Eligibility for Special Assistance Medicaid and Special Care Medicaid

Special Assistance Medicaid (or SA Medicaid) is the program that provides monetary assistance for those people in assisted living facilities.  Special Care Medicaid is the program that provides monetary assistance for those people living in locked dementia units at nursing homes.  Determining an applicant’s eligibility for Special Assistance or Special Care Medicaid requires an examination of the applicant’s monthly income, along with the applicant’s assets.

Monthly Income Limit

Unlike Long Term Care Medicaid (discussed here), Special Assistance and Special Care Medicaid have set income limits that do not vary based on facility.  They instead have set income limits that an applicant must be under in order to be eligible.  If the applicant's income exceeds this amount, they are not eligible for Special Assistance or Special Care Medicaid.

The income limit for Special Assistance is $1,228.00 per month. 

The income limit for Special Care is $1,561.00 per month.


Asset Limit

The asset limit for Special Assistance or Special Care is the same as it is for Long Term Care -- an applicant may have no more than $2,000.00 in countable assets.  However, these programs value countable assets differently than Long Term Care.  Generally speaking, the following are not countable assets:

1)  An applicant's homeplace, and any contiguous real property, are not countable.

2)  Life insurance with a face value of less than $2,000.00 is not a countable asset.  (This is different from Long Term Care, where the limit is $10,000.00)

In contrast with Long Term Care, the following items are considered countable assets of the applicant:

1)  Life estate interests in real property.

2)  Tenancy in common, joint tenancy, or joint tenant with the right of survivorship interests in real property. 

These restrictions on real property ownership can make qualification for SA or SC Medicaid much more difficult, so it is important to speak with an attorney that is intimately familiar with these matters when faced with a long term care situation.

Provided, however, that an applicant meets these income and asset requirements, and is in a Medicaid-approved bed, he or she should be eligible for SA or SC Medicaid assistance.

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