What is Long Term Care?
Long Term Care (LTC) services help people with a chronic illness or disability meet health or personal needs. Most long term care services assist people with activities of daily living, such as dressing, bathing and using the bathroom. Long term care can be provided at home, in the community or in a nursing home or other facility. While most people who need long term care are 65 or older, a person can use long term care services at any age. A person may need long term care services for a short period of time after an acute illness or hospitalization or over several months or years.
People may receive long term care services in an institutional setting such as a nursing home, or may be able to receive care in their own homes under one of the Home and Community Based (HCBS) Waivers.
Who is eligible for Medicaid Long Term Care Services?
You may be eligible for Medicaid coverage of Long Term Care (LTC) services, if you:
- Are a District Resident
- Are a US citizen or have eligible immigration status
- Have income equal to or less than 300% of the Supplemental Security Income (SSI) payment level (individuals eligible for SSI can receive long term care services, plus full Medicaid benefits)
- Have resources up to $4,000 for one person or $6,000 for a married couple. Resources include, but are not limited to: cash, bank accounts, stocks, bonds, trusts, annuities, property and life insurance. Resources do not include the value of your home, one vehicle and ordinary home and personal goods; and
- Meet the medical need criteria.
| Covered group | Who is included | Income limits | Asset limits | Eligibility period | Benefits |
|---|---|---|---|---|---|
| Supplemental Security Income (SSI) | Individuals who are receiving or eligible for SSI. | There is no income limit because SSI recipients are categorically eligible for Medicaid. | There is no asset limit because SSI recipients are categorically eligible for Medicaid. | One year. | Full Medicaid benefits. |
| Special Income Standard (SIS) | Individuals who are ineligible for SSI because their income is too high. | 300% of the SSI federal benefit rate ($2,829 in 2024) | $4,000 for one person or $6,000 for a married couple. | One year. | Medicaid coverage of long-term care services. |
| Spend Down | Individuals who are ineligible for coverage of their long-term care services under the Special Income Standard (SIS) because their income is too high and who have high medical expenses. | Medically Needy Income Level (MNIL) ($809.08 for individual and $851.67 for a married couple in 2024). Individuals qualify by deducting medical expenses from their grow countable income. | $4,000 for one person or $6,000 for a married couple. | Six months. Once the individual meets the spend-down obligation for the six month period, he or she will automatically be enrolled in Medicaid from the first day of the month in which the individual meets the spend-down obligation through the rest of the six month period. At the end of the six month period, the individual must file a new application for Medicaid to re-determine their eligibility and/or spend down obligation for the next six month period. | Full Medicaid benefits after the spend-down obligation is met. |