What Assets Count for Medicaid Eligibility in Missouri?

For long-term-care Medicaid purposes, the central question is generally whether an asset is considered an available resource to the applicant.

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Assets that are readily available and can generally be used for the applicant’s support are more likely to count toward eligibility. Assets that are exempt under Medicaid rules, unavailable to the applicant, or subject to special treatment may not be counted in the same way.

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The classification can depend on factors such as:

• who owns the asset;

• whether the applicant is married;

• how the property is being used;

• whether the applicant can access or liquidate it;

• whether it produces income;

• whether it was transferred before the Medicaid application;

• and whether a specific Medicaid exemption applies.

That is why two families with similar net worth can have very different Medicaid eligibility results.

Assets That Commonly Count Toward Medicaid Eligibility

The following are examples of assets that often require close review when determining eligibility.

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Cash and Bank Accounts

Cash, checking accounts, savings accounts, certificates of deposit, and similar liquid assets are generally among the first resources considered in a Medicaid eligibility analysis.​

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Stocks, Bonds, and Other Investments

Stocks, bonds, securities, investment accounts, and money owed to the applicant can also be treated as available resources.

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Additional Real Estate

Real estate other than a protected residence may be countable depending on the circumstances. This can include rental property, vacant land, acreage, or other property that is not subject to an exemption.

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Certain Life Insurance and Annuities

Some life insurance policies have a cash surrender value that may need to be considered. Annuities are subject to particularly technical Medicaid rules and should not be assumed to be either automatically countable or automatically protected. Missouri has specific eligibility rules governing annuities.

Other Valuable Personal Property

Certain business interests, equipment, vehicles beyond those qualifying for an exemption, or other valuable personal property may also require analysis.​

This is where many families are surprised. An asset can have substantial value and still receive different treatment from an ordinary bank account.

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The Home

A residence may receive favorable treatment under Medicaid eligibility rules, depending on the circumstances.

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That does not mean the home can always be ignored. Issues can include:

• whether the applicant intends to return home;

• whether a spouse or certain other family members live there;

• how the home is titled;

• whether it is later sold; and

• whether Missouri may assert a lien or estate-recovery claim.

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A home may receive favorable treatment when determining Medicaid eligibility, but that does not necessarily resolve what happens to the property later. Sale of the property, changes in occupancy, liens, and Missouri’s estate-recovery rules can create separate issues that should be considered as part of the planning process.

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A Vehicle

Medicaid rules may exclude a vehicle in appropriate circumstances, while additional vehicles can require separate analysis. Missouri’s eligibility process specifically asks applicants to identify vehicles and explain how each is used.

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Personal and Household Items

Ordinary household goods and personal effects are generally treated differently from liquid investments. However, unusually valuable property or business-related assets may require closer review.

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Burial Arrangements

Burial plots and certain prepaid burial arrangements may receive favorable treatment under Missouri Medicaid rules. Missouri specifically exempts burial plots from available-resource treatment, while other burial arrangements depend on their structure and revocability.

What Happens When One Spouse Needs Nursing-Home Care?

For married couples, Medicaid planning should not be reduced to the idea that both spouses must become impoverished before assistance is available.

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When one spouse becomes institutionalized and the other remains in the community, federal and Missouri Medicaid rules provide a process for evaluating and dividing the couple’s assets. Missouri conducts an assessment of assets in connection with the first continuous period of institutionalization or certain home-and-community-based services.

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Those rules can allow the spouse who remains at home to retain more property than would otherwise be available to a single Medicaid applicant.

The result depends heavily on:

• the amount and type of property owned;

• how assets are titled;

• when the nursing-home stay begins;

• income available to each spouse; 

• and whether planning occurred before the need for care arose.

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This is one of the strongest reasons not to assume that assets must simply be spent down without first reviewing the available options.

Does Giving Assets Away Solve the Problem?

Usually, this is where families need to be especially careful.

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Long-term-care Medicaid applies transfer-of-property rules, and Missouri’s eligibility standards specifically require consideration of transfers when determining eligibility for nursing-facility and related benefits.

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Giving away property, adding children to accounts or deeds, or transferring assets for less than fair value can create eligibility problems rather than solve them.

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The effect of a transfer depends on:

• what was transferred;

• when it was transferred;

• who received it;

• whether an exception applies; 

• and whether the transfer occurred within the applicable look-back period.

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This is why Medicaid planning generally works better when the family evaluates the entire asset picture before making transfers.