US Medicaid Eligibility Analysis, 2009

Eligibility Pathways for Medicaid and Long-Term Care

The following state profiles show the eligibility groups and other rules states selected for calendar year 2009.

Source: State website, http://www.medicaid.alabama.gov/CONTENT/3.0_apply/3.2_Qualifying_for_Medicaid.aspx, and waiver application.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment, the community spouse may retain up to $1,822 in income and between $25,000 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $30 monthly, with an additional $90 monthly supplement for veterans or widows of a veteran.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related and special income pathways. The state does not apply spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $1,658 in an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

^a   Unearned income must be at or below $1,156 per month.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the state's Buy-In pathway. The state makes the special income rule pathway available to individuals who have lived in an institution for at least 30 days. The state makes the special income rule pathway available up to 246% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related, Buy-In, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $75 monthly or $90 monthly for veterans in LTC facilities.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, Buy-In, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $1,656 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust may not exceed $5,808 in urban areas and $5,158 in rural areas.

Institutional LTC: The SSI-related, 100% FPL, Buy-In, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $1,822 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $101 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA or higher with a Miller Trust.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

^a Net personal income (earned plus unearned, after SSI income exclusions); unearned income must be less than SSI threshold plus $20.

^b The type, amount and scope of benefits offered to the medically needy population may be less than under traditional benefit packages.

^c The state does not extend nursing home care to eligible medically needy individuals. Our survey did not ask whether states extend other institutional services to these individuals.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 80% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a three month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related, 100% FPL, Buy-In, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain between $1,822 and $2,739 in income and $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $40 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the special income pathway. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in a monthly maintenance needs allowance (MMNA), or an unlimited amount with a Miller Trust.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

^a Excludes disability-related income including SSDI benefits.

^b The type, amount and scope of benefits offered to the medically needy population may be less than under traditional benefit packages.

^c The state extends nursing home care to eligible medically needy individuals. Our survey did not ask whether states extend other institutional services to these individuals.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a one month budget period to the state's medically needy threshold.

Institutional LTC: The SSI-related, 100% FPL, medically needy, and Buy-In pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $35 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, and medically needy pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Individual waiver recipients may retain up to $600 in an MMNA. Couples that are both waiver recipients may retain up to $934 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are capped by region.

Institutional LTC: The SSI-related and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $30 monthly for SSI recipients and higher for certain others with non-service connected disabilities.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA or higher with a Miller Trust.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: Connecticut is a 209(b) state and applies more restrictive rules to the counting of income and resources than are applied under the federal government's SSI thresholds. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a six month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related 209(b), Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain between $1,821 and $2,739 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $69 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related: 209(b) and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $1,806 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain between $1,821 and $2,739 in income and between $25,000 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $44 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the special income pathway. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $1,685 in an MMNA or higher with a Miller Trust.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses to the state's medically needy threshold from a selected budget period between one and six months. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related, 100% FPL, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $70 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, medically needy, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 88% of the FPL. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a one month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related, 100% FPL, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $1,822 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $35 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain an unlimited amount for an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a one month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $50 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $674 in an MMNA or higher with a Miller Trust.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009.

Traditional Benefits: Hawaii is a 209(b) state and applies more restrictive rules to the counting of income and resources than are applied under the federal government's SSI thresholds. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a one month budget period to the state's medically needy threshold.

Institutional LTC: The SSI-related: 209(b), 100% FPL, and medically needy pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $50 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related: 209(b), 100% FPL and medically needy pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $674 in an MMNA if they live in a residential care facility. All other waiver recipients may retain up to $1,038 in an MMNA.

Other pathway: Other:The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

^a Excludes retirement accounts, life insurance; earned income >15% of total earned and unearned.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the state's Buy-In pathway. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $1,821 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $40 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, Buy-In, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients with a mortgage or rent may retain up to $1,011 in an MMNA. Waiver recipients with no mortgage or rent may retain up to $674 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

^a Increased to $3,160 in February 2009.

^a Increased to $25,000 and exempts retirement and medical savings accounts.

Traditional Benefits: Illinois is a 209(b) state and applies more restrictive rules to the counting of income and resources and the definition of disability than are applied under the federal government's SSI thresholds. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a one month budget period to the state's medically needy threshold.

Institutional LTC: The SSI-related: 209(b), 100% FPL, Buy-In, and medically needy pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $30 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related: 209(b), 100% FPL applicants. Waiver recipients may retain up to $674 in an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: Indiana is a 209(b) state and applies more restrictive rules to the counting of income and resources than are applied under the federal government's SSI thresholds. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a one month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related: 209(b), Buy-In, and medically needy pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $52 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the Buy-In, medically needy, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a two month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related, Buy-In, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $50 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a six month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related, Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain between $1,821 and $2,739 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $62 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, medically needy, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $727 in an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses to the state's medically needy threshold from a selected budget period between one and three months. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain between $1,822 and $2,739 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $40 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the special income pathway. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $694 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 75% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a three month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related, 100% FPL, Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $38 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

^a Up to $903 on unearned income (includes spousal income).

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% pathway is available to individuals with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a six month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related, 100% FPL, Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $1,822 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $40 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, Buy-In, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $1,129 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a six month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related, Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain between $1,821 and $2,739 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $71 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related Buy-In, medically needy, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

^a Notes: 100% of FPL Pathway disregards 33% of income above 100% of the FPL if the beneficiary is blind or disabled.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a six month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related, 100% FPL, Buy-In, and medically needy pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $73 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL and special income pathways. The state does not apply spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

^a Pre-enrollment: Total countable income (earned and unearned) cannot exceed $903 using SSI methodology. During enrollment: No limit on earned income, but unearned income cannot exceed $903. (Excludes spousal income)

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a one month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related, 100% FPL, Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $60 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the 100% FPL and Buy-In pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: Minnesota is a 209(b) state and applies more restrictive rules to the counting of income and resources than are applied under the federal government's SSI thresholds. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a six month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related: 209(b), 100% FPL, Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain between $1,823 and $2,739 in income and between $31,094 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $89 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the 100% FPL, medically needy, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $935 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $44 monthly. This amount can increase if the beneficiary participates in a work therapy program.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009.

Note: State-reported survey data shows an inconsistency about whether Missouri offers the Special Income Rule pathway.

^a For the blind and/or, disabled, the income threshold is $903 for an individual and $1,215 for a couple.

^a For the blind and/or disabled, the resource amount for a couple is $4,000.

Traditional Benefits: Missouri is a 209(b) state and applies more restrictive rules to the definition of disability than are applied under the federal government's SSI thresholds. The 100% FPL pathway is available to individuals with incomes up to 85% of the FPL.

Institutional LTC: The SSI-related: 209(b) and 100% FPL pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain between $1,822 and $2,739 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $30 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related: 209(b) pathway. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a one month budget period to the state's medically needy threshold.

Institutional LTC: The SSI-related and medically needy pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $1,821 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $50 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related and medically needy pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Medically needy waiver recipients may retain up to $625 in an MMNA; other waiver recipients may retain $674.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a one month budget period to the state's medically needy threshold.

Institutional LTC: The SSI-related, 100% FPL, Buy-In, and medically needy pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $50 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, and medically needy pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $903 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

^a Unearned income is capped at $699.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the state's Buy-In pathway. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related, Buy-In, and special income pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment, the community spouse may retain between $1,821 and $2,739 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $35 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI related and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: New Hampshire is a 209(b) state and applies more restrictive rules to the definition of disability than are applied under the federal government's SSI thresholds. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a one month or six month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related: 209(b), Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $1,822 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $56 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related: 209(b), Buy-In, medically needy, and special income pathways. The state does not apply spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

^a Unearned income threshold disregards SSDI benefits received under individual's account (SSN, not survivor's SSN).

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a six month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related, 100% FPL, Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $35 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the special income pathway. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients in an alternative living facility may retain up to $674 in an MMNA. All other waiver recipients may retain up to $2,022 in an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

^a To be eligible for Medicaid Buy-In in New Mexico beneficiaries must earn at least $970 over three months.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Working individuals with disabilities may also qualify for Medicaid state plan services through the state's Buy-In pathway. The state makes the special income rule pathway available to individuals who have been in an institution for at least 30 days. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related, Buy-In, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment, the community spouse may retain up to $1,822 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $63 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010. Additional information was obtained from, http://www.health.state.ny.us/health_care/medicaid/program/buy_in/index.htmState Plan.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a six month budget period to the state's medically needy threshold.

Institutional LTC: The SSI-related, Buy-In, and medically needy pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and between $74,820 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $50 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, Buy-In, and special income pathways. The state does not apply spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $787 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

^a Phased implementation open to individuals with monthly incomes up to $1,354 in December 2009.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a six month budget period to the state's medically needy threshold.

Institutional LTC: The SSI-related, 100% FPL, Buy-In, and medically needy pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $1,822 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $30 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, and medically needy pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $903 in an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: North Dakota is a 209(b) state and applies more restrictive rules to the counting of income and resources than are applied under the federal government's SSI thresholds. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a one month budget period to the state's medically needy threshold.

Institutional LTC: The SSI-related: 209(b), Buy-In, and medically needy pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,267 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $50 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related: 209(b), Buy-In, and medically needy pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $750 in an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

^a Persons with a severe work disability are given an unearned income disregard of up to $20,000 per year.

Traditional Benefits: Ohio is a 209(b) state and applies more restrictive rules to the counting of income and resources than are applied under the federal government's SSI thresholds. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a one month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related: 209(b), Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $40 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related: 209(b), Buy-In, medically needy, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $1,314 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009.

Traditional Benefits: Oklahoma is a 209(b) state and applies more restrictive rules to the counting of resources than is applied under the federal government's SSI threshold. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL in Oklahoma. The state makes the special income rule pathway available up to 300% of SSI. No more than $3,000 can be deposited in a Miller Trust.

Institutional LTC: The SSI-related: 209(b), 100% FPL, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and between $25,000 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $50 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related: 209(b) and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $1,011 in an MMNA or up to $3,000 with a Miller Trust.

Other pathway: Other:The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the state's Buy-In pathway. The state makes the special income rule pathway available up to 300% of SSI. Up to $6,494 can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related, Buy-In, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment, the community spouse may retain up to $1,822 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $30 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, Buy-In, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $1,822 in an MMNA or $6,494 with a Miller Trust.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010. Pennsylvania 1915(c) waiver application, http://www.temple.edu/thetrainingpartnership/resources/mrBulletins/wv/00-09-04_attch2.pdf

^a Income threshold evaluated across six months.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a six month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related, 100% FPL Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain between $1,821 and $2,739 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $45 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, Buy-In, medically needy, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a six month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related, 100% FPL, Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $50 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, medically needy, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $923 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related, 100% FPL, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and between $66,480 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $30 monthly.²⁷

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. MMNA was not available through survey or state contacts.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the state's Buy-In pathway. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related, Buy-In, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment, the community spouse may retain up to $1,821 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $60 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, Buy-In, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $694 in an MMNA or higher with a Miller Trust.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $50.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $1,348 in an MMNA or higher with a Miller Trust.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010. Texas section 1915(c) waiver application, http://www.dads.state.tx.us/providers/CBA/CBAWaiver.pdf

^a To be eligible for Medicaid Buy-In in Texas beneficiaries must earn at least $1,090 in qualifying SSA quarter prior to application date.

^b Half of any jointly owned (with spouse) assets considered.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the state's Buy-In pathway. The state makes the special income rule pathway available to individuals who have been in an institution for at least 30 days. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related, Buy-In, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment, the community spouse may retain up to $2,739 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $60 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI related, Buy-In, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA or higher with a Miller Trust.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a one month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related, 100% FPL, Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $1,822 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $45 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, Buy-In, medically needy, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $903 in an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

^a After disregarding SSDI and veteran's benefits, income cannot exceed either the Medicaid protected income level for one, or the SSI/Aid to the Aged, Blind, and Disabled (AABD) payment level for two.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses living in an LTC facility can spend down their income on medical expenses over a one-month budget period (six-month, if living in the community) to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related, 100% FPL, Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $1,829 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $47 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, medically needy, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $991 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: Virginia is a 209(b) state and applies more restrictive rules to the counting of resources than is applied under the federal government's SSI thresholds. The 100% FPL pathway is available to individuals with incomes up to 80% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related: 209(b), 100% FPL, Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $40 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the 100% FPL, medically needy, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a budget period to the state's medically needy threshold. The beneficiary's budget period may have a retroactive base period that is one, two, or three months depending on the client's circumstances and eligibility. The prospective base period may be either three or six months and is the beneficiary's option. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related, Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain between $1,821 and $2,739 in income and between $48,639 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $70 monthly for institutionalized persons.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, Buy-In, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $903 in an MMNA.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

^a Unearned income must be equal to or less than the SSI benefit plus $20.

^b Liquid assets are excluded up to $5,000.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the state's Buy-In pathway. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related, Buy-In, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment, the community spouse may retain between $1,821 and $2,739 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $50 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related and special income pathways. The state does not apply spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is not available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

Traditional Benefits: All SSI recipients are eligible for Medicaid. The 100% FPL pathway is available to individuals with incomes up to 100% of the FPL. Individuals with disabilities may qualify under the state's Buy-In pathway. Under the medically needy pathway, certain individuals with high medical expenses can spend down their income on medical expenses over a six month budget period to the state's medically needy threshold. The state makes the special income rule pathway available up to 300% of SSI.

Institutional LTC: The SSI-related, 100% FPL, Buy-In, medically needy, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment rules, the community spouse may retain up to $2,428 in income and between $21,912 and $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $45 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, 100% FPL, Buy-In, medically needy, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA.

Other pathway: The Katie Beckett pathway is available. The hospice only eligibility pathway is available.

Source: CRS/AARP State Survey, 2009. Buy-In Pathway Data for 2009: Matthew Kehn, Sarah Croake, and Jody Schimmel, A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure, Mathematica Policy Research, Inc., Final Report, Washington, DC, December 23, 2010.

^a Gross countable income only.

Traditional Benefits: All SSI recipients are eligible for Medicaid. Individuals with disabilities may qualify under the state's Buy-In pathway. The state makes the special income rule pathway available to individuals who have been in an institution for at least 30 days. The state makes the special income rule pathway available up to 300% of SSI. Amounts that can be deposited in a Miller Trust are unlimited.

Institutional LTC: The SSI-related, Buy-In, and special income rule pathways are available to individuals to qualify for institutional LTC. Under spousal impoverishment, the community spouse may retain up to $2,739 in income and up to $109,560 in assets. The personal needs allowance for an individual in an LTC facility is $50 monthly.

HCBS Waiver: For HCBS waiver services, individuals can qualify through the SSI-related, Buy-In, and special income pathways. The state applies spousal impoverishment rules to HCBS waiver applicants. Waiver recipients may retain up to $2,022 in an MMNA or higher with a Miller Trust.

Other pathway: The Katie Beckett pathway is not available. The hospice only eligibility pathway is available.

Upper Income Threshold for Non-Working Aged and Disabled Medicaid Applicants

Below, the aged and disabled are divided into two groups: (1) applicants who are non-working regardless of whether they require LTSS and (2) applicants with higher income who apply to Medicaid for LTSS and require the level-of-care offered in an institution.²⁵ The following analysis looks at the highest income thresholds available in each state for both groups. Decisions states make about these thresholds often reflect the amount of state revenue they want to dedicate toward Medicaid for aged and disabled populations in general and LTSS in particular.

Table 2 summarizes the highest level of income, in 2009, that non-working elderly or disabled applicants could have and qualify for Medicaid by state. Specifically, it includes the upper income threshold, as a percent of the federal poverty level, for the SSI-related, 100% FPL, and medically needy pathways. (Table 2 does not describe the upper threshold for applicants applying to Medicaid because they require LTSS. These pathways are described in Table 3.)

Thirty-one states (30 used medically needy rules and 1 used spend-down rules) had no limit on the amount of income an aged or disabled individual (or individual with high medical expenses) could have to qualify for Medicaid. In these states, applicants could access Medicaid with higher income levels than in other states. Benefit packages for those who qualify for Medicaid through the SSI-related and 100% FPL pathways are generally more comprehensive than the benefit packages offered to medically needy individuals.

Among the 21 states with income caps for the non-working elderly and disabled applicants, 4 states (Arizona, Massachusetts, Utah, and Vermont) allowed applicants to qualify with income up to 100% FPL while the remaining states set thresholds at lower levels.

Source: CRS Analysis of CRS/AARP State Survey, 2009.

Table excludes eligibility for LTSS through the Special Income Rule and the Medicaid Buy-In pathway. Table shows the maximum threshold for individuals. In 2009, the federal poverty level (100% FPL) in the lower 48 states and the District of Columbia was $10,830 for an individual; in Hawaii it was $12,460; and in Alaska it was $13,330. See, Federal Poverty Guidelines for 2009 at http://aspe.hhs.gov/poverty/09poverty.shtml. Under the medically needy pathway, aged or disabled individuals qualify when their medical expenses (on such things as nursing home (NH) care, prescription drugs, etc.) deplete, or "spend down," their income and assets to specified Medicaid thresholds.

Upper Income Threshold for Applicants Meeting the State's Level-of-Care Criteria for Institutional LTSS

Table 3 summarizes the upper income threshold for applicants applying to Medicaid because they require LTSS and meet the state's criteria for institutional care. LTSS in Table 3 is divided into two service types: nursing homes and states' largest HCBS waivers. By showing the upper income thresholds for both service types, one can begin to evaluate the extent to which parity exists between these services. However, to fully evaluate parity, additional information is needed about the number of waiver slots a state offers compared to demand as well as the amount of income an individual is allowed to retain to pay for living expenses in a home and community-based setting (i.e., MMNA). The latter of these measures is presented in Table 4.

Although states have many rules for determining eligibility, 45 states had no maximum income limit for accessing nursing home care in their state (see Table 3). In addition, 39 states had no income limit for accessing their states' largest HCBS waiver program. In general, a state's use of either the medically needy pathway or miller trust, in conjunction with the special income rule, results in No upper income limit. This shows that at least six states (Connecticut, Louisiana, Massachusetts, Michigan, New Jersey, and Washington) allow applicants with higher income to access nursing home care, while limiting access to HCBS waiver services to individuals with lower income levels. Parity between nursing home and HCBS waivers was not as great in these states as in others.

Source: CRS Analysis of CRS/AARP State Survey, 2009.

Notes: Table shows the maximum threshold for individuals. In 2009, the federal poverty level (100% FPL) in the lower 48 states and the District of Columbia was $10,830 for an individual; in Hawaii it was $12,460; and in Alaska it was $13,330. See, Federal Poverty Guidelines for 2009 at http://aspe.hhs.gov/poverty/09poverty.shtml States with no upper income limit either use the medically needy pathway, in which medical expenses (on such things as nursing home (NH) care, prescription drugs, etc.) deplete, or "spend down," income and assets to specified Medicaid thresholds, or the special income rule with a Miller Trust, for eligibility purposes.

Monthly Maintenance of Need Allowance (MMNA) for Enrollees in Home and Community-Based Waiver Services

Table 4 shows each state's monthly maintenance of need allowance (MMNA). The MMNA is the maximum amount of income an individual enrolled in the state's HCBS wavier program may retain for living expenses; amounts above the MMNA are applied toward the cost of the beneficiary's care. Waiver enrollees use these funds to pay for living expenses, including housing, food, transportation, clothing, personal care products, among others.²⁶

Higher MMNAs allow Medicaid beneficiaries more income to live in their homes or community setting while accessing Medicaid. Lower MMNAs leave individuals less income to reside in home and community-based settings, increasing the likelihood that individuals will seek institutional care to meet their LTSS and housing needs. Fifteen states have MMNAs of less than $1,000 for all or some beneficiaries while the remainder of states have MMNAs of higher than $1,000. Although the information provided in Table 4 is useful for comparative purposes, it is not adjusted for differences in the cost of living across states.

Source: CRS Analysis of CRS/AARP State Survey, 2009.

¹ Information collected per telephone, or email, contact with the state's Medicaid office.
² Information collected from the state's section 1915(c) waiver application.

Analysis of Selected Survey Findings

The survey looked at states' criteria for access to Medicaid for people aged 65 and over and certain people with disabilities. Questions concerning the income and asset thresholds associated with each eligibility pathway available in each state were among the many issues surveyed. In general, states' responses helped to measure the level of generosity or restrictiveness of a states' eligibility rules. States with higher income thresholds, for example, allow people with higher income levels to access Medicaid, while states with lower thresholds are more restrictive.

Medicaid Enrollment by State and Basis of Eligibility for Aged and Disabled

Although information on income thresholds is useful for comparative purposes, it does not tell the entire picture. To more accurately measure a state's generosity or restrictiveness for eligibility purposes, the wealth status of the state, the size of its population, and its demands on Medicaid enrollment should be considered. For example, a poorer state may have lower income thresholds than a richer state but have higher enrollment. Simultaneously, a richer state may have higher thresholds and have comparable, or even lower, enrollment numbers. Although an analysis of this complexity is not included in this report, Table 1 shows state-by-state enrollment numbers for the aged and disabled. The survey was conducted in calendar year (CY) 2009; the most recent enrollment data available are for FY2008.

Source: Medicaid and CHIP Payment and Access Commission (MACPAC), Report to Congress on Medicaid and CHIP, Washington, DC, March 2011, Table 2.

Notes: Numbers reflect individuals ever enrolled during the year, even if for a single month. FY 2008 unavailable for Hawaii, FY 2007 shown instead.

¹ Components do not sum to totals due to a small number of enrollees with unknown status.

View PDF of entire report: Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities: 2009 State Profiles.

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