercado puede afectar al pago de servicios, pero deben revisarse la operación y las excepciones aplicables. Conserve fechas, titularidad, contraprestación recibida y finalidad de operaciones inusuales. El período retrospectivo no significa que toda persona deba subir inmediatamente cinco años de todos sus documentos. Siga la solicitud concreta de verificación y guarde copias de lo entregado." }, "estate_recovery_merp": { "en": "Estate recovery and eligibility are different decisions. Washington’s 2026 brochure describes recovery of specified federally funded LTSS received after age 55 and certain state-funded benefits under different age rules. A home excluded during eligibility can still be relevant to a later estate claim. Surviving-spouse and qualifying-child protections, tribal exclusions and other exceptions must be considered. The application also discusses limited circumstances involving liens during permanent institutionalization. Ask for the current recovery brochure rather than assuming either that every medical visit is recoverable or that home ownership is always protected.", "es": "La recuperación patrimonial y la elegibilidad son decisiones distintas. El folleto estatal de 2026 describe la recuperación de determinados cuidados prolongados financiados federalmente después de los 55 años y de ciertas prestaciones estatales sujetas a otras reglas de edad. Una vivienda excluida al solicitar ayuda puede tener relevancia para una reclamación posterior. Deben considerarse las protecciones del cónyuge superviviente, determinados hijos, bienes tribales y otras excepciones. La solicitud explica además situaciones limitadas de gravámenes durante una institucionalización permanente. Pida el folleto vigente en lugar de asumir que toda consulta médica genera recuperación o que cualquier vivienda queda protegida." }, "document_notes": { "en": "Use the aged, blind, disabled/long-term-care application or the official benefits route identified by DSHS, and tell the office that long-term care is requested. Organize benefit award letters, bank ownership and balances, insurance premiums, property details and unpaid medical bills. Record the requested service setting and the contact handling the CARE assessment. If information is missing, ask what alternative verification is accepted and how to preserve the application date. Keep the eligibility notice and cost-participation notice together; they answer different financial questions.", "es": "Utilice la solicitud para personas mayores, ciegas, con discapacidad o que necesitan cuidados prolongados, o la vía oficial indicada por DSHS, y especifique que solicita estos cuidados. Organice cartas de prestaciones, titulares y saldos bancarios, primas de seguros, datos inmobiliarios y facturas médicas pendientes. Anote el lugar previsto de atención y quién gestiona CARE. Si falta documentación, pregunte qué prueba alternativa aceptan y cómo conservar la fecha de solicitud. Guarde juntas la resolución de elegibilidad y la contribución económica: responden a cuestiones diferentes." }, "faqs": [ { "q": { "en": "Is COPES limited to the special income level?", "es": "¿COPES termina en el nivel especial de ingresos?" }, "a": { "en": "No. WAC182-515-1508 includes an alternative above-SIL calculation. The HCS specialist must evaluate the allowed deductions and current state nursing-facility rate.", "es": "No. WAC182-515-1508 incluye un cálculo alternativo por encima del SIL. El especialista HCS debe evaluar las deducciones autorizadas y la tarifa estatal vigente." } }, { "q": { "en": "Is WA Cares the same as Apple Health?", "es": "¿WA Cares es lo mismo que Apple Health?" }, "a": { "en": "No. This guide covers Medicaid financial eligibility. Do not apply these resource and income references to a different long-term-care insurance program.", "es": "No. Esta guía trata de elegibilidad económica de Medicaid. No aplique estas referencias de ingresos y patrimonio a otro programa de seguro de cuidados." } }, { "q": { "en": "Is the institutional PNA my eligibility limit?", "es": "¿La asignación institucional es mi límite de elegibilidad?" }, "a": { "en": "No. A personal needs allowance affects income retained after eligibility. Washington publishes different allowances for medical institutions, cash-assistance recipients and community settings.", "es": "No. La asignación para necesidades personales afecta a los ingresos conservados tras la aprobación. Washington publica cantidades distintas para instituciones, asistencia monetaria y entornos comunitarios." } }, { "q": { "en": "Why is regular Apple Health income blank here?", "es": "¿Por qué faltan los ingresos de Apple Health ordinario?" }, "a": { "en": "The complete current categorically-needy row was not confirmed during this review. A blank avoids presenting a medically-needy or federal reference as the wrong state threshold.", "es": "No se confirmó la fila completa vigente de necesidad categórica. Dejarla vacía evita presentar una referencia federal o de necesidad médica como otro límite estatal." } } ] }, { "code": "WI", "state": "Wisconsin", "state_es": "Wisconsin", "slug_en": "wisconsin-medicaid-income-asset-limits", "slug_es": "wisconsin-limites-ingresos-bienes-medicaid", "medicaid_name": "Wisconsin Medicaid", "agency_url": "https://www.dhs.wisconsin.gov/medicaid/member-info.htm", "reviewed": "2026-11-16", "income_rule_type": "program_specific", "single_income_limit_ltc": 2982, "single_asset_limit_ltc": 2000, "csra_max_spouse_assets": 162660, "home_equity_limit": 752000, "lookback_months": 60, "personal_needs_allowance": 55, "sources": [ { "id": "WI-1", "title": "Medicaid Eligibility Handbook 39.4, release 26-03", "url": "https://www.emhandbooks.wisconsin.gov/meh-ebd/policy_files/39/39.4.htm", "accessed": "2026-11-16", "method": "page", "supports": "Current 2026 institutional andGroup B income 2982; regularCN1086.16/1636.26 effectiveMay; assets 2000/3000; PNA55; CSASmax 162660; home 752000." }, { "id": "WI-2", "title": "HCBWLTC eligibility groups and cost sharing 28.6", "url": "https://www.emhandbooks.wisconsin.gov/meh-ebd/policy_files/28/28.6.htm", "accessed": "2026-11-16", "method": "page", "supports": "Group A/B/BPlus routes; gross-income test forGroup B; higher incomeGroup B Plus; cost share differs bygroup." }, { "id": "WI-3", "title": "Institutional LTC financial rules 27.5", "url": "https://www.emhandbooks.wisconsin.gov/meh-ebd/policy_files/27/27.5.htm", "accessed": "2026-11-16", "method": "page", "supports": "Institutional financial test, CN vs medically-needy; married both need comparison; resource assessment." }, { "id": "WI-4", "title": "Spousal impoverishment assets 18.4", "url": "https://www.emhandbooks.wisconsin.gov/meh-ebd/policy_files/18/18.4.htm", "accessed": "2026-11-16", "method": "page", "supports": "Combined assessment,2000 applicant component, CSAS formula 50 k floor and 162660 ordinarymax; exclusions." }, { "id": "WI-5", "title": "Real property 16.8", "url": "https://www.emhandbooks.wisconsin.gov/meh-ebd/policy_files/16/16.8.htm", "accessed": "2026-11-16", "method": "page", "supports": "Home exclusion distinct from equity test; spouse/qualifyingchild occupancy exceptions and hardship." }, { "id": "WI-6", "title": "Divestment evaluation 17.2", "url": "https://www.emhandbooks.wisconsin.gov/meh-ebd/policy_files/17/17.2.htm", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "60-month lookback, program startingpoint, allowed transfers and exceptions." }, { "id": "WI-7", "title": "Estate Recovery Program", "url": "https://www.dhs.wisconsin.gov/medicaid/erp.htm", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "LTC recovery scope and ordinary community coverage distinction." }, { "id": "WI-8", "title": "Wisconsin Estate Recovery Program Handbook", "url": "https://www.dhs.wisconsin.gov/publications/p1/p13032.pdf", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Surviving spouse and child protections; hardship waiver process." }, { "id": "WI-9", "title": "Mandatory verification items 20.3", "url": "https://www.emhandbooks.wisconsin.gov/meh-ebd/policy_files/20/20.3.htm", "accessed": "2026-11-16", "method": "search_excerpt", "supports": "Asset verification system, discrepancy followup and verification checklist." } ], "programs": { "nursing_home": { "name": { "en": "Institutional Medicaid: categorically needy reference", "es": "Medicaid institucional: referencia de necesidad categórica" }, "income_rule_type": "program_specific", "single": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "individual", "income_note": { "en": "Categorically-needy reference. Institutional medically-needy eligibility also considers monthly need.", "es": "Referencia de necesidad categórica. La necesidad médica institucional también considera las necesidades mensuales." }, "asset_note": { "en": "Countable resources after exclusions.", "es": "Recursos computables después de las exclusiones." }, "source_ids": [ "WI-1", "WI-3", "WI-4" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "contextual", "asset_basis": "applicant_only", "income_note": { "en": "Categorically-needy reference. Institutional medically-needy eligibility also considers monthly need. This is the applicant’s reference, not combined marital income.", "es": "Referencia de necesidad categórica. La necesidad médica institucional también considera las necesidades mensuales. Es la referencia del solicitante, no los ingresos conjuntos del matrimonio." }, "asset_note": { "en": "Applicant-side resources after the spousal assessment; not a ceiling on all marital property.", "es": "Recursos atribuidos al solicitante después de evaluar al matrimonio; no es un tope para todos sus bienes." }, "source_ids": [ "WI-1", "WI-3", "WI-4" ] }, "married_both": { "income": null, "assets": null, "income_basis": "unknown", "asset_basis": "unknown", "income_note": { "en": "No verified combined-couple threshold is published here; each spouse needs a separate eligibility review.", "es": "No publicamos un límite conjunto verificado; cada cónyuge necesita su propia evaluación." }, "asset_note": { "en": "Do not double the single-person limit or apply a community-spouse allowance when both receive institutional care.", "es": "No duplique el límite individual ni aplique una reserva para cónyuge comunitario cuando ambos reciben atención institucional." }, "source_ids": [ "WI-1", "WI-3", "WI-4" ] }, "note": { "en": "Do not treat this reference as the maximum income for all institutional coverage.", "es": "No utilice esta referencia como máximo de ingresos de toda cobertura institucional." } }, "hcbs_waiver": { "name": { "en": "Family Care/IRIS community waivers: Group B reference", "es": "Exenciones comunitarias Family Care/IRIS: referencia del grupo B" }, "income_rule_type": "program_specific", "single": { "income": 2982, "assets": 2000, "income_basis": "gross", "asset_basis": "individual", "income_note": { "en": "Group B gross-income reference. Group A and Group B Plus eligibility require different review.", "es": "Referencia de ingresos brutos del grupo B. Los grupos A y B Plus requieren otra evaluación." }, "asset_note": { "en": "Countable resources after exclusions.", "es": "Recursos computables después de las exclusiones." }, "source_ids": [ "WI-1", "WI-2", "WI-4" ] }, "married_one": { "income": 2982, "assets": 2000, "income_basis": "gross", "asset_basis": "applicant_only", "income_note": { "en": "Group B gross-income reference. Group A and Group B Plus eligibility require different review. This is the applicant’s reference, not combined marital income.", "es": "Referencia de ingresos brutos del grupo B. Los grupos A y B Plus requieren otra evaluación. Es la referencia del solicitante, no los ingresos conjuntos del matrimonio." }, "asset_note": { "en": "Applicant-side resources after the spousal assessment; not a ceiling on all marital property.", "es": "Recursos atribuidos al solicitante después de evaluar al matrimonio; no es un tope para todos sus bienes." }, "source_ids": [ "WI-1", "WI-2", "WI-4" ] }, "married_both": { "income": null, "assets": null, "income_basis": "unknown", "asset_basis": "unknown", "income_note": { "en": "No verified combined-couple threshold is published here; each spouse needs a separate eligibility review.", "es": "No publicamos un límite conjunto verificado; cada cónyuge necesita su propia evaluación." }, "asset_note": { "en": "Do not double the single-person limit or apply a community-spouse allowance when both receive institutional care.", "es": "No duplique el límite individual ni aplique una reserva para cónyuge comunitario cuando ambos reciben atención institucional." }, "source_ids": [ "WI-1", "WI-2", "WI-4" ] }, "note": { "en": "The 2000 resource figure describes the standard institutional/spousal route, not every possible Group A source of Medicaid.", "es": "La referencia patrimonial de 2000 corresponde a la vía institucional/matrimonial estándar, no a todas las fuentes de Medicaid del grupo A." } }, "abd_regular": { "name": { "en": "SSI-related categorically-needy EBD Medicaid", "es": "Medicaid EBD de necesidad categórica vinculado a SSI" }, "income_rule_type": "program_specific", "single": { "income": 1086.16, "assets": 2000, "income_basis": "countable", "asset_basis": "individual", "income_note": { "en": "Countable-income references effective May 1,2026. A separate medically-needy deductible route is available.", "es": "Referencias de ingresos computables vigentes desde el 1 de mayo de 2026. Existe otra vía de necesidad médica con deducible." }, "asset_note": { "en": "Individual countable resources.", "es": "Recursos computables individuales." }, "source_ids": [ "WI-1" ] }, "married_one": { "income": 1636.26, "assets": null, "income_basis": "countable", "asset_basis": "unknown", "income_note": { "en": "Couple/household reference where spouses are included together; exclusions and deeming require agency review. Countable-income references effective May 1,2026. A separate medically-needy deductible route is available.", "es": "Referencia de pareja u hogar cuando los cónyuges se incluyen juntos; la agencia debe revisar exclusiones y atribución de ingresos. Referencias de ingresos computables vigentes desde el 1 de mayo de 2026. Existe otra vía de necesidad médica con deducible." }, "asset_note": { "en": "The couple resource reference is 3,000 dollars combined, not an applicant-only allowance.", "es": "La referencia patrimonial de la pareja es de 3,000 dólares en conjunto, no una reserva individual." }, "source_ids": [ "WI-1" ] }, "married_both": { "income": 1636.26, "assets": 3000, "income_basis": "countable", "asset_basis": "couple_combined", "income_note": { "en": "Combined couple countable-income reference, not a gross-income ceiling. Countable-income references effective May 1,2026. A separate medically-needy deductible route is available.", "es": "Referencia de ingresos computables conjuntos, no un límite de ingresos brutos. Referencias de ingresos computables vigentes desde el 1 de mayo de 2026. Existe otra vía de necesidad médica con deducible." }, "asset_note": { "en": "Combined countable resources for the two-person assistance unit.", "es": "Recursos computables conjuntos de la unidad de dos personas." }, "source_ids": [ "WI-1" ] }, "note": { "en": "These are current categorically-needy values, not the older January-April 2026 amounts.", "es": "Son los valores vigentes de necesidad categórica, no los anteriores de enero a abril de 2026." } } }, "summary": { "en": "Wisconsin separates the financial work done by an income maintenance agency from the functional assessment used for long-term care. Family Care, Family Care Partnership, PACE and IRIS do not all begin with one universal financial test. Community waiver applicants can qualify through different groups, while nursing-facility residents have institutional rules. The current eligibility handbook also changed regular SSI-related categorically-needy income figures during 2026. Check both the program label and effective date before comparing a pension with a table. A Medicaid card by itself does not establish eligibility for every long-term-care service.", "es": "Wisconsin separa el trabajo económico de la agencia de mantenimiento de ingresos de la evaluación funcional para cuidados prolongados. Family Care, Family Care Partnership, PACE e IRIS no parten todos de una única prueba económica. Las exenciones comunitarias permiten distintos grupos de elegibilidad, mientras que los residentes de centros de enfermería siguen reglas institucionales. El manual vigente también modificó durante 2026 los importes de necesidad categórica vinculada a SSI. Compruebe el programa y la fecha antes de comparar una pensión. Tener una tarjeta Medicaid no demuestra elegibilidad para todos los servicios prolongados." }, "excess_income_solution": { "en": "For community waivers, Group B uses the institutional categorically-needy gross-income reference. Group B Plus can accommodate some people above that figure under a different comparison involving institutional care costs and a medically-needy standard. Group A comes through another full-benefit Medicaid category and has different cost-sharing treatment. Nursing-facility applicants also have a medically-needy review, and regular EBD coverage may involve a deductible. Ask which route the agency considered before concluding that income is too high. A monthly waiver cost share and a deductible are not interchangeable names for the same calculation.", "es": "En exenciones comunitarias, el grupo B utiliza la referencia bruta de necesidad categórica institucional. El grupo B Plus puede incluir a algunas personas que la superan mediante otra comparación con costes institucionales y un estándar de necesidad médica. El grupo A procede de otra categoría Medicaid de cobertura completa y tiene otro tratamiento de contribuciones. Las solicitudes institucionales también contemplan necesidad médica, y EBD ordinario puede exigir un deducible. Pregunte qué vía examinó la agencia antes de concluir que los ingresos son excesivos. La contribución mensual de una exención y el deducible no son el mismo cálculo." }, "exempt_assets_notes": { "en": "Wisconsin’s home-property rule distinguishes the ordinary homestead exclusion from the additional long-term-care equity restriction. Living in the home, intending to return, and certain resident relatives affect the first question. For the separate equity restriction, the handbook identifies protections when a spouse or specified child lives there, as well as hardship review. An equity value is not simply the property’s sale price; secured debts and ownership matter. Report these details instead of entering the entire house value as cash in the resource comparison. Other property and retirement accounts require their own classification.", "es": "La regla inmobiliaria distingue la exclusión ordinaria de la vivienda de la restricción adicional de patrimonio neto para cuidados prolongados. Residir allí, tener intención de regresar y determinados familiares residentes afectan a la primera cuestión. Para la restricción adicional, el manual contempla protecciones cuando vive allí un cónyuge o determinado hijo, además de dificultades excepcionales. El patrimonio neto no equivale al precio de venta: importan deudas garantizadas y titularidad. Declare esos datos en lugar de introducir el valor íntegro como dinero disponible. Otros inmuebles y cuentas de jubilación necesitan su propia clasificación." }, "spousal_notes": { "en": "Wisconsin assesses the couple’s countable assets at the relevant institutionalization or waiver-eligibility date. Its community-spouse asset-share formula has state-specific bands, so substituting the federal minimum is misleading. The current handbook includes a 50,000-dollar floor in the ordinary formula and a 162,660-dollar usual maximum, with court or hearing provisions considered separately. The applicant’s 2,000-dollar component is not a cap on everything the marriage owns. Request the completed asset assessment and distinguish the spouse’s protected assets from the separate income allocation used when calculating the cost of care.", "es": "Wisconsin evalúa los bienes computables conjuntos en la fecha pertinente de institucionalización o elegibilidad para la exención. La fórmula de participación patrimonial del cónyuge tiene tramos estatales; sustituirlos por el mínimo federal sería engañoso. El manual vigente incluye un suelo de 50.000 dólares en la fórmula ordinaria y un máximo habitual de 162.660, con disposiciones judiciales o de audiencia por separado. El componente de 2.000 del solicitante no limita todos los bienes matrimoniales. Solicite la evaluación completa y distinga los bienes protegidos de la asignación de ingresos utilizada para calcular el coste de atención." }, "lookback_rules": { "en": "The handbook evaluates transfers during a 60-month lookback for institutional and community-waiver coverage. It also examines relevant transfers while a person receives long-term care. The starting point is tied to program facts, not merely today’s date. A transfer must be evaluated for whether it is allowed and whether a penalty follows; not every transaction creates ineligibility. Preserve records explaining unusual withdrawals or changes in title. If a spouse later needs services, that spouse’s own review can matter even when an earlier transfer was considered in the other spouse’s case.", "es": "El manual evalúa transferencias durante 60 meses retrospectivos para cobertura institucional y exenciones comunitarias. También revisa operaciones pertinentes mientras se reciben cuidados. El punto inicial depende del programa, no simplemente de la fecha actual. Debe determinarse si la transferencia está permitida y si produce penalización; no toda operación genera inelegibilidad. Conserve pruebas de retiradas inusuales o cambios de titularidad. Si el cónyuge necesita cuidados más adelante, puede importar su propia revisión, aunque una transferencia anterior ya se hubiera considerado en el expediente de la otra persona." }, "estate_recovery_merp": { "en": "Wisconsin’s Estate Recovery Program includes specified community-based long-term care, home care, nursing-home and personal-care services. Ordinary community coverage without the relevant services is not automatically the same recovery situation. The estate handbook explains protections for surviving spouses and certain children and a process for requesting hardship relief. A home excluded from the resource test may still be relevant later. Keep service and coverage notices so an estate representative can identify the benefits involved, and follow the deadlines in any actual recovery notice rather than relying on a generic online description.", "es": "El programa de recuperación de Wisconsin incluye determinados cuidados comunitarios prolongados, atención domiciliaria, centros de enfermería y asistencia personal. La cobertura comunitaria ordinaria sin esos servicios no produce automáticamente la misma situación. El manual patrimonial explica protecciones para cónyuges supervivientes y ciertos hijos, además de solicitudes por dificultades excepcionales. Una vivienda excluida al evaluar recursos puede ser relevante después. Conserve resoluciones de servicios y cobertura para que el representante identifique las prestaciones, y siga los plazos de cualquier notificación real en vez de depender de una descripción general de internet." }, "document_notes": { "en": "Contact the local aging and disability resource center for the long-term-care pathway and the income maintenance agency for financial verification. Organize balances, ownership, income awards, insurance costs and the documents requested for a spouse’s assessment. Wisconsin uses an Asset Verification System; discrepancies can generate a verification checklist rather than an immediate final decision. Answer that checklist with dated evidence. Ask for the correct worksheet for an institution or community waiver and retain the resulting cost-share explanation. A change of care setting can require recalculation even when monthly income is unchanged.", "es": "Contacte con el centro local de recursos para mayores y discapacidad para la vía de cuidados, y con la agencia de mantenimiento de ingresos para la comprobación económica. Organice saldos, titularidad, prestaciones, seguros y documentos matrimoniales solicitados. Wisconsin utiliza un sistema de verificación patrimonial; las discrepancias pueden producir una lista de comprobaciones, no una decisión definitiva inmediata. Contéstela con pruebas fechadas. Pida la hoja correspondiente a institución o exención y guarde la explicación de contribuciones. Cambiar de lugar de atención puede exigir recalcular aunque los ingresos sigan iguales." }, "faqs": [ { "q": { "en": "Why are some 2026 EBD tables different?", "es": "¿Por qué difieren algunas tablas EBD de 2026?" }, "a": { "en": "Wisconsin increased the SSI-related categorically-needy figures effective May 1. Use the current handbook and the month being evaluated rather than an older January chart.", "es": "Wisconsin aumentó las cifras de necesidad categórica vinculada a SSI desde mayo. Utilice el manual vigente y el mes evaluado, no una tabla antigua de enero." } }, { "q": { "en": "Does Group B Plus mean a guaranteed waiver place?", "es": "¿El grupo B Plus garantiza acceso a la exención?" }, "a": { "en": "No. It describes a financial eligibility route. Functional eligibility, program enrollment and the calculated contribution still require separate decisions.", "es": "No. Describe una vía económica. La elegibilidad funcional, inscripción y contribución calculada requieren decisiones independientes." } }, { "q": { "en": "Must a married couple reduce everything to 2,000 dollars?", "es": "¿Un matrimonio debe reducirlo todo a 2.000 dólares?" }, "a": { "en": "No. Spousal impoverishment rules assess combined countable assets and a protected community-spouse share. The applicant component cannot be applied to the entire marriage.", "es": "No. Las reglas matrimoniales evalúan bienes computables conjuntos y una parte protegida para el cónyuge. El componente del solicitante no limita todo el matrimonio." } }, { "q": { "en": "Does high home equity cancel all Medicaid?", "es": "¿Mucho patrimonio en la vivienda cancela todo Medicaid?" }, "a": { "en": "The handbook distinguishes LTC payment from ordinary card services and provides specified exceptions. The agency must evaluate the actual coverage and household circumstances.", "es": "El manual distingue el pago de cuidados prolongados de la cobertura ordinaria y contempla excepciones. La agencia debe evaluar cobertura y circunstancias concretas." } } ] } ] }