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 Oklahoma Health Care Authority – Medicaid Agency. For 2025, the Medicaid income limit for individuals eligible is $2,901 per month.
For an institutionalized individual, the look-back date is 60 months before the first day the individual is both institutionalized and has applied for SoonerCare. An “institutionalized” individual is one who is receiving ADvantage program services.
The penalty period begins the first day of the first month during which assets have been transferred and which does not occur in any other period of ineligibility due to an asset transfer. When there have been multiple transfers, all transferred assets are added together to determine the penalty.
The penalty period consists of a period of ineligibility (whole number of months) determined by dividing the total uncompensated value of the asset by the average monthly cost ($2,000) to a private patient in a skilled nursing facility (SNF) level of care in Oklahoma. In this calculation, any partial month is dropped. There is no limit to the length of the penalty period for these transfers. Uncompensated value is defined as the difference between the fair market value at the time of transfer less encumbrances and the amount received for the resource.
Assets are defined as all income and resources of the individual and the individual’s spouse, including any income or resources which the individual or such individual’s spouse is entitled to but does not receive because of action:
(i) by the individual or such individual’s spouse;
(ii) by a person, including a court or administrative body, with legal authority to act in place of or on behalf of the individual or such individual’s spouse; or
(iii) by any person, including any court or administrative body acting at the direction or upon the request of the individual or such individual’s spouse.
OHCA Policies and Rules 317:35-17-10
SoonerCare and Insure Oklahoma Income Guidelines – 2025