In order to qualify for Medicaid benefits, applicants and their spouses must meet certain financial and non-financial criteria. Among these requirements are limitations related to their income, which vary depending on their state of residence and marital status.
Medicaid Income Limit for the Institutionalized Individual
In most states, the institutionalized individual’s income, including Social Security, pension, and other earned and unearned sources, must be less than the private pay rate of the facility. Some forms of income may be exempt, but these exemptions are rare.
However, a few states apply a different income cap from the private pay rate, including:
- Colorado – QIT Gross Income Cap by region
- Connecticut –Medicaid Reimbursement Rate
- Iowa – QIT Gross Income Cap
- Kansas – Medicaid Reimbursement Rate
- Montana – Medicaid Reimbursement Rate
- New Hampshire – Medicaid Reimbursement Rate
- North Carolina – Medicaid Reimbursement Rate
- Oklahoma – QIT Gross Income Cap
- Rhode Island – LTCC Medically Needy Income Cap
- Vermont – Medicaid Reimbursement Rate
- West Virginia – Medicaid Reimbursement Rate
What About Qualified Income Trusts? About half of states apply an additional income restriction beyond the hard income limitation. If the applicant’s monthly income exceeds 300% of the SSI rate, it must flow through a Qualified Income Trust (QIT), also known as a Miller Trust. For 2025, this limit is $2,901.
Read More: What Is a Qualified Income Trust and When Is One Required?
Community Spouse Medicaid Income Limit
In the case of a married couple, the spouse in the nursing home is subject to the rules outlined above. The spouse living at home, on the other hand, is not subject to any income restrictions, meaning they can receive unlimited income and still qualify the institutionalized spouse for benefits. If the couple receives joint income, one-half will be attributed to the institutionalized spouse, and one-half will be attributed to the community spouse.
Read More: Medicaid Compliant Annuity Strategies for Married Couples
Whether you have a single client seeking financial assistance for long-term care or you’re working with a married couple, you can offer them a solution to qualify for Medicaid benefits while also preserving their assets and income. That’s where the Medicaid Compliant Annuity comes in. Book a call with us to learn more!
Read More: Determining If a Medicaid Compliant Annuity Is Right for Your Client