Minnesota Medicaid (Medical Assistance) Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. In Minnesota, Medicaid is also called Medical Assistance. This article focuses on Minnesota Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers and ABD Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.

Last Updated: Dec 30, 2023

Minnesota Medicaid Long Term Care Programs Nursing Home Care Care at Home via HCBS Waivers Care at Home via ABD Medicaid Eligibility Criteria Nursing Homes HCBS Waivers ABD Medicaid How Medicaid Treats the Home Applying Choosing a Nursing Home

Minnesota Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Minnesota Medicaid, or Medical Assistance, will cover the cost of long-term care in a nursing home for financially limited Minnesota seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
Skilled nursing care
Physician’s visits
Prescription medication
Medication management
Mental health counseling
Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Minnesota Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover nursing home costs. They are allowed to keep a “personal needs allowance” (PNA) of $121/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Minnesota Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

A Nursing Home Alternative – Nursing Home Medicaid beneficiaries in Minnesota who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through the Moving Home Minnesota program. This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. Moving Home Minnesota beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents. Moving Home Minnesota is part of Medicaid’s Money Follows the Person program.

Home and Community Based Services (HCBS) Waivers

Minnesota Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help Minnesota Medical Assistance (Minnesota Medicaid) recipients who require a Nursing Facility Level of Care remain living “in the community” instead of moving to a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Minnesota residents who live in their own home, the home of a loved one, an adult foster care home or an assisted living residence. While HCBS Waivers can pay for some long-term care services in those settings, they will not cover room and board costs such as mortgage payments, rent, utilities bills, facility fees or food expenses.

The HCBS Waiver relevant to Minnesota seniors is the Elderly Waiver.

Elderly Waiver
Minnesota’s Elderly Waiver (EW) provides long-term care benefits to financially limited Minnesota seniors who require a Nursing Facility Level of Care but live in their own home, the home of a loved one, an adult foster care home or an assisted living residence. Minnesota determines if EW applicants require a Nursing Facility Level of Care by testing their ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (these include shopping, cooking, housekeeping and medication management).

EW benefits include adult day care, meal delivery, home and vehicle modifications, housekeeping assistance, skilled nursing visits and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Minnesota Medical Assistance can assign licensed caregivers to provide these services, but EW program beneficiaries also have the option to self-direct some of their benefits using the Consumer Directed Community Supports option. This allows the EW beneficiary to choose their own caregivers, including spouses and other family members.

Unlike Nursing Home Medicaid, the EW is not an entitlement. Instead, there are a limited number of enrollment spots The EW has a limited number of enrollment spots (38,800 per year as of 2023). Once those spots are full, additional eligible applicants will be placed on a waitlist.

Aged, Blind, and Disabled (ABD) Medicaid

Minnesota’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care services and supports to financially limited Minnesota residents who are aged (65 and over), blind or disabled. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the beneficiary’s region.

Minnesota ABD Medicaid beneficiaries who show a medical need for long-term care benefits can receive some of those benefits through the following programs: Minnesota Senior Health Options (MSHO), Minnesota Senior Care+ (MSC+) and Personal Care Assistance (PCA).

Minnesota Senior Health Options (MSHO) and Minnesota Senior Care Plus (MSC+)
Both of these programs will coordinate healthcare coverage and long-term care services and supports for Minnesota seniors who live in the community. The main difference between the two programs is that Minnesota Senior Health Options (MSHO) also coordinates Medicare benefits for individuals who are dual eligible (eligible for both Medicaid and Medicare). Minnesota Senior Care+ (MSC+) does not incorporate Medicare benefits into its plan, although dual eligible people can still use MSC+, they just continue to receive their Medicare benefits through Medicare.

MSHO and MSC+ long-term care benefits include care coordination, home health care, durable medical equipment, transportation and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These benefits are made available depending on the functional needs and circumstances of each individual. Program participants have the option to self-direct some of these benefits by hiring caregivers of their choice, including family members and spouses.

Both MSHO and MSC+ are entitlement programs, which means all eligible applicants are guaranteed by law to be admitted. Program participants will receive care coordination without wait, but there may be a waitlist for some of the long-term care services because they are administered by other state programs with limited funds or enrollment spots.

Personal Care Assistance (PCA)
Minnesota ABD Medicaid beneficiaries who need help with at least one Activity of Daily Living (mobility, bathing, dressing, eating, toileting) or exhibit a qualifying behavior can receive long-term care services and supports in their home or the home of a loved one through the Personal Care Assistance (PCA) program. A qualifying behavior is one that puts the individual, another person, or property in danger. This might include wandering for applicants with Alzheimer’s disease or other related dementias, although having Alzheimer’s or dementia is not an automatic qualifier for this program.

PCA benefits include behavior observation and correction, medication assistance and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). The PCA program can assign licensed caregivers to provide these benefits, but the PCA program participant also has the option of self-directing their care by hiring a caregiver of their choosing, including friends and relatives, although spouses can not be hired. However, Minnesota is in the process of changing PCA to the Community First Services and Supports (CFSS) program, and when that happens, spouses will be allowed to be hired as caregivers. CFSS will also offer consultation services, home modifications and assistive technology as benefits, but otherwise it will look just like the PCA program.

The PCA program is an entitlement, which means that all eligible applicants are guaranteed by law to receive benefits. The CFSS program will also be an entitlement program.

Eligibility Criteria For Minnesota Medicaid Long Term Care Programs

To be eligible for Minnesota Medical Assistance (Minnesota Medicaid), a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

Just For You: The easiest way to find the most current Minnesota Medical Assistance (Minnesota Medicaid) eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

Minnesota Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Minnesota residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Minnesota Medical Assistance (Minnesota Medicaid). The asset limit for a single applicant from July 2023 to June 2024 is $3,000, which means they must have $3,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The income limit for Minnesota Nursing Home Medicaid for a single applicant from July 2023 to June 2024 is $1,215/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Minnesota Nursing Home Medicaid recipients are required to give most of their income to the state to help cover the cost of care. They are only allowed to keep $121/month of their income as a “personal needs allowance,” plus enough to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy spouses who are not covered by Medicaid.

For married applicants with both spouses applying, the asset limit for nursing home coverage through Minnesota Medical Assistance from July 2023 to June 2024 is a combined $6,000, and the income limit is a combined $1,644/month. For a married applicant with just one spouse applying, the asset limit is $3,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $1,215/month for the applicant spouse, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for Minnesota Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Minnesota has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Minnesota Nursing Home Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. To determine if the Nursing Facility Level of Care requirement is met for Medicaid purposes, Minnesota tests an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (these include shopping, cooking, housekeeping and medication management).

Minnesota Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
Minnesota residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2024, the asset limit for HCBS Waivers in Minnesota is $3,000, which means they must have $3,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Minnesota is a combined $6,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $3,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant spouse and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for Minnesota HCBS Waiver applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Minnesota has a Look-Back Period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers through Minnesota Medical Assistance (Minnesota Medicaid) is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. To determine if the Nursing Facility Level of Care requirement is for Medicaid purposes, Minnesota tests an applicants ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (these include shopping, cooking, housekeeping and medication management).

Minnesota Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
Minnesota residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid through Minnesota Medical Assistance. The asset limit for a single applicant from July 2023 to June 2024 is $3,000, which means they must have $3,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The income limit for Minnesota ABD Medicaid for a single applicant from July 2023 to June 2024 is $1,215/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants, the asset limit for Minnesota ABD Medicaid from July 2023 to June 2024 is a combined $6,000, and the income limit is a combined $1,644/month. These limits apply to married couples with both spouses applying and married couples with just one spouse applying.

Plan Ahead: There are alternative pathways to eligibility for Minnesota ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Minnesota has a Look-Back Period of five years for Nursing Home Medicaid and Home and Community Based Services Waivers applicants to make sure they don’t give away their assets to get under the limit, there is no Look-Back Period for ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirement to receive basic healthcare coverage through Minnesota ABD Medicaid is being aged (65 and over), blind or disabled. For ABD Medicaid applicants and beneficiaries who require long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management) to determine the kind of long-term care benefits the state will cover.

How Minnesota Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Minnesota Medicaid Long Term Care applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Minnesota and how you can protect your home from it, click here.

Applying For Minnesota Medicaid Long Term Care Programs

The first step in applying for Minnesota Medical Assistance (Minnesota Medicaid) Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Minnesota Medical Assistance when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Minnesota Medical Assistance applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Minnesota residents can apply for Minnesota Medical Assistance online at MNsure. They can also call the Minnesota Health Care Programs Member Help Desk at 1-800-657-3739 or 1-651-431-2670 to request an application, or they can download an application here. They can also apply in person at their local county office or tribal human services office.

For step-by-step guides to applying for each of the three types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

Choosing a Minnesota Medicaid Nursing Home

After being approved for nursing home coverage through Minnesota Medical Assistance (Minnesota Medicaid), a senior has to decide which Medicaid-accepting nursing home best fits their circumstances. Even though Medicaid nursing home coverage is an entitlement, not all nursing homes accept Medicaid, and those that do might not have any available beds. Finding the right facility can be difficult, especially if you’re looking in specific locations.

Minnesota has roughly 350 nursing homes, and most of them accept Medicaid. There are about 65 nursing homes that take Medicaid within 10 miles of Minneapolis/St. Paul, but that number jumps to around 100 facilities within 25 miles of the twin cities. Plus, there are another dozen or so nursing homes in St. Cloud. The choices thin quickly in the northern part of the state with just three nursing homes within 25 miles of Brainerd. There’s not much more in the western half, either, with only four nursing homes within 25 miles of Marshall.

Residents in some Minnesota communities may regularly cross the state line for personal or business reasons, including healthcare. Medicaid coverage, however, does not cross state lines. So, someone with Minnesota Medical Assistance would not be covered for nursing home stays in Fargo, North Dakota, or La Crosse, Wisconsin, even if facilities in those places are well-suited and convenient for the Minnesota Medicaid beneficiary.

TOOLS: To find and compare nursing homes, Minnesota residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country. They can also use this Minnesota Department of Health search tool.

When you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can be a great source of information. You can also contact your local Area Agency on Aging to find out more information about nursing homes in the state.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? How does it help residents with vision and dental care? Who are the staff doctors? What is the food like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

Data collected by CMS during a three-year period from 2019-2022 shows the nursing homes in Minnesota are on par with national averages in most areas. This includes health conditions, fire safety and resident-to-staff ratios.