Kentucky Medicaid Long Term Care for Seniors

Kentucky Medicaid Long Term Care is a group of programs offered under Kentucky’s Medicaid program. They provide long-term care and support services  to people who can’t live on their own anymore because of aging or chronic medical conditions. Medicaid Long Term Care can be used by people of any age, but these questions focus on Kentucky Medicaid Long Term Care for seniors.

You have to live in Kentucky, and you have meet asset limits and  income limits to be financially eligible. 

Use this website to get an idea if your income and assets meet the Kentucky financial eligibility guidelines for Medicaid Long Term Care.

Also, you have to need “nursing facility level of care.”  This means that you need the kind of full-time care and supervision that is normally the kind you get when you are in a nursing home.  The care can be both medical and non-medical. 

The financial requirements vary based on:

• your marital status,
• if your spouse is also applying, and
• what program you are applying for.

The programs are:

• Nursing Home Medicaid,
• Home and Community Based Services (HCBS) Waivers and
• Program of All-Inclusive Care for the Elderly (PACE).

The Kentucky Medicaid agency checks to see if you or your spouse have given away assets or sold something for less than fair market value.  They look back 5 years from the date you apply.  They can impose a penalty if you have given away or sold your assets for less than fair market value.  They look at the value of the assets you gave away or sold for less than fair market value and calculate a period of “ineligibility.” This means they decide on a certain period of time that you can’t get Medicaid Long Term Care.

If this happens to you, contact a lawyer or your legal aid program.  They can help to check if you can get excused (exempted) from the period of ineligibility or see if you qualify because of undue hardship.

The income limit for Medicaid Long Term Care changes every year.  If your income is over the limit, you need to set up an Irrevocable Qualifying Income Trust (QIT) to become eligible.  Contact a lawyer or your legal aid program to help you set up the QIT.

The Kentucky Medicaid agency evaluates you and completes an Activities of Daily Living assessment. This means they look at how you deal with things like:

• Moving around
• Bathing
• Dressing
• Eating
• Toileting 

 They also do a cognitive or behavioral issues assessment. This includes Alzheimer’s disease and other dementias.

• Nursing Home Medicaid: For people in residential nursing homes .It pays for all care costs including room and board.
• Home and Community Based Services (HCBS) waivers: For people who are at home or in assisted living.  It covers all care costs but not room and board. Waivers are not always available and wait-lists are common.
• Program of All-Inclusive Care for the Elderly (PACE): For people who are at home and want to get all their services through one agency.  PACE is not available in all Kentucky counties. People who use PACE must be:
  • at least 55 years old,
  • eligible for Medicaid or be eligible for both Medicaid and Medicare (dual eligible),
  • or pay for the services themselves.

For more information on PACE, go here.

If you live in Kentucky, apply for Medicaid online at kynect benefits or in-person at your local Department for Community Based Services (DCBS) office. If you have questions, you can also call DCBS at 1-855-306-8959. 

It is complicated.

Your home may be considered an asset.  Under Medicaid Long Term Care rules, your total assets can’t be more than $2,000.  So: 

• if you go into a nursing home and
• you are not married, and
• a dependent family member doesn’t live in the home, and
• the equity you have in your home is more than $2,000,

then that equity counts against you after you have been in the nursing home for 6 months.  The next section explains what “dependent family member” means.

After 6 months, if you have more than $2,000 in equity, you are no longer eligible for Medicaid Long Term Care unless you are trying to sell your home.  You can also file an “intent to return home” statement.  If the equity in your home is less than $730,000, you may still be eligible.

If your spouse or dependent family member lives in the home, there are different rules. The home is exempt as long as the equity is less than $730,000.  The next section explains what “dependent family member” means.

If you don’t have a spouse or dependent family member living there, your home can be exempt if you file an “intent to return home” statement. The equity must be less than $730,000. 

A dependent family member is a child, stepchild, parent, stepparent, brother, sister, stepbrother, stepsister, half-brother or half-sister. 

If there is no spouse, you have to show that the dependent family member: 

• Lived with you in the home before you went into the nursing home and is still living in the home; and
• Got more than one-half of their annual financial support from you;  and
• Claimed that person as a dependent.

If your spouse goes into a nursing home or gets Medicaid waivers services at home, you are called the community spouse.

Usually, when only one spouse of a married couple goes into a nursing home or gets Medicaid waiver services at home, only that spouse’s income is counted. This means that your income as the community spouse does not count and does not affect your spouse getting Medicaid.  If your monthly income is below a certain amount, you can keep some of your spouse’s income to bring your income up to $2,643.75 per month.  This is called the Minimum Monthly Maintenance Needs Allowance.  You may be able to keep even more of your spouse’s income if your housing costs are high. 

If you got Nursing Home or Waiver Services, Medicaid asks your estate to pay back some or all of the amounts paid for services you got.   This is called Medicaid Estate Recovery.  Your estate is all the property, assets, and liabilities that you own at the time of your death.

When the person who was in the nursing home or got waiver services dies, the Kentucky Medicaid agency sends a Notice of Intent to Recover to the estate representative.

Yes.

Medicaid Estate Recovery  doesn’t happen if:

• There is proof of a living spouse or child(ren) under 2.  Or a child of any age who is blind or disabled as defined by the Social Security Administration; or
• Doing recovery would cause undue hardship.  For example, when the assets of an estate are they only way the “surviving recipient family member” makes money.   Surviving recipient family member means the surviving spouse, child or sibling of a deceased recipient.

Yes.  Medicaid Estate Recovery may not happen if it is not really worth it compared to the value of the estate.   That means the value of the estate is:

• Less than what it would cost to do the work of recovering from the estate; or
• $10,000 or less.

Also, Medicaid Estate Recovery may not happen on a case-by-case basis if it can be shown that an heir to the estate needs the funds to pay for continuing education or health care needs.

The person handling the estate is called the “estate representative.” The best thing them to do is to contact a lawyer who knows about Medicaid Estate Recovery or contact a local legal aid office. 

If there is a living spouse or child(ren) under 21 or a child who is blind or disabled, the estate representative should write a letter right away to the Kentucky Medicaid agency let them know.  Send the letter to address listed on the notice. 

If the estate representative wants to ask for an undue hardship exemption, they must:

• Make a written request to the Department of Medicaid Services within 30 days of getting the Notice of Intent to Recover, and
• Prove the undue hardship situation to the Department.   

Yes.  The estate representative can appeal the denial of an undue hardship.  They need to file a request for a hearing with the Department of Medicaid Services.   The request for a hearing must:

• Be in writing and explain the reason for the request; and
• Be postmarked within 30 days from the date of the denial of undue hardship exemption.