Medicaid is a health care program for low-income individuals of all ages. While there are several different coverage groups, the focus here is long term care Medicaid eligibility for elderly Arkansas residents, aged 65 and over. In addition to care services in nursing homes, adult foster care homes / adult family homes, and assisted living facilities, AR Medicaid pays for non-medical services and supports to help frail seniors remain living at home. There are three categories of Medicaid long-term care programs for which Arkansas seniors may be eligible.
1) Institutional / Nursing Home Medicaid – An entitlement; anyone who is eligible will receive assistance. Care is provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; there are a limited number of participant slots and wait lists may exist. Intended to delay nursing home admissions, services are provided at home, adult day care, an adult family home, or in assisted living. More on Waivers.
3) Regular Medicaid / Aged Blind and Disabled (AABD) – An entitlement; anyone who meets the requirements is able to receive benefits. Various long-term care services, such as personal care assistance or adult day care, may be available.
Medicaid in Arkansas is also called Health Care. The Medicaid program is state and federally funded and is administered by the state under federally set parameters. The Arkansas Department of Human Services’ (DHS) Division of Medical Services (DMS) is the administering agency.
The American Council on Aging now offers a free, quick and easy Medicaid Eligibility Test for seniors.
Each of the 3 Medicaid long-term care programs have varying financial and medical eligibility criteria. Financial requirements change annually, vary depending on marital status, and is further complicated by the fact that Arkansas offers alternative pathways towards eligibility.
Simplified Eligibility Criteria: Single Nursing Home Applicant
AR seniors must have limited income and assets, and a medical need to qualify for Medicaid long-term care. In 2024, a single Nursing Home Medicaid applicant must meet the following criteria: 1) Income under $2,829 / month 2) Assets under $2,000 3) Require a Nursing Home Level of Care.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from an Arkansas Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the criteria does not mean one is ineligible or cannot become eligible for Medicaid. More.
| 2024 Arkansas Medicaid Long-Term Care Eligibility for Seniors | |||||||||
| Type of Medicaid | Single | Married (both spouses applying) | Married (one spouse applying) | ||||||
| Income Limit | Asset Limit | Level of Care Required | Income Limit | Asset Limit | Level of Care Required | Income Limit | Asset Limit | Level of Care Required | |
| Institutional / Nursing Home Medicaid | $2,829 / month* | $2,000 | Nursing Home | $2,829 / month per spouse* | $3,000 | Nursing Home | $2,829 / month for applicant* | $2,000 for applicant & $154,140 for non-applicant | Nursing Home |
| Medicaid Waivers / Home and Community Based Services | $2,829 / month† | $2,000 | Nursing Home | $2,829 / month per spouse† | $3,000 | Nursing Home | $2,829 / month for applicant† | $2,000 for applicant & $154,140 for non-applicant | Nursing Home |
| Regular Medicaid / Aged Blind and Disabled | $1,004 / month (eff. 4/1/24 – 3/31/25)‡ | $9,430 | Help with ADLs | $1,362.67 / month (eff. 4/1/24 – 3/31/25)‡ | $14,130 | Help with ADLs | $1,362.67 / month (eff. 4/1/24 – 3/31/25)‡ | $14,130 | Help with ADLs |
*All of a beneficiary’s monthly income, with the exception of a Personal Needs Allowance of $40 / month, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must be paid to the nursing home. This is called a Patient Liability.
†Based on one’s living setting, a program beneficiary may not be able keep monthly income up to this level.
‡The income and asset limits above are for ARSeniors, and to be clear, this pathway to Medicaid eligibility is only for seniors (aged 65+). Another pathway to Medicaid eligibility is via SSI. Persons who are eligible for SSI are automatically eligible for AR Medicaid. In 2024, the income limit for SSI is $943 / month for an individual and $1,415 / month for a couple. The asset limit is $2,000 for an individual and $3,000 for a couple.
Countable vs. Non-Countable Income
Nearly all income received is counted towards the income limit. This includes cash from family and friends, employment wages, alimony payments, pension payments, annuity payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in AR, the VA Aid and Attendance, which is above and beyond the Basic VA Pension, does not count as income.
Treatment of Income for a Couple
When only one spouse of a married couple applies for Nursing Home Medicaid or a Medicaid Waiver, the income of the non-applicant spouse is disregarded. Furthermore, the non-applicant spouse (also called a community spouse) is entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse. The MMMNA is the minimum amount of monthly income a non-applicant spouse is said to require to avoid impoverishment.
Effective 7/1/24 – 6/30/25, the MMMNA is $2,555. If a non-applicant’s income is under $2,555 / month, income can be transferred to them from their applicant spouse, bringing their income up to this level. In Arkansas, a non-applicant spouse can further increase their Spousal Income Allowance if their housing and utility costs exceed a “shelter standard” of $766.50 / month (eff. 7/1/24 – 6/30/25). However, in 2024, a Spousal Income Allowance cannot push a non-applicant’s monthly income over $3,853.50. This is the Maximum Monthly Maintenance Needs Allowance. More on how this allowance is calculated.
In addition to providing spousal support, the Monthly Maintenance Needs Allowance is effective in lowering the applicant’s countable income for eligibility purposes.
Income is counted differently when only one spouse applies for Regular Medicaid / Aged Blind and Disabled; the income of both the applicant and non-applicant spouse is calculated towards the applicant’s income eligibility. There is no Minimum Monthly Maintenance Needs Allowance for the non-applicant spouse. More on how Medicaid counts income.
Seniors who are eligible for SSI are automatically eligible for Arkansas Medicaid.Countable vs. Non-Countable Assets
Countable assets are calculated towards Medicaid’s asset limit. These non-exempt assets include cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), pension funds, and real estate in which one does not reside. In Arkansas, IRA’s and 401K’s are also counted. There are also many assets that are non-countable; they are exempt from the asset limit. This includes personal belongings, household goods / furnishings, an automobile, life insurance policies without a cash surrender value, burial spaces, irrevocable burial plans, and generally one’s primary home.
Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This remains true regardless of the long-term care Medicaid program for which one or both spouses is applying. There is, however, a Community Spouse Resource Allowance (CSRA) that protects a larger amount of a couple’s assets for a non-applicant spouse of a Nursing Home Medicaid or Medicaid Waiver applicant. This is intended to prevent a non-applicant spouse from becoming impoverished, and in 2024, allows that spouse to keep 50% of the couple’s assets, up to a maximum of $154,140. If 50% of the couple’s assets falls under $30,828, the non-applicant spouse can keep all of their assets up to $30,828.
Medicaid’s Look-Back Rule
Arkansas has a 60-month Medicaid Look-Back Period for Nursing Home Medicaid and Medicaid Waivers that immediately precedes the date of application. During the “look-back”, Medicaid checks all asset transfers to ensure none were sold or gifted under fair market value. This includes asset transfers made by one’s spouse. The Look-Back Rule is meant to discourage persons from gifting assets to meet Medicaid’s asset limit. Violations are penalized with a Penalty Period of Medicaid ineligibility. The Look-Back Rule does not apply to those applying for Regular Medicaid.
Persons sometimes mistakenly think that the U.S. Federal Gift Tax Rule extends to Medicaid eligibility. This rule, in 2024, allows individuals to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s 5-year Look-Back Period.
For the home to be exempt, the Medicaid applicant or their spouse must live in it. If there is no spouse in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of the home’s equity that is owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live there, the applicant must have “Intent to Return”. For single seniors applying for Regular Medicaid, there is no home equity interest limit. Other exemptions exist.
While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program (MERP). Following the death of a long-term care Medicaid beneficiary, AR’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.
An applicant must have a medical need for long-term care Medicaid. For Nursing Home Medicaid and Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Furthermore, there may be additional eligibility requirements for specific program benefits. As an example, for a Medicaid Waiver to cover the cost of home modifications, it may be required that one be unable to safely live independently without modifications. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living is required, but a NFLOC is not necessarily required.
Elderly AR residents (aged 65 and over) who do not meet the eligibility requirements above, can still qualify for Medicaid.
1) Medically Needy Pathway – Arkansas has a Spend Down Program for Regular Medicaid / Aged, Blind or Disabled for persons who have income over the Medicaid income limit. This program allows persons to become income-eligible for Medicaid services by spending the majority of their income on medical bills. In 2024, the Medically Needy Income Limit in AR is $108.33 / month for a single applicant and $216.66 / month for a couple. The “spend down” amount is the difference between one’s monthly income and the Medically Needy Income Limit. In AR, it is calculated for a 3-month period. Once the “spend down” is met, one is Medicaid eligible for the remainder of the period. The Medically Needy Asset Limit is $2,000 for an individual and $3,000 for a couple.
2) Qualified Income Trusts (QIT’s) – Also called Miller Income Trusts (MIT’s), these trusts allow Nursing Home Medicaid and Medicaid Waiver applicants with income over Medicaid’s limit to still become income-eligible. Monthly income put into an irrevocable QIT is not counted as income by AR Medicaid. Irrevocable means the terms of the trust cannot be changed or cancelled. Overly simplified, a trustee has legal control of the trust funds, which can only be used for very specific purposes. An example includes paying medical expenses accrued by the Medicaid enrollee.
3) Asset Spend Down – Persons who have countable assets over AR Medicaid’s asset limit can “spend down” assets to meet the limit. This is done by spending “excess” assets on non-countable ones. Examples include making home modifications (i.e., addition of wheelchair ramps, stair lifts, walk-in showers), prepaying funeral and burial expenses, and paying off debt. Remember, assets cannot be gifted or sold under fair market value. Doing so violates the Look-Back Rule and causes a Penalty Period of Medicaid ineligibility. It is recommended one keep documentation of how assets were spent as proof this rule was not violated.
Our Spend Down Calculator can assist persons in determining if they might have a spend down, and if so, provide an estimate of the amount.
4) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid Planning Professional, families can employ a variety of strategies to not only become Medicaid eligible, but also to protect their home from Medicaid’s Estate Recovery Program. Connect with a Medicaid Planner.
1) AR Choices in Homecare Waiver – Supportive services and goods for independent living are provided for seniors and adults with physical disabilities. This may include adult day care, meal delivery, home modifications, personal emergency response systems, and attendant care services. Program participants can receive a cash allowance with which to self-direct their own care via a program option called Independent Choices (IC). This allows one to hire the caregiver of their choosing, including select relatives.
2) Living Choices Assisted Living Waiver (ALW) – While this program does not cover the cost of room and board in assisted living facilities, it does pay for personal care services. Other benefits may include medication oversight, non-medical transportation, and nursing evaluations.
3) Medicaid State Plan Personal Care – Assistance with daily living activities is provided. This includes bathing, dressing / undressing, grooming, eating, meal preparation, housekeeping, and grocery shopping. Care can be participant-directed via a cash allowance through the Independent Choices option. This allows persons to hire the caregiver of their choice. Program participants may live at home, an assisted living facility, or a residential care facility.
4) Program of All-Inclusive Care for the Elderly (PACE) – Combines the benefits of Medicaid, including long-term care, and Medicare into a single program.
5) Money Follows the Person (MFP) – This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.
For more information, or to apply for any of the Medicaid programs listed above, persons should contact their local Department of Human Services (DHS) Office or the state DHS office at 501-682-1001. Alternatively, persons can apply online at Access Arkansas or complete a paper application. One’s local Area Agency on Aging office may be helpful in answering questions or offering application assistance. The application process may vary based on the program for which one is applying.
Arkansas Medicaid applicants should be certain that all eligibility requirements are met prior to applying for benefits. For seniors who have income and / or asset(s) greater than the allowable amounts, Medicaid planning can be invaluable. Furthermore, the application process is complicated and assistance with the process may be welcomed. Familiarizing oneself with general information about applying for long-term care Medicaid can be helpful.