The remaining $78,000 would be excess assets that must be spent on nursing home care before the husband becomes eligible for Medicaid. Shore Elder Services, Inc. Massachusetts Legal Assistance Corporation. If you are married and seeking coverage from Medicaid Long-Term Care, you may be in one of two situations. All financial services, shopping products and care services 
are presented without warranty. Eligibility requires an income of no more than $1,061 per month for an individual or $1,430 per month for a married couple in 2019. If they live in a state that allows the community spouse to keep the first $50,000, all of the assets will be attributed to the community spouse. The remaining $78,000 would be excess assets that must be spent on nursing home care before the husband becomes … 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 For this reason, the assessment often is referred to as a "snapshot" of the couple’s assets on the date of admission to the nursing home. community spouse) impoverished. of the community spouse, but usually require legal help. Excess assets must be spent before the institutionalized spouse will become eligible for Medicaid. This figure, which is based upon a combination of federal and state laws, is called the Community Spouse Resource Allowance, or CSRA. Medicaid eligibility is incredibly complex, especially in the case of married couples. $2019 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. This amount ranges from $30 to $75 per month, depending upon what state you live in. Medicaid is a wide-ranging, federal, health care program for low-income individuals of any age. Here’s an example to show you how Medicaid eligibility would be determined. Using income of the institutionalized spouse is called the "community spouse maintenance needs allowance," or "CSMIA." By the time the spousal needs allowance is calculated, Medicaid The Affordable Care Act established a consistent methodology for determining income eligibility, which is based on Modified Adjusted Gross Income (MAGI). Either spouse can request a fair hearing to dispute the calculation of assets and/or continue receiving benefits pending appeal if a hearing request is filed within a However, in most states, Medicaid eligibility is still mandatory for all SSI recipients, including those in same-sex marriages, as explained more fully later in this guidance. 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. particular amount (currently $80,760), the community spouse may keep all of the assets. Barring unusual circumstances (explained below), there is also a federal maximum. As a general rule the income of the institutionalized spouse must go to the nursing home as a "patient paid amount", or "PPA." Due to the high cost of nursing home care, and the limitations of the Medicare and long 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). The Medicaid managed care program for long-term care ser… As of 1996 this amount was $76,740. If she was allowed a revised CSRA, this added income would provide only $75 per month (assuming the same 5% annual interest rate), leaving her with a continuing shortfall of $250 between her separate income and her MMMNA. can be retained by the applicant or spouse. As of 1997 it is $1,295 per month. eligibility has generally been established and the couple's assets will have already been The community spouse always keeps the first few thousand dollars. These transfers incur no penalty. A couple will have to meet income guidelines, as well as fall below the allowable countable resource level. 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. meet the monthly maintenance needs allowance. 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. Unlike assets, the income of the community spouse is not considered available to the institutionalized spouse. because financial records may be more readily available than at a later date. If the community spouse is forced to depend upon that income in order to avoid poverty, he or she will fall into poverty when the income is lost. Once Medicaid eligibility is established, the community spouse may be entitled to a The community Assets that are not countable, such as the home, do not count toward the CSRA either. Some states allow the community spouse to keep all countable assets up to the federal maximum. The second principal is that the first principal should not be carried too far. Medicaid income limits for married couples. than $2,000 in countable assets in order to be eligible for Medicaid. This is known as the "income-first" rule, which has been adopted in some states. spouse may be given an allowance from the income of the institutionalized spouse to Here we’ve merely outlined the basic eligibility rules. provided a Medicaid application has been filed. 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. Increasing the CSRA is called the "revised CSRA." Here is how it works: In the example above, suppose there were no excess assets, but the husband has income of $1,500 per month. 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. The Division of Medical Assistance will then inform Medicaid may want to inquire whether any of their assets can be converted into non- That said, there are some over-arching eligibility principles that should be mentioned. 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. INFORMATION MARRIED COUPLES SHOULD KNOW ABOUT MEDICAID ELIGIBILITY AND COVERAGE OF NURSING HOME CARE. whether a couple is lawfully married. Specific planning must be done to protect your home. 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. Most married couples own a home, and unless planning is done to protect it, it can be lost to Medicaid “estate recovery,” which enables the State to recover Medicaid benefits paid to someone when that person later dies. 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. her own use. In order to make sure that the CSRA is not spent before Medicaid is applied for, the state agency must look at the number of assets on the date of admission to the nursing home, not the amount that is left when the couple actually applies for Medicaid. The Medicaid program attempts to prevent total impoverishment of community spouses, while continuing to hold them financially responsible for their institutionalized spouses. The MAGI-based methodology considers taxable income and tax filing relationshi… 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. The state Medicaid agency must provide anyone who is institutionalized with an "assessment" of eligibility, if requested by the individual or spouse. Make note, Medicaid in Florida is sometimes referred to as the Statewide Medicaid Managed Care (SMMC) program. The home of a Medicaid recipient is not a countable asset, even if the ” Medicaid is a federally funded program that is administered by the individual states. 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). The above information is accurate as of June 30, 1998. Social Security Administration. The couple usually begins spending assets after the ill spouse is admitted to the nursing home. It is advisable to have the All assets in excess of this total are attributed to the institutionalized spouse. As of 2021, the annual FPL for an individual is $12,880 ($1,073 / month), and for a married couple is $17,420 ($1,452 / month). countable assets. Furthermore, assets are defined as countable or non-countable or exempt assets under the Medicaid … In addition, income may be given to the community spouse or to dependent children, if their separate income is not considered sufficient to meet their needs. It is important to file a request Medicaid establishes a minimum income standard for the community spouse, called the "minimum monthly maintenance needs allowance," or "MMMNA." Only assets above that amount are attributed to the institutionalized spouse. The Spousal Impoverishment Law . Income requirements: Parents or relatives with a dependent child can qualify with household income up to 58% of the FPL ($1,050 a month for a family of three). No assets, therefore, will be attributed to the institutionalized spouse. In this case study, we will develop a … Mystic Valley Elder Services, Inc. Boston assessment of their countable assets. It is important for couple in this situation to If Mary purchases an immediate annuity that meets the criteria above for $150,000, she … 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. Assistance will consider in determining eligibility (cash, money in the bank, stocks, a nursing home almost all of a couple's assets had to be spend in order to establish 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. As of 1997 this amount is $441.66 per month. amount. The community spouse may request a hearing in order to be allowed to keep more than this (see Right to Request a Hearing). Between the minimum and the maximum figures, states can use a variety of methods to allocate assets. 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. 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. But the community spouse may be able to benefit from the revised CSRA procedure under appropriate circumstances. When evaluating offers, please review the product’s Terms and Conditions. Together they live on $2,200 per month. A free, non-binding Medicaid eligibility test is available here. Married couples who need assistance purchasing food can apply for SNAP, the Supplemental Nutritional Assistance Program, otherwise known as food stamps. Unfortunately, the income-first rule does not allow the community spouse to go back and recover assets that were spent on the nursing home after the institutionalized spouse dies. Medicaid eligibility is determined at many levels, and each state has its own requirements, which change every year. Elder Law Attorney, Brent Van Deysen on Network West Virginia's Legally Speaking discusses Medicaid Eligibility for married couples. This is referred to as the Community Spouse Resource Allowance (CSRA). The exact rules for attributing a couple’s assets vary from state to state, some being more generous than others. This is the same whether one or both spouses are applying. Within each state, each target constituent group has its own requirements. 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. This issue probably will remain unsettled, unless and until Congress clarifies the federal statute, or a case reaches the U.S. Supreme Court. The Medicaid eligibility hurdle for a couple needing home care…. If the couple has more than double the minimum CSRA, additional assets are divided equally between the spouses until the maximum CSRA has been attributed to the community spouse. The first situation is if both you and your spouse are entering a nursing home and are seeking coverage. The spouse in the nursing home may have no more 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. 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. care. for a hearing within the required time limit, ordinarily 30 days after the initial When one spouse enters a nursing home the facility must notify both husband and wife As of 1996 this amount was $15,348. The community spouse can request a fair hearing to have the monthly maintenance For married couples, the income limit rises to $1,281 per month and the asset limit is $6,000. The spousal needs allowance cannot exceed this maximum unless the This fact sheet has been provided by Greater Boston Legal Services 197 Friend Street, Fair Hearing- Most decisions of the Division of Medical Holding the community spouse totally financially responsible for the institutionalized spouse would (and under older versions of Medicaid, did) lead to severe impoverishment of many community spouses. bonds, certain insurance policies). Thus it is critical for married couples to understand the Medicaid regulations 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. Other states use more complicated formulas. Pays for covered services, subject to deductibles and 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. He or she immediately will qualify for Medicaid as an applicant having less than $2,000 in resources. monthly needs allowance, based on his or he r income and housing costs. the couple how their assets can be divided, establishing the amount of assets which can be spent down. until it is too late. This test takes approximately 3 minutes to complete. 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. There has been a considerable amount of litigation over the income-first rule, with mixed results. 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. The focus will also be on long term care, whether that be at home, in a nursing home, adult foster care, or in assisted living. Using one set of income counting rules and a single application across programs, is intended to make it easier for people to apply and enroll in the appropriate program. Income Eligibility for Married Couples. 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. Congress passed spousal impoverishment protections, Not all states would allow the community spouse to keep the first $50,000 as a CSRA. Commission of Affairs of the Elderly Chelsea/Winthrop/Revere Home Care Corporation South specified time. The federal law also provides that either spouse can also request a fair hearing to recipient is in a nursing home, provided that the nursing home recipient intends to return 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. John needs nursing home care and Mary is still able to live at home. Best Medicare Supplement Insurance Services, The Minimum Monthly Maintenance Needs Allowance, The Revised Community Spouse Resource Allowance, The Community Spouse Maintenance Needs Allowance, Reconciling the Revised CSRA and the CSMIA, MEDICAID ELIGIBILITY: TREATMENT OF ASSETS FOR MARRIED COUPLES. Medicaid- A federal and state needs based program cost of covered services subject to spend down and patient paid amount of nursing home One of our expert Benefits Coordinators will get in touch with you soon. 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. Finding funds to increase the income for the community spouse up to his or her MMMNA (or revised MMMNA) is somewhat complicated. A lawyer knowledgeable in Medicaid issues may be indispensable in these circumstances, particularly in states where notices and other information provided by the state Medicaid agency may be inadequate or faulty. Medicaid will allow Mary to keep $120,000 and John to keep $2,000. To get answers to all of the questions you might have about your particular case, contact us. Medicaid eligibility for the institutionalized spouse, leaving the remaining spouse (the If you’d like to know more, watch the webinar above. The separate income of the community spouse always his or hers to keep. term care insurance, the Medical Assistance program (Medicaid) often becomes the ultimate Pregnant … administered by the Division of Medical assistance for eligible individuals. increase his or her monthly income up to a minimum monthly maintenance needs allowance, 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. If you are married, and only one of you needs long-term care you may be concerned how the Medicaid rules will affect the other spouse. But since the wife has a shortfall of $325 between her separate income and the amount of the MMMNA allowed for her, the husband can deduct $325 from his PPA and give this to the wife each month. MAGI is used to determine financial eligibility for CHIP, Medicaid, and the health insurance marketplace. When one spouse of a married couple applies for long-term care Medicaid, the value of both spouses' assets are considered for eligibility purposes. Boston, MA 02114 (617) 371-1234. 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 countable. Couples are not always clearly advised of The combined amount of income from the spouse will be used to determine Medicaid eligibility. and know that they can request a fair hearing as soon as the assessment is completed, 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. needs allowance increased above the maximum in the event of hardship. 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. In addition, ownership of certain assets does not affect the Medicaid eligibility of married couples. Again, the purpose of doing the assessment as a separate procedure is twofold. Greater Boston Legal Services is supported by, among others, the following sources: United Way of Massachusetts Bay, Inc. Non-countable Assets- Certain assets are not countable and Grandfolk® editorial staff provides in-depth product and service reviews to empower senior buying decisions. The income deduction for the community spouse is more complicated, as explained below. A small amount per month may be set aside as a "personal needs allowance" ("PNA"). Pays entire These are considered "excess assets." Medicare- A health insurance program administered by the The above example works only if the revised CSRA is allowed before the husband’s income is used. Both are provided for in the federal Medicaid statute, as explained below. So, pension, annuity payments and social security payments will follow the person whose name is on the check.