How to Apply for a Medicaid Waiver When You Have Too Much Money

Don’t get discouraged if someone tells you that you have too much money for Medicaid. There are many different medicaid programs and many ways to qualify. It is not possible in all cases, however, many of our readers were told they would not qualify, but still found ways to apply and get approved.How to Get Medicaid When You Get Turned Down

Step One: Exclude other people’s income

To start out make sure you are not including other people’s income:

  • For married adults, in most cases your spouse’s income will not count, unless your spouse is also applying for disability home aides. Count your income only.
  • For disabled children, in most cases parent’s income will not count, unless your spouse is also applying for disability home aides. Count child’s income only (child support, SSI, etc)
  • If you live with other people, other people’s income does not count (unless they are giving the money to you).

Exception, if both you and your spouse are applying for Medicaid waivers, the rules are different. Your spouse’s income will count.

Step Two: Make Sure Medicaid Excludes Other People’s Income

One common reason people get denied is because the person processing their application doesn’t know how waivers work (or doesn’t understand that this is a waiver application) and includes income from a spouse, parent, or someone else you are living with.

Make sure any application you fill out is for “medicaid waiver” or “medicaid long term care” – not regular Medicaid health insurance. Some people apply on paper and write in large letter on the top of every page “Medicaid Waiver application – Income excluded.” Some people find it helpful to call and talk to supervisors or ask for the name of the person at the local Medicaid office who oversees “Medicaid Waivers” or “Medicaid Long Term Care.”

In some states, Medicaid will instruct people to simply leave excluded people off the application. Please check with the Medicaid longterm care worker before doing this. For example, some Medicaid workers will tell parents to leave their own names and finances off their child application, including only their child’s name and income (SSI, child support, etc).

Step Three: Make Sure You Are Looking at the Right Income Limits

In many states, the income limit for disability Medicaid is $800 per month. The income limit for Medicaid waivers is often $2,300 per month. Big difference!

Step Four: Make Sure Medicaid is Looking at the Right Income Limits

Once again you want to apply for “Medicaid Waivers” or “Medicaid Long Term Care” or whatever the waiver program is in your state.

Step Five: More Complicated Problems

If everyone’s income is excluded, and you still have too much money, there are sometimes other solutions.

Medicaid financial rules are complex and detailed. You may wish to contact your local Centers for Independent Living and Area Agency on Aging and Disability (serves all ages) and request a referral to someone who can assist with Medicaid planing. Or set up a consultation with a special needs planning lawyer

Below is an overview of solutions that have worked for some of our readers.


What’s Your Problem?

If you got turned down for Medicaid for financial reasons you are probably experiencing one of the following problems:

  • Too much income (work or disability check)
  • Too much resources (stuff you own or savings)
  • Too much income and too much resources
  • You never applied. Someone told you that you don’t qualify and you gave up. (Don’t do this!!!)

Depending on the problem, there are many possible solutions.


OPTIONS FOR TOO MUCH INCOME

Ignore Your Spouse – If you see an income limit for “married” you can ignore this unless your spouse is also applying for a Medicaid waiver.

Don’t Be a Dependent – Some forms of Medicaid consider a “household” to be anyone declared as a dependent. If someone has declared you as a dependent, and this is disqualifying you, make sure to look into this. Tip: The rules usually state that they consider who is expected to be declared as a dependent on next year’s taxes. So if you were a dependent last year, it may not be too late to apply on your own.

Open an Income Trust – If your income is still too high, some states will allow you to open a “miller trust” or “qualifying income trust” or “pooled income trust” so that you can qualify. Some of your income will go into your trust, but can still be used to help you pay your bills. You may wish to consult with a medicaid planner or hire a special needs planning lawyer. Or try contacting independent living centers or aging and disability resource centers in your area to see if anyone can provide free assistance. Here is a list of pooled income trusts in New York

Note About Pooled Income Trusts – This type of trust is different than a Special Needs Trust. Special Needs Trusts are for assets and are much more common. Very little information is available online about pooled trusts, and we have not yet heard from any readers who have tried this. Please comment below if you have experience or input with pooled trusts. Learn more how these trusts work in This Fact Sheet  (this link is from new york, but gives very helpful information that may apply in other states.)

If You are Married – If you are married and the problem is your own income (not your spouse’s income) some states will allow you to designate a portion of your income towards your spouse. In some cases that can help you to qualify. Because these rules are complex, meeting with a medicaid planner or special needs lawyer may be helpful.

Medicaid Buy-In Programs – Most states have Medicaid buy-in program for working people with disabilities. Many people who are too disabled to work regular jobs still qualify for this program if they are doing small amounts of at-home work (babysitting, pet sitting, art making, etc). Income limits vary a lot. Sometimes as high as $80,000 per year. Spousal income does not count. Medicaid buy in programs

Income Exclusions – Some states have regulations that allow you to not count all your income. For example, in California they do not count any amount you pay for health insurance premiums, so many people purchase some dental, vision, or other supplemental insurance. This brings down their countable income, allowing them to qualify.

Avoid Spend Down and Share of Cost – Some states will offer you Medicaid through a “medically needy” or “medicaid spend down” or “share of cost” program. In many states these programs are terrible and will leave you impoverished. How to Eliminate Share of Cost, Patient Pay and Spend Downs

Move – If you need home care to survive, some people move to a different state with a higher income limit. You are generally able to start the Medicaid waiver application process the first day you establish residency in your new state, but it make take several months (or more) to process.

Ignore People Who Work at Medicaid – Many of our readers report being told wrong information by people who work at Medicaid. Do your own research, and make sure to see any policy in writing. Never let anyone turn you down verbally. How to Respond When You Are Told You Can’t Get Medicaid

Get Married – You’ve probably heard stories of people getting divorced to get medicaid. Ironically, in some situations, the opposite is true. Some states have “spousal impoverishment protections,” allowing you to dedicate some of your income or resources to a spouse. If your spouse is not also applying for a Medicaid waiver, their income and resources usually won’t count.


OPTIONS FOR TOO MUCH RESOURCES 

Rules for resources are different than rules for income. Resources are things you own and money in the bank.

Don’t Count Everything – Not all resources count. One car, one house, and many other things do not count. The rules are different in every state, however, they are very often very similar (and sometimes exactly the same) as the SSI rules. You can see those here: What Counts as a Resource for SSI?

Check the Limits – Once again, DO NOT LOOK AT THE MEDICAID GUIDELINES. Resource limits for Medicaid waivers are totally different then for other forms of Medicaid. $2,000-$3,000 is a common resource limit in most states, but it is higher in some places. The financial information about waiver programs on Paying for Senior Care is generally accurate. (Most senior programs will also be open to younger people with disabilities)

Ignore Your Spouse Again – Rules for spouses are tricky and confusing. If you see a financial limit for a married couple, you may be able to ignore this. In some states, this limit is only if your spouse is also applying for a home aide. Some states allow spouses to keep extra resources – sometimes as high as $120,000 plus a house. Some states will allow you to count 50% of resources as belonging to spouse and other states will allow you to count 100%. Some states have stricter limits for spouses.

Learn About Buy Ins – Some states have no asset limit for buy in programs. Most have Medicaid buy-in program for working people with disabilities. Many people who are too disabled to work regular jobs still enter this program if they are doing small amounts of at home work (such as babysitting, pet sitting, art making, etc). Medicaid buy in programs

Don’t Give Stuff Away – If you give away money or resources, you may be ineligible for up to five years. If you sell something for less than it is worth the same thing can happen. For example, do not sell your car to your son for $1.The rules are different in every state, however, they are very often very similar (and sometimes exactly the same) as the SSI rules. You can see those here: How to Handle If You Are Over the Resource Limit

Open a Special Needs Trust – If your money or resources are in certain types of trusts, they will not count for Medicaid. This can cost a few thousand dollars. However, many people find it worth it, as it can protect assets and help you get care for the rest of your life. You may wish to consult with a medicaid planner or hire a special needs planning lawyer.

Notes About Special Needs Trusts – In some situations, after opening a trust you will need to wait five years before being eligible to apply for a medicaid waiver (this generally only applies to seniors). Also, certain types of trusts are called “self-settled trusts.” For this type, when you pass away, any money left in the trust will go back to Medicaid. It cannot be inherited by anyone.

Open an ABLE Account – This is similar to a trust, but there are limits to how much you can put in and it is only for people who first became disabled before age 26. Costs are minimal and you can do it yourself without needing a lawyer.

Notes about ABLE Accounts – Many people wrongly think that an ABLE account will help them if they have too much income. It will not help if you have too much income on a monthly basis. It can be helpful if you have too much savings, or if you have one-time income (such as a small inheritance or lottery winning).

Spend Money or Buy Stuff – You are also allowed to spend resources in certain allowable ways. The rules are different in every state, however, they are very often very similar (and sometimes exactly the same) as the SSI rules. You can see those here: How Can I Spend Money While on SSI?

Wait Five Years – Most states have a five year look back period. If you have given money or resources away, you may need to wait up to five years before you are eligible to apply. The length of time you have to wait depends on your state, and the value of the resources. After five years, Medicaid no longer cares what you did with your money.

Too Many Cars – Some state Medicaid programs will only allow you to own one car (even if married). Other states do not have this rule. If cars are an issue for you, these SSI rules are similar to many Medicaid programs: How to Own Two Cars

Once Again, Ignore People Who Work at Medicaid – Many of our readers report being told wrong information by people who work at Medicaid. Do your own research, and make sure to see any policy in writing. Never let anyone turn you down verbally. How to Respond When You Are Told You Can’t Get Medicaid

Get Married – Once again, some states have “spousal impoverishment protections,” allowing you to dedicate some of your income or resources to a spouse. For example, in Florida, a spouse can keep $120,000 of shared assets (plus a house of course). These rules are complex, so please research carefully.

OTHER (NOT AS GOOD) OPTIONS

Medicaid waivers are widely viewed as the best home aide programs and will give you more hours, support, choice and flexibility than most other programs. If all else fails, here’s a few back up options:

💠 If you live in Florida and you are working and not receiving disability: WIPAS Program

💠 If you are over age 55 and live in Washington State: TSOA program.

💠 If you are over age 60, and live in Georgia: Non-medicaid program.

💠 In Indiana, at any age: CHOICE program.

💠 In North Carolina, any age if disabled: Home Aide Program

💠 Other types of programs: Other Caregiver Programs

💠 Also check programs in your state here: State-by-State List (ignore where it says senior. Most programs will accept disabled people of any age.

DISABLED CHILDREN

💠 If you are a parent and your child is disabled, most waiver programs will not count any of your income or assets. Learn more Kids Waivers.

💠 Many readers who are parents report being told the wrong information about this by the Medicaid office or having their application processed incorrectly. Do your own homework, and make sure your income is excluded.

💠 They will still count income and assets belonging to your child. If child support is making your child ineligible, some parents have had success consulting with a medicaid estate planning lawyer to see if it is possible to change the court support order to direct support into a special needs trust.

💠 Bonus: In California and Colorado, parents can be paid to be caregivers for their disabled children who are minors. In all states, parents can be paid caregivers of adult children.

More Reading

💠 If you’d like to chat with other people in Medicaid waiver programs and learn how they did it: Facebook Groups for Medicaid Home Care

💠  Check out Pansy’s Story: How Pansy Got on Medicaid By Being Smart, Scrappy & Persistent

Updated April 2018. Please comment below with stories, ideas, questions or suggestions. Please let us know if any links on this page stop working. If you found this page helpful, please share it with others by pressing one of these magic little buttons: 

23 thoughts on “How to Apply for a Medicaid Waiver When You Have Too Much Money”

  1. Hi! My grandmother is 92 and lives alone in her home. She receives my late grandfathers pension and social security benefit from when he worked at IRS, a combined total of 2000/ month. Her Medicare premium is automatically deducted from her benefit, i think 400$ per month. Her mortgage and other bills add up to 1500 a month leaving her 100$ for food and incidentals. Two years ago she got sick and had a brief stay in a care facility. We applied for Medical and ihss for when she returned home and her soc ended up being 1400$ a month. How can we get her soc down? She is getting older and needs in home assistance, her quality of life is suffering 💔

    Like

    1. There are a few good facebook groups for IHSS.

      IHSS advocacy
      IHSS consumers and providers united.

      Several folks there have had success with elderly parents joining Medi-cal disabled workers program, while doing small at home jobs (babysitting, tutoring, making and selling arts or crafts from bed, etc) a few hours per week. If your grandmother is able to do something like that, it is worth looking into.

      The state website doesn’t spell this out… but all disability income is excluded from the income limits for that program. Not sure what the other criteria is, but worth looking into.

      If she qualifies, share of cost is completely eliminated.

      Like

  2. Hi Sleepygirl,

    My brother is receiving Disabled Adult Child Benefits through the Social Security Administration. He is currently living with my wife and I and we are trying to get him moved into a group home living facility. We tried applying for Medicaid but he was denied full coverage due to him making too much every month from Disabled Adult Child Benefits after the death of my mother. He once received SSI benefits and Medicaid, but was then disqualified. He currently makes $1 more than the allowed amount each month through his benefits. This disqualifies him from receiving Medicaid and its services for group home residential housing and we aren’t sure what path to take. We haven’t received any letters of denial, only through the online portal they offer and verbally from a representative. We are trying to figure out work arounds for the issue. I read your article about how not to take no for an answer and how to use loop holes. Do you know of anyway to reduce the disabled adult child benefit so that he qualifies for Medicaid? Thank you.

    Like

  3. Hi Sleepygirl,

    My adult son has had ME for years, but is now bed bound and severely ill with mitochondrial disease. Before his sudden deterioration he was working a little and getting covered CA health insurance, but now needs to apply for medi-cal managed care and disability. We have spent down his resources below the $2000.00 limit, but the thing is we had a joint account with my savings, and I put him as a secondary account holder for the ease of transfer if I were to pass away. I have now closed the account and moved the money into another savings under my name, as a medi-cal worker told me to do, but I asked a social worker friend of mine if that was okay and she said I should wait 2-3 months to apply him for medi-cal. Is this true? I don’t want to wait to apply as he needs medical insurance in his severe state and IHSS care as I cannot care for his 24 hour needs all by myself. Will they count the closing of the joint account as a lookback violation?

    I’m really confused as what I should do? your advice is greatly appreciated.

    Thank you for your invaluable blog for people with ME/CFS, disabilities, and people in need of help.

    Like

    1. Hi Sheena,

      Unfortunately, transferring money out of someone’s name before applying for Medi-cal or SSI can cause problems.

      This is unfortunately a complicated area that I do not know. You may wish to consult with a lawyer who specializes in special needs estate planning.

      The lookback period on medi-cal is five years, and the lookback period on SSI is three years, so I’m not sure how waiting 3 months will make any difference.

      Nothing bad happens if he applies. He can always apply and then research more if denied.

      If the amount in the account was not much (a few thousand dollars) then the period of ineligibility might only be a few months, in which case it’s true you could just wait a few months, or apply and see if they can tell you how long to wait.

      If it is less than 15k, it could easily be transferred into an ABLE account, no cost or need for a lawyer, but I do not know if it’s too late to do that. Certainly never hurts to put money in an ABLE account either way 🙂

      Google: ABLE account.

      You may wish to look into special needs planning for when you pass away, since he could lose his benefits at that time if things are not set up ahead.

      I hope it goes well for you. 💕💕🌷

      Like

    2. P.S. It just occurred to me that if he is not yet on disability, he might be eligible for MAGI medi-cal which has no asset limit.

      That doesn’t solve the SSI problem…. but it may be worth looking into/trying.

      If you go apply for medi-cal that is the default form most people apply for – it’s just not available to disabled people.

      If he is living with you and over age 22, he’s also eligible for his own calfresh account if food is separate from yours. Also, I don’t know if he’s applying for SSI or Disabled Adult Child benefits, but if it’s SSI, this might be helpful… https://howtogeton.wordpress.com/2017/01/26/how-to-figure-out-how-much-rent-to-pay-on-ssi/

      Like

  4. Hi Sleepygirl:
    First of all I love your website, so informative……my question is can I apply for my mother (91yrs. old) for a Medicaid waiver as she is on state medicaid now with PA and needs some home care as she slows down in life but does not want to go to a nursing facility? Now she has about $4000 in her checking account to pay bills and order food,etc for daily means. Her only income into that account is SSI and no other means of income but since she is pretty much home bound she does not go out to spend any money too often. Will the waiver hold that against her and does she have to spend down to $2000 before applying for the waiver? Appreciate your advice….thanks so much.

    Like

    1. Hi Dennis,

      I do not know the income limits in PA. For many states it is 2,000, so it’s possible she would need to spend some.

      However, I’m not sure how she is already on Medicaid if she’s over the limit, so obviously I’m missing something.

      If you can’t get a clear answer, she can always apply and if she gets turned down for that reason, spend down and apply again.

      Be sure to keep receipts so she can prove that the money was not hidden or given away. Maybe she can stock up on some supplies or things she will need in the upcoming year?

      Also, I am thinking she is on a different form of Social Security, not SSI? If it’s SSI, that amount in her bank account would cause problems unless she is spending most of it before the end of each month.

      Like

  5. Hello,

    My fiancee is on Pennsylvania’s Home and Community Based Waiver Service. She is permanently disabled from a brain injury 3 years ago.
    We applied for the HCBS waiver while she was awaiting her SSDI ALJ hearing. She was approved for the waiver services and I became her paid caregiver.
    About six months ago she was approved by the ALJ during her SSDI hearing and received a monthly payment of $1,444.50. Her monthly payout is under PA’s limit of $2,100ish for eligibility, so we were still okay.
    She also received a back-pay of $33,000 after attorney fees and other fees. The money was deposited almost two months ago.
    My question is will this large sum of back pay affect her waiver services? If this does, is there a window of time we have to spend the money down to an allowable asset level?
    How long would the window be and how much would we have to spend?
    Also, if not, what are our options as not to lose her waiver services? They are so important to her well-being.
    Finally, am I worrying about nothing? And how do I ease my mind?

    Thank you,
    M

    Like

    1. Hi Mart,

      Most medicaid programs will exclude backpay for a length of time. Typically 6 months or 9 months. You may need to check the regs in your state.

      If she has debt, she may not want to hang onto it that long though, because creditors can freeze bank accounts.

      If she was disabled before age 26, she can put about half the money in an ABLE account.

      More options are here. This page is for SSI, but applies to most medicaid programs too: https://howtogeton.wordpress.com/2017/10/19/ssi-resource-regulations/

      Do not give money away and avoid cash transactions.

      hope this helps. 💕

      Like

  6. My sister is 54 and had a major stroke brain bleeding she needs to go on public aid her hucband left and took off she is in medicare but they won’t cover long term care she is paralyzed on her whole right side she d takgj feed herself wears diapersand screams a lot.any day now she is going to have to leave the place she is in and I have no place to send her i.tried taking care of her at home and I just cant do it alone this is a emergency any day now she has to leave the home she is jn if you can help me at all please please help me this is just plain scarey knowing she has no one that. thank you for taking the time to read this hope you can find a way to help me thank you Mary
    ,

    T t t

    Like

  7. I am trying to guide a friend who is trying to get her elderly parents on medicaid who reside in Florida. Her parents want to remain in their own home with the help of home health aids. I live in New York where we have a medicaid waiver program which allows disabled individuals to receive medicaid services including home health aids and remain in their own home. This is as long as the cost of the services needed to remain at home does not exceed the cost of a nursing home facility. Also in NY the look back period for an individual who seeks a Medicaid Waiver and remain in their own residence is only a period of 5 weeks.
    Does anyone know if this is true in Florida? I cannot find any information on the internet to verify this.
    Thank you

    Like

  8. How can I reply for Medicade l have s s I now trying to get medicade to help me please let me know or call me 1 814 380 6445 thank you so much

    Like

      1. More terrific information.

        Two things to say–OFF RECORD please (I don’t know how to DM you so I have to do it this way):

        1) You should edit or remove the comment above yours–people should not have their full name and phone number posted publicly. That, together with personal details, could open her up to some sort of scam phone call.

        2) When I was looking into applying for a choreworker, I never got anywhere with my regular DSHS office. I knew they considered that program to be separate, but nobody ever gave me decent info about how to pursue it. When I finally insisted on them helping me get my application in, my form apparently got to the right office (somewhere else) and I was notified that I had a phone interview scheduled.

        During the phone conversation, I tried to expedite things and was told there was a separate Financial Eligibility process that could be speeded up if I gave verbal approval for them to do “a new process of bank account verification” whereby they are now contacting banks to see if you have any unreported accounts.

        I could not ask for much more info without being suspicious, although I probably was anyway when I made an excuse and declined. (But I would love to know things like: how did they decide which banks to contact–the 10 biggest? 20 biggest? had they thought to include Credit Unions? only banks in my state? national? online banks? what about Joint Accounts? CDs?)

        I know many people who forget or “forget” to report some savings or leftover lump-sum, tucked away in an old account, perhaps at a small credit union or bank nobody ever heard of. As far as I know, the govt only knows what you tell it, only credit accounts go on your credit report, so the only way any govt program would find private accounts would be if they used the Release of Information to send your Name, DOB, SSN to a bunch of banks asking if there are any accounts matching that person and what is their current or average balance. (I’m wearing my Computer Analyst hat now.)

        But there are SO many banks and CUs in each state, that I can’t imagine them doing mass mailings or emails…I think someone in IT would just run a search, as I did, for the Top 10 or 20 Banks, in that state, and do the mailing to them. Interestingly, Credit Union rankings are kept separate and I have a feeling would be overlooked…with the possible exception of BECU (Boeing Credit Union) which everybody and their sister has an account at in my area.

        So…if someone has accounts in any of the Top 20 Banks in their state, my recommendation is to declare them to any and all govt programs that ask for Asset information. Right now, it looks like the only program in WA DSHS that is checking this way is the Home Aid program known as COPES (not Food Stamps or ABD), but some federal and state programs (mostly housing, healthcare, veterans, homelessness, employment) have begun to share info. State programs may also be sharing between themselves. Therefore, it is more important now than ever for people to report the same info to ALL aid programs (and don’t try to hide anything that can be easily found).

        I’ll leave it to you to figure out how to convey that info to your readers.

        Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s