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DE Medicaid - Long Term Care Financial Eligibility

Financial Eligibility for Long Term Care depends on the particular Long Term Care program you are interested in, the Nursing Facility Program, the Acute Care Program, or the Home and Community Based (HCB) Programs.

Nursing Facility and HCB Programs

Income Limit: The applicant must have countable income that is less than 250% of the Supplemental Security Income (SSI) Federal Benefit Rate (FBR). In 2009, that amount is $1,685 for individuals and $2,528 for couples. In 2008, that amount was $1,593 for individuals and $2,390 for couples.

NOTE: If both members of a couple receive or are applying for HCB Waivers or Long Term Care, their incomes are combined and the couple limit is used. If one member of the couple is a "community spouse" (that is, a spouse who does not receive and is not applying for HCB waiver services or long term care), the community spouse's income is not counted in determining eligibility, but is counted when determining the patient pay amount.

In determining countable income, DSS follows rules that are similar to those for SSI Countable Income. Generally, the Division of Social Services (DSS) subtracts from your gross income:

·      The $20 General Exclusion; and

·      The Earned Income Disregard of $65 plus 1/2 of the remaining earned income; and

(The detailed rules are in DSS Policy Manual Sections 20100.2.2, 20200, 20210 & 20240.)

Resource Limit: Resources must not exceed $2,000 for an individual and $3,000 for a couple. Possible exclusions include: $1,500 set aside for burial; a house if still occupied by a spouse, dependent child, or adult child who has cared for the applicant; and a vehicle in some circumstances.

The resources of a community spouse are included in accordance with the Spousal Impoverishment policy. (The detailed rules are in DSS Policy Manual Sections 20300 through 20500.)

Long Term Acute Care Program:

Income and Resource Limits: The applicant must have countable income that is less than 100% of the SSI Federal Benefit Rate (FBR). In 2009, that amount is $674 per month. In 2008, the amount was $637 per month.

Otherwise the information above concerning countable income and resource limits applies.

See also:

DE Medicaid - Covered Groups

DE Medicaid - Eligibility

DE Medicaid - Application Procedures

DE DSS - Change Reporting Requirements

DE DSS - Contact Information

Source:

DSS Policy Manual (Sects. 20100 through 20900)

Back to:

Long Term Care - Overview

DE Medicaid - Overview

DE Division of Social Services - Overview

DE Benefit Information System Overview

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