Medicaid Eligibility for Nursing Home Residents Updated to Account for Inflationary Costs

Nursing home residents that receive Medicaid benefits may be affected by a change in federal poverty level standards, which are applied to eligibility requirements.

To match inflationary costs, the Centers for Medicare & Medicaid Services (CMS) on Friday announced a 2.9% increase in price between 2023 and 2024. With the exception of Alaska and Hawaii, the one-person family/household poverty guideline for 2025 is $15,650 and the two-person family-household is $21,150.

In 2024, the one-person family/household poverty guideline was $15,060 while the two-person family-household was $20,440, for comparison.

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“The Federal Poverty Level standards, updated at least annually, result in changes to eligibility for assistance programs such as Medicaid and CHIP,” Health Dimensions Group (HDG) CEO Erin Schvetzoff Hennessey said in an email to Skilled Nursing News. “The changes to the poverty level standards impact qualifications for health care coverage or benefits, which may make it easier for [nursing home] beneficiaries to access necessary care.”

For dually eligible nursing home residents, asset limits aren’t derived from the poverty guidelines but instead are based on a statutory formula within the Social Security Act, along with new standards displayed in the Medicare Savings Program categories, CMS said in a memo.

The agency broke down dual eligible monthly income limits into four sections outlined in the below paragraphs and each with a different calculation formula.

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Dual eligible standards for 2025, again excluding Alaska and Hawaii, include a qualified Medicare beneficiary income monthly limit of $1,325 for individuals and $1,783 for couples. Monthly income limits for specified low-income Medicare beneficiaries is $1,585 and $2,135 for couples.

Qualified individuals’ monthly income limit is $1,781 while qualified disabled working individuals’ monthly income limits is $5,302.

About two-thirds of nursing home residents are Medicaid beneficiaries, according to CMS. More than 80% of residents are dually eligible for both Medicaid and Medicare, Health Affairs found as of September 2024, meaning nearly 1 million people who live in skilled nursing facilities have this status.

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