Medicaid law changes often. Not all states would allow the community spouse to keep the first $50,000 as a CSRA. The remaining $78,000 would be excess assets that must be spent on nursing home care before the husband becomes … John needs nursing home care and Mary is still able to live at home. These are considered "excess assets." Medicaid eligibility is incredibly complex, especially in the case of married couples. The starting point in the treatment of assets for married couples is that all assets owned by either spouse are considered available to the institutionalized spouse for purposes of Medicaid eligibility. specified time. There are, however, a few exceptions, which are calculated as deductions from the PPA. Medicaid recipients have the right to Excess assets must be spent before the institutionalized spouse will become eligible for Medicaid. Financial Eligibility For regular Medicaid, or MMA, the income limit for singles is $948 per month and the asset limit is $5,000. Couples are not always clearly advised of Shore Elder Services, Inc. Massachusetts Legal Assistance Corporation. After adding together all countable marital assets, the state Medicaid agency then determines what share of those assets the community spouse will be allowed to keep while the other receives Medicaid nursing home benefits. payor of nursing home care. As explained below, there are provisions for using income of the institutionalized spouse to support the community spouse, but not vice versa. retained by the community spouse and the amount of assets which must be spent before the If the institutionalized spouse receives new assets, however, eligibility will be affected. a higher amount of income and/or assets. cost of covered services subject to spend down and patient paid amount of nursing home Both are provided for in the federal Medicaid statute, as explained below. Ohio found that the income-first rule violates the federal Medicaid statute. The reason it is important to count all assets as of the date of admission to the nursing home is to be sure that the community spouse gets his or her full CSRA. can be retained by the applicant or spouse. Medicaid for Married Couples. for a hearing within the required time limit, ordinarily 30 days after the initial Have a net household income of less than $834 if single or less than $1129 if married. income. The spouse in the nursing home is eligible for Medicaid beginning the first of the month by the end of which the combined, non-exempt assets of both spouses are reduced to permitted levels -- $1,600 (net that month's Pays for covered services, subject to deductibles and The amount of the MMMNA can be increased if the community spouse can show at a hearing that his or her shelter expenses are more than 30% of the minimum allowance. Such delays would create problems if assets were assessed as of the date of the application instead of the date of admission to the nursing home. No assets, therefore, will be attributed to the institutionalized spouse. the community spouse to keep a certain amount of the couple's income and assets for his or This amount ranges from $30 to $75 per month, depending upon what state you live in. The Medicaid eligibility hurdle for a couple needing home care…. Individuals or couples who plan to apply for MAGI is used to determine financial eligibility for CHIP, Medicaid, and the health insurance marketplace. The Division of Here's an example of how an immediate annuity works: John and Mary are a married couple living in Boston, Massachusetts, with total countable assets of $270,000. The drawback of the income-first rule is that some or all of the income of the institutionalized spouse may be lost when he or she dies. The federal Medicaid statute requires notice of the right to request such a hearing to be stated in the notice of denial of benefits. If one spouse needs nursing or long-term care, the decisions provide tools to protect assets and income for a community spouse when applying for Medicaid benefits. The other purpose of the assessment is to tell the couple exactly what amount of assets the agency considers available to the institutionalized spouse to pay for care. His PPA, therefore, will be reduced to $1,115, and the wife will receive her full MMMNA of $1,405.50 each month. However, this page is specifically focused on Medicaid eligibility for Florida residents who are 65 years of age and older. Boston, MA 02114 (617) 371-1234. If one spouse needs to enter a skilled nursing facility and apply for Nursing Home Medicaid, families are afraid that the assets they have accumulated over a lifetime will quickly be depleted due to the high cost of care. As a general rule the income of the institutionalized spouse must go to the nursing home as a "patient paid amount", or "PPA." Assets that are not countable, such as the home, do not count toward the CSRA either. A community spouse may be entitled to both a revised CSRA and a CSMIA: In the example above, if the couple had only $100,000, and they lived in a state that allowed the wife the maximum CSRA, there would be only $18,000 in excess assets. a nursing home almost all of a couple's assets had to be spend in order to establish Unlike assets, the income of the community spouse is not considered available to the institutionalized spouse. Either spouse can request a fair hearing to dispute the calculation of assets and/or All financial services, shopping products and care services 
are presented without warranty. In the case of dependent children, each child may receive an amount determined as one half of the Federal Poverty Level for a single adult. Mystic Valley Elder Services, Inc. Boston the couple how their assets can be divided, establishing the amount of assets which can be A couple will have to meet income guidelines, as well as fall below the allowable countable resource level. But, the results of our tools and editorial reviews are based on quantitative and qualitative assessments of product features — 
nothing else. By the time the spousal needs allowance is calculated, Medicaid The federal law also provides that either spouse can also request a fair hearing to understand the Medicaid laws or to seek assistance in order to protect their rights. The separate income of the community spouse always his or hers to keep. The first principal is that spouses are financially responsible for one another. increase his or her monthly income up to a minimum monthly maintenance needs allowance, Once Medicaid eligibility is established, the community spouse may be entitled to a Income Eligibility for Married Couples. His PPA normally would be $1,440 per month ($1,500 minus his $60 PNA). There are, however, a federal minimum and maximum CSRA to which all states must adhere. Certain assets are disregarded (i.e., not counted when calculating the applicant’s assets), including one car per household, certain burial expenses, home property, and certain life insurance policies. amount. The Spousal Impoverishment Law . The community spouse can request a fair hearing to have the monthly maintenance A revised CSRA requires that one of the spouses request a "fair hearing," or appeal, when Medicaid is denied on the basis of excess assets. As of 1996 this amount was $76,740. For married couples, where only one spouse is applying for home and community-based services via nursing home Medicaid or a Medicaid waiver, the community spouse is allotted a Minimum Monthly Maintenance Needs Allowance (MMMNA). For liquid assets, such as bank accounts, stocks and savings, it does not matter if the asset is held in a joint account with both names or in separate accounts with only one name. The financial resources of the spouse who is not applying for Medicaid (the "well spouse" or the "community spouse") are viewed as available to the institutionalized spouse to help pay for his or her care before Medicaid will pay. For a married couple where one spouse is in a nursing home, the nursing home spouse still must have no more than $2500, but the spouse still living at home can keep one half of the combined assets up to a maximum of $126,420 (for 2019). monthly needs allowance, based on his or he r income and housing costs. Medicaid eligibility is exceedingly complex and to provide the minute details is beyond the mission of this website. This test takes approximately 3 minutes to complete. To learn more about the rules in your state, check with your local agency. recipient or her spouse shows hardship at a fair hearing. Assets that are excluded when determining Medicaid eligibility of married couples: The first $3000 of assets if they live as a couple or $2000 each if they live apart The MMMNA prevents this by stating that she is allowed to have at least $1,295 per month — still a drastic loss, but significantly better than under previous Medicaid rules. Here we’ve merely outlined the basic eligibility rules. It is important for couple in this situation to Readers should be aware the maximum income limits change dependent on the marital status of the applicant, whether a spouse is also applying for Medicaid and the type of Medicaid for which they are applying. Grandfolk® editorial staff provides in-depth product and service reviews to empower senior buying decisions. their right to make such a request and may not be aware of the importance of doing so In that case, the couple would still have to spend the $18,000 in excess assets, even though the wife’s separate income was less than her MMMNA. The notice also must explain the method used to calculate the CSRA and the right to request a hearing to review the amount of the MMMNA. This means that it doesn’t matter whose name is on the check, both the income of the applicant and the non-applicant is used towards the eligibility of the applicant spouse. There are two ways to go about providing the needed income: increase the CSRA, or let the community spouse use income of the institutionalized spouse instead of requiring it all to go to the nursing home. particular amount (currently $80,760), the community spouse may keep all of the assets. This issue probably will remain unsettled, unless and until Congress clarifies the federal statute, or a case reaches the U.S. Supreme Court. The above information is accurate as of June 30, 1998. of the community spouse, but usually require legal help. If a couple marries, and then one spouse needs Medicaid, the assets of both (including assets that the other person brought into the marriage, that have always been separately owned) are subject to Medicaid spend down. The spousal needs allowance cannot exceed this maximum unless the eligibility has generally been established and the couple's assets will have already been Burial funds set aside in accordance with Medicaid regulations are not Medicaid may want to inquire whether any of their assets can be converted into non- The most important concern for those couples with low incomes who need Medicaid nursing home benefits is to find out their local state rules and to learn their rights under both federal and local regulations. In order to understand these rules, it is helpful to begin with an understanding of two traditions or principals that influence the availability of Medicaid nursing home benefits to married persons. Using income of the institutionalized spouse is called the "community spouse maintenance needs allowance," or "CSMIA." This is the same whether one or both spouses are applying. If you’d like to know more, watch the webinar above. Only by allowing the community spouse a revised CSRA before using income of the institutionalized spouse can those assets be preserved as permanent protection for the community spouse. The husband then would be entitled to deduct $250 per month from his PPA and to give her this income to make up the rest of her shortfall. Concern about this phenomenon is acute in nursing home cases, where the cost of care can consume the couple’s entire life savings in a matter of months. First, It determines the number of assets as of the date of admission to the facility instead of the date of application for Medicaid. her own use. If you are married and seeking coverage from Medicaid Long-Term Care, you may be in one of two situations. A free, non-binding Medicaid eligibility test is available here. Furthermore, in many of the states, Medicaid eligibility is automatic if one is eligible for SSI. After the institutionalized spouse has been determined to be eligible for Medicaid, some or all of his or her income may be used to bring the community spouse’s income up to her MMMNA. As of 1997 it is $1,295 per month. (see Right to Request a Hearing). Due to the high cost of nursing home care, and the limitations of the Medicare and long term care insurance, the Medical Assistance program (Medicaid) often becomes the ultimate payor of nursing home care. To get answers to all of the questions you might have about your particular case, contact us. Congress passed spousal impoverishment protections, Increasing the CSRA is called the "revised CSRA." $2019 per month). that they have the right to request that the Division of Medical Assistance conduct an Medicaid is a wide-ranging, federal, health care program for low-income individuals of any age. The assets may have to be spent, or the couple can request a revised (increased) CSRA, which is explained below. If that happened, it would be very difficult and administratively costly for them to get the money back. The home of a Medicaid recipient is not a countable asset, even if the Medicaid will allow Mary to keep $120,000 and John to keep $2,000. First, it makes sure that all assets are counted as of the date of admission to the nursing home, not the date of the Medicaid application. countable. Medical Assistance will notify the couple regarding the amount of assets which must be More and more people are living together without marriage. If assets earn 5% annual interest, the wife would need all of the excess assets in order to make up the shortfall: Depending upon local state rules, the community spouse may be able to retain excess assets as a revised CSRA, based upon calculations similar to the above formula. For example, if the couple in the example above also owns a home worth $80,000, the community spouse can keep the home in addition to the $50,000. That said, there are some over-arching eligibility principles that should be mentioned. Elder Law Attorney, Brent Van Deysen on Network West Virginia's Legally Speaking discusses Medicaid Eligibility for married couples. It is advisable to have the Finding funds to increase the income for the community spouse up to his or her MMMNA (or revised MMMNA) is somewhat complicated. bonds, certain insurance policies). In this case study, we will develop a … until it is too late. Other states use more complicated formulas. If you don’t have contact information for your state, find it at the State Medicaid Toll-Free Lines page of the Health Care Financing Administration website. One of our expert Benefits Coordinators will get in touch with you soon. He or she immediately will qualify for Medicaid as an applicant having less than $2,000 in resources. The combined amount of income from the spouse will be used to determine Medicaid eligibility. Due to the high cost of nursing home care, and the limitations of the Medicare and long For example, if a couple’s assets were assessed one year after admission, the amount would be thousands of dollars less than it was on the date of admission. In other words, “ How does Medicaid apply to married couples in Illinois? If the couple does not request an assessment separately, the assessment will be done at the time they apply for Medicaid. As of 1997 this amount is $441.66 per month. Advertiser Disclosure: We receive compensation from our partners when someone applies or gets approved for a product through 
our site. Medicaid Eligibility in Missouri. Medicaid eligibility for the institutionalized spouse, leaving the remaining spouse (the Furthermore, assets are defined as countable or non-countable or exempt assets under the Medicaid … Medicare- A health insurance program administered by the All assets in excess of this total are attributed to the institutionalized spouse. The spouse in the nursing home may have no more The result is a set of modest protections that avoids total (but not partial) impoverishment for community spouses. When one spouse of a married couple applies for long-term care Medicaid, the value of both spouses' assets are considered for eligibility purposes. administered by the Division of Medical assistance for eligible individuals. institutionalized spouse will be eligible for Medicaid. If he is institutionalized, and all of his income had to go to the nursing home in order for him to receive Medicaid, her income would drop to $700 per month, a loss of nearly 70% of their former income. Disclaimer: Grandfolk strives to keep its information accurate and up to date. As of 1997, the wife would be allowed to keep about $80,000, plus the $2,000 her husband is allowed to keep, for a total of $82,000. The income deduction for the community spouse is more complicated, as explained below. When all but $2,000 has been spent, the institutionalized spouse will qualify for Medicaid. Eligibility overview: Nebraska voted in November 2018 to expand Medicaid to all residents making less than 133% to provide Medicaid to the elderly, the disabled, pregnant women, children and parents, depending on income. Within each state, each target constituent group has its own requirements. An Example of One Married Couple. When it comes to married couples, the Medicaid income limit rules are the same. Each state uses its own interest rate, and some states now deny a revised CSRA if the institutionalized spouse has income that can be used to supplement the community spouse’s income. Countable Assets- Assets which the Division of Medical If Mary purchases an immediate annuity that meets the criteria above for $150,000, she … Non-countable Assets- Certain assets are not countable and This is called the community spouse maintenance needs allowance, or "CSMIA." This includes senior citizens. This is referred to as the Community Spouse Resource Allowance (CSRA). The CSMIA does not require a fair hearing, but it cannot be determined until after the institutionalized spouse is found eligible for Medicaid. The Division of Medical Assistance will then inform community spouse) impoverished. Couple $1483.09 $1374.41 Asset Limits Generally, the asset limit for HUSKY C is $1,600 for individuals and $2,400 for a married couple. assessment of their countable assets. Assets attributed to the institutionalized spouse under any of the formulas used by the states must be spent on nursing home care before Medicaid will be approved. By requiring the MMMNA to be determined, and by using this as a minimum income level for the community spouse, Medicaid prevents impoverishment in cases where the community spouse’s separate income is less than the MMMNA: Suppose, for example, that the husband has income of $1,500 per month and the wife has separate income of only $700 per month. Many states, for example, do not increase the community spouse’s share above the minimum amount until an equal amount has been attributed to the institutionalized spouse. If a married couple both wish to apply for Medicaid long-term care benefits, they can have no more than $3,000.00 in what Medicaid considers countable resources combined! As of 1996 this amount was $15,348.
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