What is Missouri Medicaid for Long-Term Care?

Missouri’s Medicaid program, called MO HealthNet, provides medical coverage for residents with limited income and resources. For individuals aged 65 and older, it helps pay for long-term care services such as nursing home care, assisted living, and in-home support that allows seniors to remain in their communities. There are three primary Medicaid long-term care categories available to Missouri seniors.

What is Institutional or Nursing Home Medicaid?

This program is an entitlement, meaning that all eligible applicants are guaranteed coverage. Benefits are only provided in Medicaid-approved nursing facilities.

What Are Medicaid Waivers or Home and Community Based Services (HCBS)?

These programs are not entitlements, meaning participation may be limited by available slots or waiting lists. HCBS services aim to delay nursing home placement by providing supports such as personal care, homemaker services, and adult day care in a home or community setting.

What is Regular Medicaid (MO HealthNet for the Aged, Blind, and Disabled)?

This program is also an entitlement. Eligible seniors may receive long-term care assistance like personal care or adult day health services to help with daily living needs.

Who Oversees Missouri’s Medicaid Program?

MO HealthNet is jointly funded by the federal and state governments but administered by the Missouri Department of Social Services under federal guidelines.

What Are the 2025 Financial Eligibility Rules for Missouri Long-Term Care Medicaid?

What Are the Basic Requirements for a Single Applicant?

As of 2025, a single applicant for Nursing Home Medicaid in Missouri must meet the following conditions:

• All available income (with a few exceptions) must go toward nursing home costs
• Countable assets must be under $6,068.80
• The applicant must require a Nursing Home Level of Care

What Are the Income and Asset Limits by Program Type and Marital Status?

*Except for a $50 personal needs allowance, Medicare premiums, and possibly a spouse’s needs allowance, all monthly income must be used toward care costs.

How Does Medicaid Count Income in Missouri?

What Income Sources Are Counted?

Almost all income counts toward the Medicaid limit, including wages, pensions, Social Security, alimony, IRAs, and investment dividends. Exceptions include Holocaust restitution and VA Aid & Attendance benefits.

How Is Income Handled for Married Couples?

If only one spouse applies, only that spouse’s income is counted. The non-applicant spouse may receive a Minimum Monthly Maintenance Needs Allowance (MMMNA) to prevent impoverishment. In 2025, the MMMNA is $2,644/month (effective July 1, 2025 – June 30, 2026). If housing costs exceed $793/month, the allowance can increase, up to a maximum of $3,948/month.

What Assets Are Counted for Medicaid in Missouri?

Which Assets Are Considered Countable?

Countable assets include cash, checking and savings accounts, investments, and real estate other than the primary home. Retirement accounts like IRAs and 401(k)s are countable. Exempt assets include personal items, one vehicle, household furnishings, a home, and irrevocable burial contracts. Funeral trusts are exempt up to $9,999.

How Are Assets Handled for Married Couples?

All assets are considered jointly owned, but the non-applicant spouse may keep a Community Spouse Resource Allowance (CSRA). In 2025, they can retain up to $157,920 (or 50% of joint assets). If half is below $31,584, the non-applicant can keep up to that full amount. Regular Medicaid has no CSRA provision.

What Is Missouri’s Medicaid Look-Back Rule?

Missouri enforces a 5-year look-back period for Nursing Home and HCBS programs to ensure no assets were gifted or sold below fair market value. Violations result in a period of ineligibility. The federal gift tax exclusion ($19,000 per recipient in 2025) does not protect gifts under Medicaid rules.

Is a Home Always Exempt Under Missouri Medicaid?

When Is a Home Exempt?

The home is exempt if the applicant or their spouse resides there, or if the applicant has an “Intent to Return.” When no spouse lives there, the applicant’s home equity interest must be below $730,000 in 2025. This limit does not apply to Regular Medicaid.

What Happens After Death?

While the home may be exempt during life, it can be subject to Medicaid Estate Recovery after death. The state may reclaim costs of care from the home’s value unless protective planning strategies are in place.

What Are the Medical Requirements for Long-Term Care Medicaid?

Applicants must demonstrate a medical need for care. Nursing Home Medicaid and HCBS programs require a Nursing Facility Level of Care (NFLOC). For Regular Medicaid, assistance with Activities of Daily Living (ADLs) may be sufficient.

Can Seniors Qualify If They Are Over the Limits?

What Is the Medically Needy Spend Down Program?

Missouri’s Spend Down Program allows seniors with high medical costs to qualify for Medicaid by offsetting income above the limit. For 2025, the medically needy income limit (MNIL) is $1,109/month for singles and $1,499/month for couples. The asset limits are $6,068.80 (single) and $12,137.55 (couple). Once the spend down is met, Medicaid covers care for the rest of the month.

What Is a Qualified Income Trust (QIT)?

Also called a Miller Trust, a QIT allows individuals with income above the limit to qualify for Medicaid. Excess income is placed into an irrevocable trust and used only for approved expenses, such as long-term care costs. Remaining funds at death must be paid to the state.

What Is an Asset Spend Down?

Seniors with excess assets can spend them on exempt resources—like home or vehicle modifications, prepaid funeral plans, or debt repayment—to reach eligibility. All transactions must be properly documented to avoid violating the 5-year Look-Back Rule.

How Can Medicaid Planning Help?

Many applicants exceed the limits but still cannot afford care. Working with a Medicaid planning professional can help families legally qualify while protecting assets, including the family home.

What Long-Term Care Programs Does MO HealthNet Offer?

What Is the Aged and Disabled Waiver (ADW)?

This waiver provides adult day care, respite services, homemaker assistance, and home-delivered meals to help seniors remain at home and support caregivers.

What Is the Supplemental Nursing Care (SNC) Program?

SNC offers a monthly cash benefit to help cover costs in assisted living or residential care facilities. It supplements, but does not fully cover, the total cost of care.

What Is Consumer Directed Personal Care?

Through the State Plan, this program allows eligible individuals to hire and pay family members (except spouses) to provide personal care services at home.

What Is the Structured Family Caregiving Waiver (SFCW)?

This program supports individuals with Alzheimer’s or dementia by allowing relatives, including spouses, to be compensated for providing in-home or adult foster care.

What Is PACE (Program of All-Inclusive Care for the Elderly)?

PACE combines Medicaid and Medicare benefits into one coordinated plan, including medical, dental, vision, and long-term care services.

What Is Money Follows the Person (MFP)?

Also called Show-Me Home in Missouri, MFP assists Medicaid beneficiaries in transitioning from nursing facilities back to their homes or community settings.

How Can Seniors Apply for Missouri Medicaid?

Applications can be submitted through the following methods:

• Online: myDSS Portal
• By Phone: 855-373-9994
• By Mail or In Person: Submit a completed application and supplemental form to the Family Support Division.

For assistance, call 1-855-373-4636 or visit a local Family Support Division Resource Center. Seniors should ensure they meet eligibility before applying and consider professional Medicaid planning if income or assets exceed the limits.