Understanding Medicaid
Medicaid Long-Term Care Benefits
You don’t have to "Spend Down" all of your savings and retirement before you start receiving Medicaid benefits.
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You can set aside and protect the majority of your assets for your family and still qualify for Medicaid.
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If you are married you can preserve 100% of your assets for your healthy spouse and still qualify for Medicaid.
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You can even protect a significant portion, if not all, of the equity in your home for your family.
Medicaid is available to pay for care in a community setting; however:
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Not all nursing homes accept Medicaid. It depends on census/bed availability.
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Only a select number of Assisted Living communities accept Medicaid.
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If you become a resident of an Assisted Living that accepts Medicaid there is often a Private Pay Spend-Down requirement of assets before Medicaid Benefits are accepted as payment. Generally, a spend-down policy is 3 to 24 months.
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It's important to know how to structure the Medicaid benefit so that when the private pay spend-down term has ended, Mediciad benefits begin.
Are you a Veteran?
Qualifying For Medicaid
There are 5 requirements an individual must meet in order to receive Medicaid benefits that will pay for long-term care:
Citizenship Test
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Generally, you must be a U.S. citizen or qualified alien and a resident of Colorado to receive the benefits of Medicaid within the State of Colorado.
Medical Test
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If over 65, you must need assistance with at least two Activities of Daily Living (ADLs). ADLs include needing assistance with bathing, dressing, eating, toileting, transferring (getting out of bed, out of a chair or being able to move across the room) or a need for daily supervision. Such care can be provided in a nursing home, an assisted living facility or by an at home care agency in the person’s own home.
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If under 65, you must be totally and permanently disabled.
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A determination on whether you are health eligible for Medicaid benefits is completed when you submit an application for Medicaid Long-Term care benefits
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Most county health agencies contract with an outside agency to determine if a person is health-eligible for Medicaid Long-Term Care benefits.
Income Test
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Colorado Medicaid eligibility rules limit a Medicaid Applicant’s monthly income to $2,829 (2024).
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A Spouse’s income is not limited.
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If an applicant’s income exceeds the Income limit, there are rules to qualifying income with the use of a Colorado Income Trust; otherwise known as a Miller Trust. The trust is submitted with the qualifying application.
Asset Test
Medicaid divides your assets into two categories:
Exempt Assets and Countable Assets
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Exempt Assets are those assets that will not be counted when determining eligibility for Medicaid.
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Countable Assets are those assets that will be counted when determining whether assets exceed Medicaid benefit asset limitations.
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The applicant's Countable Assets are limited to a total of $2,000.
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A Spouse who is not applying for Medicaid is permitted to retain $154,140 in Countable Assets (2024).
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Medicaid will impose a penalty waiting period if you transferred any property for less than its fair value (gifts) during the last 5 years. Commonly referred to as the “Five-Year Look Back".
Exempt Assets
Your home provided your equity does not exceed $1,091,000.
Exempt Assets
A car (any make or model)
Exempt Assets
Personal property in and around your home
Exempt Assets
Certain final expense and burial plans
Exempt Assets
Special types of annuities
Countable Assets:
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Cash
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Checking & Savings
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CD's
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Mutual Funds
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Stocks & Bonds
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Real Estate
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Business Assets
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All Other Items of Value