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Medicaid Eligibility Criteria for Seniors

Income and asset limits for the Elderly

Sam is 69 years old and the proud owner of a home, a car, and a great life insurance policy. In addition, he still receives a monthly income of $3,500 from the supermarket he had founded. His physical health has deteriorated to the extent that it is clear to his spouse and children that he requires nursing home-level care. A quick online search reveals that the current income and asset limits in New Jersey for seniors are $2,742 income per month and a total of $2,000.00 in assets.

Unaware of the various options available to applicants in NJ and other states who are above the income limit, such as setting up a QIT, Sam’s family assumes that he is ineligible for Medicaid.


Recalling that their aunt – who only owned a car and several stocks and bonds – was unable to be approved for Medicaid when she required care, convinces them not to even waste their time applying.

Thus, they continue spending upward of $2,000 each month for a live-in caretaker, while pushing through the days and weeks until they’d be forced to pay the astronomical fees involved in nursing home care.

The Complexity of Medicaid Eligibility Criteria

What Sam’s family, among many other families struggling with the costs involved in caring for an aging, loved one, fails to realize is that there are different types of care available through Medicaid and that each category of income and assets are evaluated differently.

General Medicaid Income and Asset Limits

It is important to note that, while this article includes an overview of the eligibility requirements in most states, some states have different requirements regarding long-term Medicaid and ABD Medicaid for in-home care.

An overview of the current financial criteria in NEW JERSEY and other states:

Income Limits for Nursing Home Medicaid and HCBS Waivers:

☛ The income limit for a single individual aged 65 years and older in most states is at $2742/month.

☛ With married couples income limits are more complex:

☛ If one spouse is applying, only the applicant’s income is counted.

☛ Also, some of the applicant’s income can be allocated to the non-applicant spouse as part of the Spousal Protection allowance.
In most states, up to $3,715 can be allocated to the non-applicant spouse. This limit of $3,715 includes the regular income of the non-applicant spouse.

☛If both spouses are applying, they are each allowed a maximum income of $2742/month.

Asset Limits for Nursing Home Medicaid and HCBS Waivers:

☛ A single applicant may own up to $2,000 in countable assets.

☛ NY State and California are vastly different in this aspect, with NY granting an allowance of up to $30,182, and California allowing up to $130.000.

☛ Married couples are typically able to have up to $3,000 in countable assets to qualify.

☛ When one spouse in a married couple is applying, a portion of the couple’s assets is allocated to the non-applicant spouse in what is called a Community Spouse Resource Allowance. In most states, this allows up to $148,600 in assets to be allocated to the non-applicant spouse.

☛ Home Exemption: For a home to be exempt, it must have a home equity interest (the fair market value minus any debt on the home) of under $688,000 or $1,033,000 in most states.

☛ California is once again an exception with no home equity interest limit.

☛ If the applicant does not live at home, there must be an Intent to Return for it to be exempt.

You can check the specific eligibility income guidelines in your state here.

Senior Medicaid Care Types

A Medicaid application will be evaluated based on both the level of care required, as well as the income and assets of the applicant.

Levels of care include:

☛ Nursing Home Eligibility – the determination of whether an individual requires nursing home care must be made by a medical doctor. There are also many rules around what is defined as a Nursing Home Level of Care (NHLOC) in each state.

If an aging individual (65+ years of age) meets the financial and level of care requirements, a state must pay for their complete nursing home care.

☛ Assisted Living and In-Home Care Eligibility – candidates may receive this level of assistance from Medicaid via HCBS Waivers or their state’s Aged, Blind, and Disabled (ABD) Medicaid.

☛ HCBS Waivers are designed for those who wish to receive the nursing home level of care at home. This program generally has tighter income and asset limits than ABD Medicaid.

☛ ABD Medicaid is here to help with assisted living at home, but will not pay for the extent of care, such as room and board, that HCBS waivers will cover.

What If I Don’t Qualify?

Applying for Medicaid is a very complex, confusing, and overwhelming task. Reach out to Senior Planning Services to get clarity about Medicaid.

Call us at 855.S.PLANNING or email us today for a free no-obligation consultation.