For a senior (65+ years old) to be Medicaid-eligible, their monthly income must be under Medicaid’s income limit. The exact limit is based on the state and long-term care Medicaid program for which one is applying. See state and program-specific income limits. Not all of an applicant’s income, however, is counted towards the income limit. Rather, Medicaid utilizes income disregards, exclusions, and deductions, which allows some of an applicant’s income to be “uncountable”. This means this portion of one’s income is not used in determining their income eligibility. This allows some elderly applicants who would otherwise not be income-eligible, to meet Medicaid’s income limit.
The topic of Medicaid income disregards, exclusions, and deductions is complicated. The rules governing them are not consistent across the states, nor are they consistent across all long-term care Medicaid programs within a given state. This article serves to bring awareness to the topic and the potential of becoming income-eligible in this manner. Common income disregards, exclusions, and deductions are discussed below, as well as some state variances.
Prior to beginning a discussion of income exclusions, disregards, and deductions, it is important to understand what Medicaid considers to be income. There are two types of income: earned income and unearned income.
Earned income includes wages, net earnings from self-employment, royalties earned in connection with one’s publication of work, and sheltered workshop payments.
Unearned income is essentially any income that is not earned from working. This includes alimony and spousal support payments, net rental income, annuities, pensions, Social Security benefits, cash from loved ones, interest income, State disability payments, and unemployment benefits.
Income disregards, exclusions, and deductions allow some of an elderly individual’s income to be “uncountable”. This means it is not counted towards Medicaid’s income limit.
The terms “income disregard”, “income exclusion”, and “income deduction” essentially all mean the same thing, and therefore, within this article, these terms are used interchangeably. Regardless of which term is used, it is income that is not counted towards Medicaid’s income limit. In other words, it is “disregarded”, “excluded”, or “deducted”. The way income disregards work is one’s gross income (income before taxes) is added up, and from this amount, any disregards are subtracted. The remaining amount of income, referred to as “countable income”, is what is used to determine if one meets the income limit. Therefore, one could have income over Medicaid’s income limit and still be income-eligible after income exclusions.
For seniors and persons who are disabled, most states use federal Supplemental Security Income (SSI) rules to determine if a Medicaid applicant is income-eligible. This includes the rule that not all of one’s income counts in determining their income eligibility; part of their income is “disregarded”. The three income exclusions covered below are the most commonly utilized income exclusions when establishing Medicaid income eligibility. To be clear, these income disregards are not necessarily applied in all states, nor are they applied for all long-term care Medicaid programs within any given state. As an example, some states do not apply them for persons applying for Nursing Home Medicaid, but do apply them for Medicaid Home and Community Based Services.
This is sometimes called an unearned income deduction. This is because if a Medicaid applicant has unearned income, $20 is deducted from this type of income. If they do not have unearned income, or receive less than $20 / month in unearned income, $20, or the remaining amount to reach $20, is deducted from their earned income. To be clear, unearned income can never be reduced to less than $0. Regardless of if the $20 deduction is applied to unearned income or earned income, $20 is subtracted from an applicant’s countable income. In most cases, this deduction applies to both single applicants and married couples. This means a married couple only receives one $20 deduction for their combined income.
While most states utilize the $20 general income deduction, some states use a more generous figure, and others, a more restrictive figure. For instance, in 2024 Illinois has a $25 general income deduction, and New Hampshire has a general income disregard of $13. Some states may also use varying general income deductions based on the specific Medicaid program for which one is applying. For instance, for some Medicaid programs in Mississippi, a $20 general income deduction is used, and for others, a more liberal deduction of $50 is applied.
Examples:Roy has $650 / month in unearned income. After the $20 general income deduction, he has $630 / month in countable income.
Caroline receives $10 / month in unearned income and $342 / month in earned income. The entire $10 in unearned income is disregarded and $10 of the $342 / month in earned income is disregarded. This leaves Caroline with $332 / month in countable income.
This earned income deduction allows a Medicaid applicant to deduct $65 from their earned income, plus half of any remaining earned income, from their countable income. This deduction is applied after the $20 general income deduction. The earned income deduction generally applies to both single applicants and married couples. Clarified, a married couple only receives one earned income deduction for their combined income.
Examples:Joann has $1,350 / month in earned income. A $20 general income deduction is applied, leaving her $1,330 in earned income. From, this amount, the $65 earned income deduction is applied, leaving her $1,265. Half of the remaining earned income is $632.50, which means Joann has $632.50 of countable income.
Ralph has $80 / month in unearned income and $450 / month in earned income. The $20 general income deduction is applied to his $80 of unearned income. This leaves him $60 in unearned income. From the $450 of earned income, $65 is subtracted for the earned income deduction. This leaves Ralph $385 in earned income. Half of this amount, which is $192.50, is subtracted from $385, leaving him a remaining $192.50 in earned income. This $192 of earned income combined with the $60 in unearned income gives him $252.50 in countable income.
Some income, such as the VA Aid and Attendance Allowance (A&A Pension) and VA Housebound Alowance, is prohibited by federal law from being counted towards Medicaid income eligibility. These pensions provide a monthly cash benefit for wartime veterans and their surviving spouses to help cover the cost of their long-term care. They are an “add on” cash benefit to the Basic Veterans Pension / Basic Survivors Pension cash benefit. Put differently, there is a cash amount for the Basic Pension, and for those who qualify for the A&A Pension or Housebound Pension, there is an additional cash allowance. Some states disregard both the basic VA pension amount and the A&A or Housebound amount, while other states disregard only the A&A or Housebound portion of the cash benefit. As examples, New York and Wisconsin only disregard the A&A or Housebound allowance portion.
Any income that is excluded under other federal laws should be deducted from one’s countable income prior to applying any other income deductions.
In addition to the common income disregards mentioned above, a state may allow for additional disregards based on the Medicaid program for which one is applying. As mentioned previously, the topic of income disregards, exclusions, and deductions is complicated. Therefore, it is difficult to cover it in specific detail for each state and long-term care Medicaid program. To learn about income disregards in one’s state of residence, one should contact their state Medicaid agency.