Oklahoma
What is the Definition of Oklahoma Medicaid Long-Term Care?
Medicaid is a health care program for low-income individuals of all ages. This guide focuses on long-term care Medicaid eligibility for senior residents of Oklahoma (aged 65 and over). Oklahoma provides Medicaid coverage for services in nursing homes, assisted living facilities, and for supports that enable seniors to live at home. There are three Medicaid long-term care programs for which Oklahoma seniors may be eligible.
What is Institutional / Nursing Home Medicaid?
Institutional Medicaid is an entitlement program, meaning that anyone who qualifies will receive assistance. Benefits are available only in nursing homes.
What are Medicaid Waivers / Home and Community Based Services (HCBS)?
Medicaid Waivers are not an entitlement, and participation is limited due to enrollment caps. These services aim to delay the need for nursing home admissions and are provided in home settings, adult day care, or assisted living.
What is Regular Medicaid / Aged Blind and Disabled?
This is an entitlement program for individuals who meet the eligibility requirements. Long-term care services, such as personal care assistance or adult day care, may be available.
In Oklahoma, Medicaid is referred to as SoonerCare, jointly funded by the state and federal government and administered by the Oklahoma Department of Human Services (OKDHS).
What Are the Income and Asset Limits for Eligibility?
Oklahoma’s Medicaid long-term care programs have different financial and medical eligibility criteria. Eligibility may vary annually, with criteria differing based on marital status. Oklahoma offers various pathways to eligibility.
Simplified Eligibility Criteria: Single Nursing Home Applicant (2025)
A single Nursing Home Medicaid applicant in Oklahoma must meet the following criteria:
- Income under $2,901 per month
- Assets under $2,000
- Require a Nursing Home Level of Care
The table below provides a quick reference to help seniors determine if they could qualify for Oklahoma Medicaid long-term care.
2025 Oklahoma Medicaid Long-Term Care Eligibility for Seniors
Type of Medicaid | Single | Married (both spouses applying) | Married (one spouse applying) |
---|---|---|---|
Income Limit | $2,901/month | $5,802/month | $2,901/month for applicant |
Asset Limit | $2,000 | $4,000 ($2,000 per spouse) | $2,000 for applicant & $157,920 for non-applicant |
Level of Care Required | Nursing Home | Nursing Home | Nursing Home |
Note: Certain income exclusions apply, such as a $75/month Personal Needs Allowance.
What is Countable vs. Non-Countable Income?
Most types of income are considered countable towards Medicaid’s income limits, including wages, pension payments, Social Security Income, and stock dividends. However, certain sources of income are not counted, including the VA Aid & Attendance benefit.
How is Income Treated for a Couple?
When only one spouse applies for Nursing Home Medicaid or Medicaid Waivers, the income of the non-applicant spouse is not counted. The applicant’s income alone determines eligibility, and the non-applicant may receive a Monthly Maintenance Needs Allowance (MMNA) to avoid financial hardship.
In 2025, the MMNA in Oklahoma is $3,948. If the non-applicant’s income is below this level, it can be supplemented by income from the applicant spouse.
For Regular Medicaid, both spouses’ income is calculated in determining eligibility.
What is Countable vs. Non-Countable Assets?
Countable assets include cash, investments, second homes, and certain retirement accounts like IRAs. Non-countable assets include personal belongings, household items, one’s primary home, and up to $10,000 in irrevocable burial contracts.
How are Assets Treated for a Couple?
For married couples, both spouses’ assets are considered jointly owned. However, the non-applicant spouse can retain up to $157,920 of the couple’s assets in 2025, depending on the couple’s total assets.
What is the Medicaid Look-Back Rule?
Oklahoma’s Medicaid Look-Back Period is 60 months before the application date, during which Medicaid reviews transfers or gifts made below fair market value. Violating this rule results in a penalty period of ineligibility.
What Are the Oklahoma Medicaid Home Exemption Rules?
A home can be exempt from Medicaid’s asset limit if the applicant or their spouse lives in the home. The home’s equity interest must be under $730,000 in 2025. Additionally, the applicant must express intent to return if the home is unoccupied.
What Are the Medical / Functional Need Requirements?
To qualify for Nursing Home Medicaid or Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. For Regular Medicaid, a functional need for assistance with Activities of Daily Living (ADLs) must be demonstrated, though NFLOC is not necessary.
How Can Seniors Qualify if They Exceed the Limits?
Oklahoma offers several ways for individuals who exceed the income or asset limits to still qualify for Medicaid.
1. What are Qualified Income Trusts (QITs)?
A QIT allows applicants who exceed the income limit to qualify for Medicaid by placing excess income into a trust. The trust funds can only be used for long-term care services or medical expenses, and the remaining balance after the applicant’s death must be paid to the state.
2. What is the Asset Spend Down Process?
Individuals can reduce their countable assets by spending excess funds on non-countable assets, such as home or vehicle modifications, prepaying funeral expenses, or paying off debt.
3. What is Medicaid Planning?
Medicaid Planning professionals can help individuals who are over the income or asset limits navigate eligibility strategies, including protecting their home from Medicaid’s Estate Recovery Program.
What Specific Oklahoma Medicaid Programs are Available?
Oklahoma offers several Medicaid programs that support seniors in staying at home or in the community.
ADvantage Waiver Program
The ADvantage Waiver Program allows seniors to self-direct their personal care services, including hiring family members as caregivers. Other services include adult day care, assisted living, and home modifications.
State Plan Personal Care Program
This program offers personal care assistance without a waiting list, with participants able to hire and manage their caregivers.
Program of All-Inclusive Care for the Elderly (PACE)
PACE combines Medicaid and Medicare benefits, offering services such as dental and eye care, as well as long-term care.
Money Follows the Person Program
This program helps individuals transition from institutional care back to home or community-based living.
How Do You Apply for Oklahoma Medicaid?
Elderly individuals can apply online at OKDHSLive! or through the Department of Human Services. Applicants can also contact their local Area Agency on Aging or call the Director’s Helpline for assistance. It’s crucial to ensure eligibility criteria are met before applying, especially for those with excess income or assets.