This page provides a plain-English summary of key elder care and estate planning information specific to Missouri residents. It covers Missouri Medicaid limits, estate tax rules, advance directive information, and links to important Missouri agencies and resources.
Information on this page is updated periodically but laws and limits change frequently. Always verify current figures with the relevant agency or a licensed attorney.
Missouri Medicaid — 2026 Eligibility Limits for Long Term Care
Missouri’s Medicaid program is called MO HealthNet and is administered by the Missouri Department of Social Services. Long term care programs are administered through the Department of Health and Senior Services — DHSS — Division of Senior and Disability Services. Missouri expanded Medicaid through a 2020 ballot initiative — Amendment 2 — with expansion taking effect July 1 2021.
Important — Missouri has a higher asset limit than most states Missouri uses a significantly higher asset limit for long term care Medicaid than the $2,000 standard used in most states. The 2026 asset limit for a single nursing home Medicaid applicant in Missouri is $6,068.80. This figure is tied to the federal SSI payment amount and adjusts periodically. This more generous asset limit makes Missouri Medicaid somewhat more accessible than in many other states.
Income rules for nursing home Medicaid — no hard income cap Missouri nursing home Medicaid does not use a fixed income cap the way most income cap states do. Instead virtually all of a nursing home resident’s monthly income — with the exception of a small personal needs allowance Medicare premiums and a spousal allowance — must be paid to the nursing home. Applicants whose income exceeds $2,982 per month must use a Qualified Income Trust — also called a Miller Trust or QIT — to direct excess income.
Asset limit — single applicant A single applicant must have $6,068.80 or less in countable assets for nursing home Medicaid and ABD Medicaid in 2026. Exempt assets include the primary residence with equity up to $752,000 if the applicant intends to return home, one vehicle of any value, personal belongings and household furnishings, and irrevocable burial trusts up to $7,000.
Aged and Disabled Waiver — home and community based care Missouri’s Aged and Disabled Waiver — ADW — provides home and community based services for people who need nursing home level care but want to remain at home. The ADW uses a different and lower income limit than nursing home Medicaid — $1,737 per month for a single applicant in 2026. This is an important distinction — some Missouri seniors with higher incomes may qualify for nursing home Medicaid but not for the ADW. The ADW asset limit is also $6,068.80 for a single applicant.
Structured Family Caregiving Waiver Missouri offers a Structured Family Caregiving Waiver — SFCW — that pays a family member or friend to provide care for a qualifying senior at home. This program uses the nursing home income limit of $2,982 per month and the same asset limit.
Married couples — one spouse applying When only one spouse applies for Missouri Medicaid the community spouse — the spouse who remains at home — may retain 50 percent of the couple’s combined countable assets up to a maximum of $162,660. If 50 percent of the couple’s assets is less than $32,532 the community spouse may retain up to $32,532. The applicant spouse retains $6,068.80.
Monthly Maintenance Needs Allowance The minimum Monthly Maintenance Needs Allowance for the community spouse is $2,643.75 per month in 2026. The maximum is $4,066.50 per month for community spouses with high housing costs.
Personal needs allowance Missouri nursing home Medicaid recipients are allowed to keep $50 per month as a personal needs allowance. The remainder of income is applied toward the cost of care.
Look-back period and divestment penalty Missouri has a 60-month — five year — look-back period for nursing home Medicaid and HCBS Waiver applications. Asset transfers made within 60 months of applying that were for less than fair market value may result in a penalty period of ineligibility. The 2026 divestment penalty divisor in Missouri is $7,909 per month — meaning the penalty period is calculated by dividing the disqualifying transfer amount by $7,909.
Estate recovery Missouri requires Medicaid estate recovery. After a MO HealthNet recipient dies the state seeks reimbursement from the estate for long term care costs paid. Planning with an elder law attorney can help protect assets from estate recovery.
How to apply for Missouri MO HealthNet Applications can be submitted online through myDSS at mydss.mo.gov, by phone at 1-855-373-4636, or in person at your local Family Support Division — FSD — office.
Missouri Medicaid administering agency Missouri Department of Social Services — dss.mo.gov
Missouri Estate Tax — 2026
No Missouri state estate tax Missouri does not impose a state estate tax. Missouri’s estate tax was tied to the federal state death tax credit which was eliminated by federal law effective January 1 2005. As a result no Missouri estate tax has applied to any estate since 2005.
No Missouri inheritance tax Missouri does not impose an inheritance tax. Missouri’s inheritance tax was repealed in 1980. Beneficiaries who receive assets from a Missouri decedent owe no Missouri inheritance tax regardless of the size of the inheritance.
Federal estate tax Missouri residents may be subject to the federal estate tax. The federal estate tax exemption is $15,000,000 per person in 2026 following enactment of the One Big Beautiful Bill Act. The exemption is portable between spouses meaning a married couple can protect up to $30,000,000 from federal estate tax with proper planning. The top federal estate tax rate is 40 percent on amounts above the exemption.
No Missouri gift tax Missouri does not impose a state gift tax. Federal gift tax rules apply — the annual gift tax exclusion is $19,000 per recipient in 2026.
Missouri capital gains tax Starting with the 2025 tax year Missouri allows 100 percent of long term capital gains to be excluded from Missouri adjusted gross income. This means Missouri residents pay no state income tax on long term capital gains — a significant benefit for those selling appreciated assets including inherited property.
Missouri income tax Missouri has a graduated state income tax with rates ranging from 2 percent to 4.7 percent. Social Security benefits are not taxed for residents aged 62 and older or disabled. Missouri partially taxes pension income and fully taxes retirement account withdrawals.
Out-of-state property considerations While Missouri imposes no inheritance or estate tax Missouri residents who own real property in other states should be aware that those states may impose their own estate or inheritance taxes. Missouri residents with property in Kentucky Maryland Nebraska New Jersey or Pennsylvania should consult an estate planning attorney about potential tax exposure in those states.
Missouri Advance Directives
Missouri law recognizes the following advance directive documents:
Missouri Durable Power of Attorney for Health Care Names a healthcare agent — called a healthcare proxy in Missouri — to make medical decisions on your behalf when you are unable to do so. Must be signed and witnessed by two adults who are not the healthcare agent or notarized.
Missouri Declaration — Living Will Documents your wishes regarding life-sustaining treatment when you have a terminal condition. Must be signed and witnessed by two adults.
Missouri POLST — Physician Orders for Life-Sustaining Treatment Missouri uses a POLST form for seriously ill patients that documents specific medical orders regarding CPR hospitalization and artificial nutrition. Must be signed by a physician.
Missouri Do Not Resuscitate Order A physician order directing emergency personnel not to perform CPR. Missouri has standardized DNR protocols for out-of-hospital settings.
Missouri Advance Directive Registry Missouri does not maintain a statewide advance directive registry. Copies of your advance directive should be given to your healthcare proxy physician and any hospital or care facility where you receive care.
Free Missouri advance directive forms Free Missouri-specific advance directive forms are available at caringinfo.org and from the Missouri Bar at mobar.org.
Missouri Key Agencies and Resources
Missouri Department of Social Services — DSS Administers MO HealthNet — Missouri Medicaid — including long term care programs. Website: dss.mo.gov myDSS Online Portal: mydss.mo.gov Phone: 1-855-373-4636
Missouri Department of Health and Senior Services — DHSS Coordinates long term care programs and services for older Missourians including home care nutrition programs caregiver support and the Missouri SHIP program for free Medicare counseling. Website: health.mo.gov Phone: 1-800-235-5503 Missouri SHIP — free Medicare counseling: 1-800-390-3330
Missouri Area Agencies on Aging Missouri is served by ten Area Agencies on Aging that coordinate local services for older adults and caregivers. Eldercare Locator: 1-800-677-1116 or eldercare.acl.gov
Missouri Long Term Care Ombudsman Program Advocates for the rights of residents of nursing homes and assisted living facilities. Investigates complaints and helps resolve problems free of charge. Website: health.mo.gov/seniors/ombudsman Phone: 1-800-309-3282
Missouri Bar Lawyer Referral Service Connects Missourians with attorneys including those who specialize in elder law and estate planning. Website: mobar.org Phone: 1-573-635-4128
Legal Aid of Western Missouri Provides free civil legal services to low income Missourians including seniors in western Missouri on issues related to Medicaid benefits housing and elder law. Website: lawmo.org Phone: 1-800-875-8702
Legal Services of Eastern Missouri Provides free civil legal services to low income Missourians including seniors in eastern Missouri. Website: lsem.org Phone: 1-800-444-0514
Missouri Veterans Resources
Missouri Veterans Commission — MVC Provides services and benefits to Missouri veterans and their families including free VA claims assistance and connections to Missouri veterans resources. Website: mvc.dps.mo.gov Phone: 1-573-751-3779
Missouri State Veterans Homes Missouri operates veterans homes providing long term care to eligible veterans and their spouses. Facilities are located in Cameron Cape Girardeau Mexico Mount Vernon St. James and Warrensburg. Website: mvc.dps.mo.gov/care/homes.php
Missouri Senior Property Tax Benefits
Property Tax Credit — Circuit Breaker Missouri offers a property tax credit — also called the Circuit Breaker — for lower income residents aged 65 and older and certain disabled residents. The credit provides relief of up to $1,100 for homeowners and up to $750 for renters. Income limits apply. Apply using Form MO-PTC with your Missouri state income tax return.
Senior Citizens Property Tax Credit Missouri homeowners aged 65 and older who meet income requirements may be eligible for the senior property tax credit program. Contact your county assessor for information about programs available in your county.
Disabled Veteran Property Tax Exemption Missouri veterans with a total service-connected disability rating and their surviving spouses may qualify for a property tax exemption on their primary residence. Contact your county assessor for details.
Finding Elder Law and Estate Planning Attorneys in Missouri
The following resources can help you find a qualified elder law or estate planning attorney in Missouri:
- National Academy of Elder Law Attorneys — NAELA — naela.org — searchable directory by location
- Missouri Bar Lawyer Referral Service — mobar.org — 1-573-635-4128
- Missouri Chapter of NAELA — Missouri has an active NAELA chapter with members throughout the state
- Legal Aid of Western Missouri — lawmo.org — free legal assistance for income-qualifying seniors in western Missouri
- Legal Services of Eastern Missouri — lsem.org — free legal assistance for income-qualifying seniors in eastern Missouri
The information on this page is for general informational purposes only and does not constitute legal or financial advice. Missouri MO HealthNet rules and other figures change frequently. Always verify current information with the relevant agency or a licensed attorney. Laws vary and individual circumstances differ significantly.
Last updated: April 2026