Medicare-Medicaid Pay-Down of Assets
State law and regulations impose income and asset limits on persons applying for Medicaid.
The income limit for the institutional Medicaid program and certain home and community-based waiver programs is determined by the Missouri Department of Social Services – HealthNet (Medicaid). To qualify for Medicaid through SSI the income limit for an aged, blind or disabled individual cannot exceed $1,109 per month per person regardless of marital status, and may not have assets in excess of $5,909.25 as of the first day of the month ($11,818.45 for couples).
After the determination of initial eligibility for the institutionalized spouse, no resources of the community spouse not jointly owned with the institutionalized spouse shall be considered available to the institutionalized spouse in Medicaid determinations in that continuous period of institutionalization. If either spouse establishes in a fair hearing that the spousal share (in relation to the amount of income generated by that amount) is inadequate to raise the community spouse’s own income to the amount determined in 13 CSR 40-2.200(5)(A), the spousal share may be adjusted to an amount adequate to provide the additional income. At the fair hearing the maximum amount of the institutionalized spouse’s income that may be made available to the community spouse under 42 U.S.C.1396r-5(d), shall be considered the community spouse’s own income.
Spend down may be met in one (1) of the following ways:
(A) Incurred Costs Method. Spend down participants using this method must provide documentation of medical expenses they have incurred.
(B) Pay-in Method. An individual may pay their spend down amount to the state. The monthly spend down requirement may be paid by the individual, their spouse, a financially responsible relative, or a public program of a state or political subdivision of a state; and
(C) Combination Method. An individual may use a combination of the incurred costs method and the pay-in methods to satisfy the monthly spend down amount to the state.
MO HealthNet Eligibility
Mo. Code Regs. Ann. tit. 13, § 40-8.020
Mo. Code Regs. Ann. tit. 13, § 40-2.400