With the average monthly cost of a private room in a nursing home in Missouri approaching $6,000 in 2020, seniors who are likely to need long-term care should pay serious attention to ensure they have a way to pay for that care. Long-term care (LTC) is usually paid for by private funds, nursing home insurance, or Medicaid. If a patient cannot afford to pay privately and does not have LTC insurance, Missouri's Medicaid program (MO HealthNet), administered by the state's Department of Social Services (DSS) agency, might pay for his or her care.
Medicaid is a medical assistance program funded by the federal and state governments to pay for, among other things, long-term care for persons who meet certain requirements, such as being over 65, disabled, or blind. Other types of Medicaid services have different eligibility guidelines than the rules for LTC.
Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care may qualify for Medicaid benefits, if they meet certain income and resource qualifications. Missouri also operates certain Medicaid waiver plans, known as Home and Community-Based Services (HCBS) waivers, which include programs that allow elderly individuals in need of assistance to remain living independently, in their homes and communities, instead of in a nursing home.
If you are age 65 or older, blind, or disabled and meet income and resource requirements, MO HealthNet provides coverage for nursing home residents under certain circumstances.
To obtain coverage for nursing home care, you must be financially eligible, and you must need the kind of care nursing homes provide. Nursing homes provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, and other services.
For more information, visit Missouri's MO HealthNet (Medicaid) for Seniors page or call (855) 373-4636. You can also access an MO HealthNet application form here.
Before you apply for Medicaid coverage, make sure that to the best of your knowledge you meet the eligibility criteria. Typically, your nursing care facility can assist you with the Medicaid application process. For other questions about MO HealthNet and nursing home coverage, call the Missouri DSS at (800) 735-2966. You can also click here (then scroll down to "Find an Office") to identify and contact your local Family Support Division (FSD) resource center.
In Missouri, to qualify for Medicaid-paid nursing home care, known as "vendor coverage," all of a single applicant's income must go towards the cost of care. For an eligible individual, MO HealthNet would pay the cost of skilled nursing or intermediate care in excess of the person's income. Note that these LTC income rules may be different from the income limits for those applying for other health care benefits from Medicaid. For example, applicants for HCBS Medicaid waiver programs, discussed below, must meet a 2020 monthly income limit of $1,370.
For purposes of determining Medicaid LTC eligibility, any income an applicant receives, from any source, is considered. However, when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse is not counted, so that he or she has enough funds on which to live. Additionally, the non-applicant spouse is entitled to keep a minimum monthly needs allowance, which may range from $2,113.75 to $3,216.
If you qualify for Medicaid and live in a nursing home, you will be expected to spend almost all income on your care. MO HealthNet allows nursing home residents receiving Medicaid to keep only $50 per month as a personal needs allowance.
Medicaid for LTC has different resource rules, which you must satisfy to be eligible for coverage, than those for other MO HealthNet programs. Resources are assets like real property, personal property, life insurance with a cash value, vehicles, motorhomes, boats, IRAs, bank accounts and cash. You will have to total up all of these to determine how much you have in resources.
If you are a single person, you can have only up to $4,000 in assets with a few allowable exclusions such as a car and your home (up to a value of $595,000 in 2020). If you are married, your non-applicant spouse at home can keep up to $128,640 worth of joint assets.
Missouri residents may be eligible for Medicaid LTC services that are delivered outside of the nursing home facility setting. The state has programs with different eligibility requirements that offer certain other benefits, so that seniors at home or in the community can obtain needed services.
For example, MO HealthNet offers programs to eligible state residents who require nursing care but choose to live at home. Missouri operates a Medicaid HCBS waiver program, which is designed to provide eligible individuals assistance so that they can remain living independently—in their homes and communities—instead of in nursing homes. The HCBS entitlement program, also referred to as the Missouri Care Options (MCO) program, provides financial assistance to individuals receiving services at home or in the community.
MO HealthNet has a similar program, the Aged and Disabled Waiver (ADW), that is not an entitlement but rather offers assistance on a limited-availability basis. The ADW program offers in-home services to eligible individuals who would require nursing home care if they did not receive assistance with chores, homemaking, respite care, and meals. Like those receiving services under the HCBS program, ADW program participants may access adult daycare, personal care assistance, alternative care facilities, in-home support services, and others.
MO HealthNet also offers a Consumer Directed Services (CDS) program, or self-directed care, through which eligible applicants can hire, train, and supervise care providers who assist them at home. The CDS program provides consumer-directed personal care assistance, at home, that is not medical but rather aids with certain activities of daily living. The Independent Living Waiver (ILW) program is similar to CDS, requiring that applicants meet the same eligibility criteria, and offers eligible recipients other services such as environmental accessibility adaptations, specialized medical equipment and supplies, financial management services, and case management.
Finally, MO HealthNet operates the Supplemental Nursing Care (SNC) financial assistance program, providing a cash benefit to help eligible individuals pay for residential care. Program participants may receive payments in varying amounts, depending on whether the particular recipient lives in an assisted living facility or a residential care facility.
For general information about MO HealthNet waiver programs, visit the Missouri DSS website. You can find more information about Missouri independent living options in the DHSS brochure, as well. To find out more about the ILW, call the Missouri Department of Health and Senior Services at (573) 751-6400, or visit the DSS website for basic information.
You can find out more about the SNC program by contacting your county Family Support Division (FSD). For more information, call the FSD information center at (855) 373-4636 or visit the FSD contact information web page.