Medicaid Renewals / Redeterminations for Long Term Care: Frequency, Considerations & Process

Summary
After you or your loved one is enrolled in Medicaid Long Term Care, you must continue to meet the eligibility criteria in order to keep your Medicaid coverage. This is known as Medicaid Renewal,  In most cases, Medicaid Renewal happens once a year, but how it happens depends on the individual Medicaid beneficiary, their financial situation, and their state of residence. If you don’t complete the Medicaid Renewal process, or you are ruled ineligible during the process, you could have lapses in coverage or even lose your benefits.

What is Medicaid Long Term Care Renewal?

Medicaid Renewal is the annual process state governments use to make sure Medicaid beneficiaries in their state continue to meet the state’s Medicaid eligibility criteria. Medicaid is for people with limited financial means, and individuals need to meet an asset limit and an income limit in order to be eligible. So, if someone comes into money, property, or some other asset while they are enrolled in Medicaid, they could go over the asset limit and become ineligible. The same is true if they find a new source of income or if an exempt asset becomes countable while they are enrolled in Medicaid.

The Medicaid Renewal process also ensures that individuals have received and will continue to receive their benefits from any of the three Medicaid Long Term Care programs – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers, and Aged, Blind, and Disabled (ABD) Medicaid. ABD Medicaid can sometimes be referred to as regular Medicaid for Seniors, but this shouldn’t be confused with the regular Medicaid that is available to financially limited people of all ages.

Medicaid Renewal may also be referred to as Medicaid Redetermination or Recertification. All Medicaid Renewals were suspended during the COVID-19 Public Health Emergency as the federal government granted continuous enrollment, but the renewal process resumed in April 2023, and as of June 2024, all states and Medicaid programs have undergone the “unwinding” of their continuous enrollment.

What Factors are Considered During the Renewal Process?

During Medicaid Renewal, state officials will examine the beneficiary’s financial status to see if they still meet their income and asset limits for Medicaid eligibility, and to determine the value of their home, if applicable. They will also evaluate beneficiaries to ensure they still have a medical need for care. The state will do this electronically if possible. This is known as automatic renewal (or ex parte renewal) and requires little or no action from the beneficiary.

If a Medicaid beneficiary’s financial status cannot be checked automatically, they will get a letter and/or email with a Medicaid Renewal Form that must be completed, dated, signed and returned within 30 days to ensure continued coverage. The Renewal Form may be “pre-populated” with information the state has been able to gather about the beneficiary’s financial status. In some states, beneficiaries also have the option to complete the Renewal Form over the phone, online, or in person.

The types of financial holdings, documents, and limits the state will be examining during the Medicaid Renewal process can be broken down into the following categories – Income, Assets, Home Ownership:

Income

Almost all income is counted toward the Medicaid eligibility income limit – Social Security benefits, IRA payments, pension payments, wages, salary, alimony, property income, stock dividends, etc. The documents and records state officials might examine to determine income for Medicaid Renewal purposes include tax forms, SSI or VA benefit award letters, pension statements and alimony checks. In cases where there is no other written proof of income, a self-declaration letter may be enough.

In most states in 2025, the individual income limit for Nursing Home Medicaid and Home and Community Based Service (HCBS) Waivers is $2,901/month. That income limit does vary by state, and it varies even more when it comes to Aged, Blind and Disabled (ABD) Medicaid, which ranges from $967/month to about $1,800/month for an individual in 2025, depending on the state.

For married couples with both spouses receiving Nursing Home Medicaid or HCBS Waivers, the 2025 income limit in most states is $2,901/month per spouse (or $5,802/month combined). When only one spouse is a Medicaid beneficiary, the income of the non-beneficiary spouse (also called the community spouse) is not counted. For married couples with one or both spouses receiving ABD Medicaid, the 2025 income limit ranges from $1,450/month combined to about $2,600/month combined, depending on the state. To be clear, the income of the community spouse is counted when it comes to ABD Medicaid.

Use this income eligibility chart to find income limits by state, marital status and Medicaid Long Term Care program.

Assets

Assets that count against Medicaid’s eligibility asset limit include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash, second vehicles, second/vacation homes and any other financial holdings or property that can be easily converted to cash. A beneficiary’s primary home does not always count against the asset limit (details discussed below), and neither does their primary vehicle, or essential personal and household items like clothing, furniture and appliances.

For Medicaid Renewal purposes, the documents and records state officials might examine include statements from stocks, bonds, certificates of deposit, and savings, checking, retirement and money market accounts. Copies of life insurance policies may also be requested, since the cash surrender value of life insurance policies can also count as an asset for Medicaid eligibility.

In most states in 2025, the individual asset limit for all three types of Medicaid Long Term Care – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers, and Aged, Blind and Disabled Medicaid – is $2,000 and the asset limit for married couples with both spouses receiving benefits from any of the three programs is either $3,000 or $4,000. But this can vary greatly by state. In Illinois, for example, the asset limit for both individuals and married couples is $17,500. To find the asset limit in your state, click here.

For married couples with only one spouse who needs care, the asset limit rules change when it comes to Medicaid Renewals. When only one spouse applies for either Nursing Home Medicaid or HCBS Waivers, the assets of both spouses are counted. For Medicaid Renewals, however, the assets of the community spouse are not counted. This is the reason community spouses are encouraged to put all assets that may have been jointly owned in their own name after the application process is complete.  It should be noted that the non-applicant spouse is allowed to keep up to $157,920 of the couple’s assets during the application process, thanks to the Community Spouse Resource Allowance.

Home Ownership

If a person owns a home, it is usually their most valuable asset, and if it was counted for Medicaid Renewal purposes, that home would likely push them over the asset limit for eligibility. However, in many situations the home is not counted against the asset limit, but that often depends on the value of the home as measured by home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage / debt). So, if the value of a senior’s home has increased while they are enrolled in Medicaid, it may push the home above the home equity exempt limit in their state, which would make the senior ineligible.

If the Medicaid beneficiary lives in their home and the home equity interest is less than $730,000 or $1,097,000 (as of 2025 and depending on state) then the home will NOT be counted against the limit (also known as exempt). States with higher average property values use $1,097,00, while most states use $73o,000. If the beneficiary’s spouse, minor child, or blind or disabled child of any age lives in the home, it is exempt regardless of the beneficiary’s home equity interest, and regardless of where the beneficiary lives. If none of the above-mentioned people live in the home, the home can be exempt if the beneficiary files an “intent to return” home and the home equity interest is at or below $730,000 or $1,097,000, depending on the state.

It’s important to note that the rules regarding home equity amounts only apply to Nursing Home Medicaid and Home and Community Based Services (HCBS) Waivers beneficiaries. Value does not matter when it comes a home’s exempt status for Aged, Blind, and Disabled (ABD) Medicaid beneficiaries.

Care Requirements

In addition to meeting financial criteria, Medicaid Long Term Care beneficiaries also have to meet functional, or medical, criteria to qualify for certain programs. This medical criteria may also be reevaluated during the Medicaid Renewal process, but in general states are more focused on reassessing financial criteria. In most cases, seniors who have previously met the medical criteria will continue to meet it.

The following are some general guidelines to the medical criteria for the three types of Medicaid Long Term Care:

To qualify for Nursing Home Medicaid, a senior must require a Nursing Facility Level of Care, (NFLOC) which means they need the type of full-time care and supervision usually associated with a nursing home. Exactly how a NFLOC is defined and measured depends on the state, but in general they will evaluate the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), as well as any cognitive or behavioral issues. This will usually include an in-person assessment and communication with the applicant’s care providers. A diagnosis of Alzheimer’s disease or other dementias does not guarantee a NFLOC designation, although it can certainly impact the evaluation. For Medicaid Renewals, re-assessing this condition is often a formality since it is unlikely seniors who qualified in the first place will improve enough to no longer need this level of care.

To qualify for most HCBS Waivers, applicants must also require a Nursing Facility Level of Care (NFLOC). There are some states and programs, however, that only require applicants to be “at risk” of needing a NFLOC, or be unable to live independently without the services provided by the HCBS Waiver.

The only functional requirements to receive basic healthcare coverage – physician’s visits, prescription medication, emergency room visits and short-term hospital stays – through ABD Medicaid are being aged (65 or over), blind, or disabled. For ABD Medicaid applicants who require long-term care services and supports, they must show a functional need for those long-term care benefits, and the state will conduct an evaluation to see if that is the case. This need can be rexamined during Medicaid Renewal, especially for ABD Medicaid beneficiaries who are in good health otherwise.

How Often Do Medicaid Renewals Happen?

Medicaid Renewals happen once a year. Most often it will happen on the anniversary of the beneficiary’s initial enrollment date. That did change during the COVID-19 pandemic as renewals were put on hold and then returned at various times depending on the state, program, individual and other factors like vulnerability, potential ineligibility and time since last renewal.

Medicaid Renewals can happen more than once a year according to federal regulations, but it’s unlikely. Also, it’s important to note that Medicaid beneficiaries are required to report any changes in income or assets within 10-30 days of the change.

What Happens if Denied During a Medicaid Renewal?

Medicaid beneficiaries have 30 days to complete, date, sign, and submit their Renewal Forms. If they do not do this, their benefits and coverage will stop. This is also known as being disenrolled. If Medicaid beneficiaries are found to be no longer eligible after state officials have reviewed their Renewal Form, or if they are found to no longer be eligible during the renewal process, their benefits and coverage will also stop.

From the day of the stoppage, beneficiaries have another 90 days to submit or resubmit their Renewal Form. This gives them a chance to be re-enrolled in their Medicaid coverage without needing to reapply. If they do not submit or resubmit within 90 days, or if they are still found to be ineligible, they will lose their coverage and benefits and they will need to reapply for Medicaid.

In a worst-case scenario, disenrollment could mean the individual being evicted from a nursing home. Or, in another worst-case scenario, it could mean losing in-home long-term care services and supports if they are in an HCBS Waivers program, and then potentially being put on a waitlist after reapplying and before receiving the long-term care benefits they were relying on.

However, in most cases, seniors who come into extra income or assets while they are enrolled in any of the Medicaid Long Term Care programs can come to an arrangement with the state that will allow them to stay in their nursing home or keep their in-home long-term care benefits. For example, they could potentially avoid any lapse in coverage by using their newfound money to cover costs for the nursing home, long-term care benefits, or any other Medicaid-approved healthcare expenses they need, until they get back under the Medicaid financial limits. While this kind of strategy is possible, it’s also complicated and would most likely require assistance from a Medicaid planning professional.

How to Prepare for a Medicaid Renewal

The first step in preparing for Medicaid Renewal is making sure your local Medicaid offices have your proper street address and email address. This will ensure you receive your Medicaid Renewal Form or notification of your automatic renewal. This May 2023 KFF report says 33% of all Medicaid beneficiaries have not updated their contact information with their state Medicaid offices. That same report also states that 68 percent of Medicaid beneficiaries over the age of 65 will be going through the renewal process for the first time. So, if you’re in unfamiliar territory, you’re not alone.

To help prepare for Medicaid Renewal, you can also check your financial status against your state’s Medicaid criteria and see if you think you are still eligible. The easiest way to figure out your specific eligibility criteria is by using our Medicaid Long Term Care Eligibility Requirements Search Tool.

If you think you are going to be over the asset limit, you could start to spend those assets on Medicaid-approved healthcare goods and services in order to get below the limit before the renewal. It’s very important to strictly follow your state’s Medicaid guidelines during this “spend down” process, and implementing this strategy without the help of a Medicaid expert is not recommended. In fact, the majority (85%) of all Medicaid beneficiaries polled for the May 2023 KFF survey mentioned above said they would find it useful to have someone help them with the entire Medicaid renewal process.

If you think the state will not be able to conduct an automatic renewal for your case, you could start gathering some of the financial documents listed above. Gathering documents can be the most time-consuming part of the renewal process, so getting a head start can be a good idea.

Assistance Options to Help with Medicaid Renewals

If one’s financial situation and home ownership has not changed, and one still meets the Medicaid eligibility criteria, they can get free assistance from their Medicaid Case Managers. One might also find help from Public Benefits Counselors who work at Area Agencies on Aging, Aging and Disability Resource Centers, or even at state Medicaid offices.

However, if a senior has, for example, recently inherited money and no longer meets the Medicaid eligibility criteria, free assistance from a Public Benefits Counselor will not be available. Another example is when a home’s value or the residents of the home have changed. If this is your situation, you can get help with your Medicaid Renewal through a Certified Medicaid Planner.