Application Process for Aged, Blind or Disabled (ABD) Medicaid

Summary
Aged, Blind, and Disabled (ABD) Medicaid can provide long-term care benefits to seniors who show a medical need for those benefits and have limited financial resources. During the application process, seniors must prove they meet Medicaid’s financial limits by submitting the proper documents. ABD Medicaid applicants who need long-term care benefits may also be assessed to see if they meet the medical criteria for those benefits.

Last Updated: Mar 28, 2024

Step 1: Find Long Term Care Benefits Step 2: Medical Eligibility Step 3: Financial Eligibility & Documents Step 4: Pick Your Path Step 5: Alternative Pathways to Eligibility Step 6: Complete Your Application Step 7: Submit and Wait for Approval

Step 1: Find and Select Available Long Term Care Benefits in Your State

The long-term care services and supports available through Aged, Blind, and Disabled (ABD) Medicaid vary by state. So, the first step in the application process is researching what long-term care benefits are available in your state, what their medical eligibility requirements are and if they will be a fit for your situation. A good place to start is our 50-State Guide, which outlines the ABD Medicaid programs in every state. We also recommend checking with your state Medicaid offices or consulting with a professional, like a Certified Medicaid Planner or Elder Law Attorney, who will know what ABD Medicaid long-term care benefits are available in your state.

Medicaid is not Medicare – Both are government-run health insurance programs, but Medicare is for all Americans 65 and older while Medicaid is for Americans with limited financial means. Often, however, Medicaid and Medicare can be combined to cover healthcare costs for applicants who are eligible for both.

Step 2: Assess Medical Eligibility

After researching the ABD Medicaid long-term care benefits available in your state, you need to determine if you meet the medical (also called functional) eligibility requirements for those benefits. Often the requirements will be related to the applicant’s ability to independently complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Asking your physician, and other relevant healthcare providers, if you meet the medical requirements is recommended. Chances are the state will consult with them to see if you meet the requirements as your application is being reviewed.

If you meet the medical criteria for the available ABD Medicaid long-term care benefits, move on to Step 3 below. If you don’t meet the medical criteria for the long-term care benefits, you can still qualify for basic healthcare coverage through ABD Medicaid, so you can also move on to Step 3 and then re-apply for the long-term care benefits when your medical condition changes and you will qualify for them.

Step 3: Assess Financial Eligibility and Gather Documents

To know if you’re financially eligible for ABD Medicaid you’ll first need to find the specific asset limit and income limit for your situation. In most states in 2024, the asset limits for ABD Medicaid are $2,000 for an individual and a combined $3,000 for a married couple. The income limits have a greater variance and are between $943/month and $1,751/month for an individual in most states in 2024, and between $1,415/month and $2,593/month combined for a married couple.

To figure out the exact financial criteria for your specific situation, use our Medicaid Eligibility Requirements Finder by clicking here.

After you’ve found your exact limits, you’ll need to see if you meet them by adding up your countable resources. Most assets will count toward the asset limit – bank accounts, retirement accounts, stocks, bonds and cash. But some assets are exempt, meaning they won’t be counted toward the limit, such as personal items like wedding rings, clothes, household furniture and appliances, and, in most cases, the applicant’s home. There are fewer exemptions for income. Almost all of your income will be counted, including Social Security benefits, pension payments, wages, alimony, property income and retirement account payouts. COVID-19 stimulus checks and Holocaust restitution payments are among the only income sources not counted toward Medicaid’s income limit.

As applicants are adding up their assets and income, they should also be gathering documents that detail these financial resources. The burden of proof is on the applicant to show the state they meet the financial limits and the applicant must do this with official documents. These documents can include:

Bank records
Retirement account statements
Life insurance policies
Final statements for all closed financial accounts
Deeds for all homes and land owned by the applicant
Titles to vehicles owned by the applicant
Benefit letters for Social Security, Supplemental Security Income (SSI), disability payments, etc.
Pension statements
Alimony checks
Dividend checks
Income tax return
Up-to-date pay stubs

Check It Out: For a longer list of the documents you might need when applying for ABD Medicaid, go to our Medicaid Long Term Care Application Documents Checklist by clicking here.

Step 4: Pick Your Path

If you believe you are financially eligible for ABD Medicaid, go to Step 6: Complete Your Application.

If you believe you are over the financial limits, there are still ways you can qualify for ABD Medicaid, so go to Step 5: Alternative Pathways to Eligibility.

Step 5: Alternative Pathways to Medicaid Eligibility

Even if your resources exceed the financial limits for ABD Medicaid, there are still methods you can use to help you become eligible. These strategies can be complicated, as are Medicaid’s rules, so it’s recommended that you consult with a professional like a Certified Medicaid Planner or an Elder Law Attorney before attempting to use any of the strategies on your own.

Strategies for Excess Income
If your income is above the income limit, your options for reducing it to become eligible depend on the state where you live. Some states offer a Medically Needy Pathway to eligibility, which allows Medicaid applicants and beneficiaries to spend their excess monthly income on medical expenses to reduce their income and become eligible. In states that don’t offer the Medically Needy Pathway, Medicaid applicants and beneficiaries can put their excess income into a Qualified Income Trust to become eligible.

Strategies for Excess Assets
If your asset total is above the limit, there are multiple options you can use to get below the limit. Click on any of the items in the list below to learn more about them:

Spend Down – This is a common strategy to reduce assets that involves applicants spending money on themselves or their spouses. They can spend on almost anything, as long as it’s not for someone else.

Medicaid Compliant Annuities – These financial products will turn a lump sum of cash into a monthly income stream. The lump sum of cash will no longer be counted toward the asset limit, but the income stream will count toward the income limit.

Medicaid Asset Protection Trusts – Any assets placed in a Medicaid Asset Protection Trust will be protected from the asset limit. These trusts are expensive to create, so they’re not especially helpful for anyone with less than around $100,000 in assets. They also violate the Look-Back Period, which doesn’t apply to ABD Medicaid, but it does apply to the other types of Medicaid Long Term Care and ABD Medicaid applicants may eventually need that type of care.

Irrevocable Funeral Trusts – These trusts will pay for funeral and burial expenses after a senior dies. The value of Irrevocable Funeral Trusts will not count up to a certain limit, which is $15,000 in most states.

Step 6: Complete Your ABD Medicaid Application

There are many types of Medicaid and applications to go with them, so the first part of this step is finding the ABD Medicaid application. You should know that some states have different names for ABD Medicaid, such as Aged & Disabled (AD) or Elderly, Blind and Disabled (EBD), or state-specific names like MassHealth in Massachusetts and Medi-Cal in California.

You’ll also need to indicate what long-term care benefits you need. You might be able to do this on the general ABD Medicaid application, or you might need an additional application or form.

The application can be digital and completed and submitted online, or it can be paper and submitted in person or by mail. To find the right application form(s) for ABD Medicaid and its available long-term care benefits in your state, you can reach out to your local Medicaid office by using the “Contact Your State Medicaid Agency” tool on this official Medicaid.gov webpage.

Before you complete the application, you should have someone else check your calculations concerning your financial eligibility. It’s easy to make mistakes on a Medicaid Long Term Care application, which will probably result in a denial, and applying correctly the first time is less time-consuming than appealing a denial. Your local Area Agency on Aging may have staff that will check your calculations, the state Medicaid office might offer this service, or you can contact a professional like a Certified Medicaid Planner or an Elder Law Attorney.

Step 7: Submit Your ABD Medicaid Application and Wait for Approval

Seniors can submit their ABD Medicaid application in person, by mail or online. Most applicants are advised to apply online at their state’s Medicaid website if they can, because online applications are processed faster than those submitted in person or through the mail.

By law, Medicaid state offices are supposed to approve or deny an application within 90 days. However, extensions are often granted and it can take longer than 90 days. The time between submitting an application and getting approved or denied is known as “Medicaid Pending.” Some caregivers may be willing to provide services and supports to seniors who have Medicaid Pending status without getting paid immediately. These caregivers are assuming that the senior will be approved for Medicaid and the state will retroactively pay for the services and supports once the senior is approved, which is what happens with Medicaid Pending. However, if the senior is denied ABD Medicaid, they will be responsible for paying for whatever care they received.