Medicaid planning for a spouse in a nursing home

When a spouse enters a nursing home the cost of care can be financially devasting. Many families are simply unable to afford long-term care without applying for Medicaid. To qualify for Medicaid there are limits on the resources that an applicant may have. Resources include both income and assets. In Pennsylvania, the Medical Assistance program is managed by the Department of Human Services (DHS), and through the local County Assistance Office (CAO). One of the most complex requirements for Medicaid is the financial eligibility. The financial eligibility rules for the cost of long-term care are tricky and can be difficult to understand. This is especially true where the Medicaid applicant is married.

Generally, to be eligible for Medicaid for longterm care the applicant may have no more than $2,400 in countable assets in their name if their gross monthly income is $2,382 (2021 income limit) or more. An applicant may have no more than $8,000 in countable assets if their gross monthly income is less than $2,382 (2021 income limit).

However, Federal law mandates certain protections that are designed to prevent a spouse from becoming impoverished when their spouse enters a nursing home and applies for Medicaid. In 2021, the spouse of a Medicaid recipient living in a nursing home (the Community Spouse) may keep as much as $126,420 (the maximum Community Spouse Resource Allowance “CSRA”) and a minimum of $26,076 (the minimum CSRA) without jeopardizing the Medicaid eligibility of the spouse who is receiving long-term care. To determine the amount of the CSRA, the countable assets of both the community spouse and the spouse in the nursing home are totaled as of the date of admission to the nursing home. The date of admission is often referred to as the “snapshot” date. The community spouse may keep one-half of the couple’s total countable assets up to a maximum and no less than the minimum of. The rest of the assets must be spent-down to qualify for Medicaid.

In addition to the CSRA, there are also Federal rules regarding income for the spouse. In Pennsylvania the community spouse is entitled to retain all of their own income regardless of how much it is. In addition, if the community spouse’s income is less than the amount set by Pennsylvania as the minimum amount needed to live on (called the Minimum Monthly Maintenance Needs Allowance, or MMMNA), then some of the applicant spouse’s income can be allocated to the community spouse to make up the difference. This allocation is referred to as the Spousal Allowance. The MMMNA is between $2,155 and $3,259.50 in Pennsylvania for 2021. The minimum monthly maintenance needs allowance remains $2,155 until July 1, 2021.In addition, the community spouse can receive more than the MMMNA by way of court order, where expenses justify it. The rules regarding the request for additional income above the MMMNA are very tricky, so make sure to consult with an Elder Law Attorney.

Although the above referenced rules set guidelines for the resources that a community spouse is allowed to retain, as well as the income that an institutionalized spouse must pay to a skilled nursing facility, these guidelines can be modified in certain situations. Federal and state law recognize that the community spouse should not become impoverished when his or her spouse qualifies for Medicaid benefits to pay for long-term care, and the income and resources of both spouses can be examined to determine whether the community spouse is entitled to additional income or resources. Having an experienced Elder Law Attorney represent you for a Medicaid Application has several advantages, including expert advice on how best to qualify for benefits as early as possible and experience in dealing with difficult eligibility issues. It is important to consult with an Elder Law Attorney when dealing with the complex rules regarding the Community Spouse Resource Allowance.

The legal advice in this column is general in nature, consult your attorney for advice to fit your particular situation.

Elder Law Foundation as authorized by the Pennsylvania Supreme

Court. She is a principal of the law firm of O’Donnell, Weiss & Mattei, P.C., 41

High Street, Pottstown, and 347 Bridge Street, Phoenixville,610-323-2800,