Many people believe that, if their spouse goes into a nursing home, they will be left without sufficient assets or income to meet their own needs for support.  However, Medicaid law provides assets and income allowances for the at-home spouse’s needs if they are married to the individual in the nursing home, and allows a residence to be saved for the surviving spouse from Medicaid’s claim upon that person’s death.
Medicaid’s “long term care” (LTC) coverage pays nursing home costs for eligible individuals.  A single Medicaid applicant may have monthly countable income of up to $2,199 (2016) and countable assets of up to $4,000 to qualify for Medicaid for LTC.  Under “spousal impoverishment” rules for married applicants, the at-home spouse (“community spouse” or CS) may keep all of his/her own separate income, plus enough of the applicant’s income to get the CS’s income up to $2,981  per month (the “monthly maintenance needs allowance”) (2016) if the CS’s separate income is less than this amount.  The CS may also own separate countable resources of up to $119,220 (the “community spouse resource allowance”).  Assets may be transferred from the nursing home spouse to the community spouse to achieve these levels, without any penalty to eligibility (and even though the transfer is made within five years before filing the application).  The separate income (Social Security, etc.) of the applicant spouse that is not assigned to the CS as part of the monthly maintenance needs allowance  must be applied to pay nursing home cost as the applicant’s “share of cost”, but the community spouse’s income and assets need not be spent for this care. (Penalties are imposed for transfers of assets by the applicant or the applicant’s spouse to others, with a few exceptions.)
Federal law requires that each state Medicaid agency seek to recover reimbursement from the estate of each deceased Medicaid recipient for nursing home services paid by Medicaid after the recipient was 55 years of age.  However, this claim will be waived by Medicaid (a) if there is a surviving spouse, (b) if there is a surviving dependent who is under the age of twenty-one (21) years or who is blind or disabled, or (c) if it is determined by Medicaid or by court order that there is undue hardship.  Estate recovery against a residence may also be waived if an immediate family member of the applicant is living in the home or if there is a surviving spouse, child or grandchild.
If you have questions about any Medicaid issues or need Medicaid advice or advocacy, contact us or call us today at 601-987-3000.