Breakdown of Medicaid Requirements for Singles and Couples
For singles and couples, the path to qualifying for Medicaid can differ significantly, especially when considering income thresholds, asset limits, and long-term care needs. Having clear guidance is essential to make decisions that protect what matters most.
Medicaid, a joint federal and state program, provides health coverage to individuals who meet specific financial and medical eligibility criteria. While its benefits are essential for those needing long-term care, nursing home placement, or at-home assistance, the application process is often challenging without the right support.
The Law Offices of Steven H. Peck, Ltd in Cook County and Lake County, Illinois, works with individuals and families throughout Illinois who are trying to understand Medicaid requirements while preserving their dignity, independence, and financial well-being.
Whether someone is applying as a single person or a married couple, the requirements must be met precisely. Understanding the distinctions between these categories can help avoid disqualification, delayed approvals, or penalties.
Medicaid Income and Asset Limits for Individuals
For single applicants, Medicaid eligibility largely depends on both monthly income and total countable assets. These financial thresholds are adjusted annually and vary by state. In Illinois, single individuals applying for long-term care Medicaid must remain within strict guidelines.
Key limits for singles include:
Monthly income: Typically around $1,215 to $1,563, depending on the program and county
Countable assets: Limited to $2,000 for standard eligibility
Some assets aren’t counted toward this total. These non-countable assets include:
Primary residence: If the applicant intends to return home and the equity is under a certain cap
One vehicle: If it’s used for transportation for medical appointments or daily needs
Household belongings: Furniture, clothing, appliances
Burial spaces and some pre-paid funeral expenses
However, any savings accounts, CDs, non-exempt real estate, or investment accounts typically count toward the $2,000 limit. Planning ahead can allow a single individual to restructure assets in a way that supports Medicaid eligibility while maintaining access to essential services.
Medicaid Requirements for Married Couples (When Both Apply)
When both spouses in a couple apply for Medicaid, the income and asset limits apply to them jointly. The couple is treated as a single economic unit, and the limits are calculated to reflect shared financial resources.
Illinois standards for couples include:
Combined monthly income: Approximately $1,643 to $2,106, depending on regional Medicaid variations
Combined countable assets: Limited to $3,000 for eligibility purposes
Again, certain assets are excluded from this limit. If both spouses are entering care, their home may be protected under Medicaid rules, particularly if they plan to return or if it’s considered unavailable for sale due to market or legal reasons.
Planning for two applicants requires careful coordination. The firm often assists couples in:
Reviewing how existing assets are held
Transferring exempt assets to the proper categories
Structuring income in a way that supports eligibility and ongoing care
Medicaid When One Spouse Applies and the Other Doesn’t
Perhaps the most misunderstood scenario occurs when one spouse applies for Medicaid but the other remains at home. In this case, Medicaid applies the "spousal impoverishment" protections to prevent the community spouse (the one staying home) from losing all financial resources.
Under these protections:
The applying spouse must meet the standard Medicaid income and asset limits ($2,000 in countable assets)
The non-applying spouse may retain a larger share of the couple’s assets, known as the Community Spouse Resource Allowance (CSRA)
For 2024 in Illinois:
CSRA minimum: $29,724
CSRA maximum: $148,620
Additionally, the non-applying spouse is entitled to a Monthly Maintenance Needs Allowance (MMNA), which lets them keep a portion of the couple’s income for living expenses.
Key protections for the non-applying spouse include:
Home retention: The community spouse may continue to live in the primary residence
Income shielding: The community spouse may keep their own income plus a portion of the applicant’s, if needed to meet the MMNA
These protections allow the well spouse to maintain housing, pay bills, and continue living independently while their spouse receives care through Medicaid. The Law Offices of Steven H. Peck, Ltd assists in structuring these arrangements with compassion and legal clarity.
How Asset Transfers Affect Eligibility
One of the most important Medicaid rules applies to asset transfers. Medicaid uses a five-year look-back period for long-term care applications. If an applicant has transferred assets for less than fair market value during this period, a penalty may apply.
The penalty period:
Delays Medicaid coverage for long-term care services
It’s calculated by dividing the value of transferred assets by the average monthly cost of nursing home care in Illinois
Transfers that may trigger penalties include:
Gifting cash or property to family members
Selling assets below value
Adding someone’s name to property titles without compensation
Some transfers are allowed without penalty, such as:
To a spouse
To a disabled child
To a trust for the benefit of a disabled person under 65
The firm helps clients avoid unintended disqualification by evaluating any prior transfers and suggesting compliant planning options.
Income Treatment Under Medicaid Rules
Income is treated differently depending on whether a person is applying for institutional care or for waiver programs that allow them to remain at home. For institutional care, Medicaid requires most of the applicant’s income to be used toward care costs before benefits begin.
Income rules include:
Personal needs allowance: A small monthly amount (around $30) is set aside for personal expenses
Remaining income: Paid directly to the facility as a cost-share
For couples, income rules are more flexible:
Spousal income isn’t counted against the applicant if only one spouse is applying
If income is low, the non-applying spouse may receive income transfers to help them meet minimum needs
In certain cases, individuals with income over the Medicaid limit may still qualify using a Qualified Income Trust (QIT). These trusts allow excess income to be redirected in a legally compliant way.
Asset Protection Strategies for Singles and Couples
Medicaid planning involves more than just reducing assets. It means protecting financial security, personal dignity, and long-term care access. With the right strategies, many singles and couples can qualify for Medicaid without sacrificing everything they’ve built.
Some asset protection strategies include:
Spending down: Paying off medical debt, making home repairs, or purchasing exempt assets like burial plots
Converting countable assets: Turning cash into a Medicaid-compliant annuity
Using irrevocable trusts: Transferring ownership of assets in a way that shields them after the look-back period
Prepaying for future needs: Funeral expenses, insurance, or home modifications
The Law Offices of Steven H. Peck, Ltd works closely with families to assess their situation and provide thoughtful options. Each plan is tailored to the individual or couple’s health, financial condition, and family goals.
Medicaid and Long-Term Care Insurance
While Medicaid is the largest payer of long-term care in the United States, some individuals also have long-term care insurance. When structured properly, these policies can help cover care while preserving Medicaid eligibility.
Considerations include:
Policy benefit triggers: Does it activate with ADLs or cognitive decline?
Payout amounts and duration: Will it delay Medicaid eligibility?
Partnership policies: Some states offer asset protection benefits for those with approved long-term care coverage
Combining Medicaid with private insurance requires thoughtful coordination. Clients benefit from legal review of their coverage as part of a broader care plan.
Speak to a Medicaid Planning Attorney Today
The Law Offices of Steven H. Peck, Ltd serves Cook County and Lake County, Illinois, as well as McHenry County and DuPage County. For compassionate and thorough guidance on Medicaid eligibility for singles and couples, contact the firm to speak with an experienced Medicaid planning attorney to protect what matters most.