When marriage includes caregiving
Let’s agree that love brings rewards and challenges. This is for the spouse or domestic partner who may be struggling to care for their frail or ill partner, and who doesn’t have the finances to pay for caregivers to help in the home. Their household might benefit from the InHome Supportive Services Program (IHSS) funded by Medi-cal, but they aren’t sure they qualify.
As a couple they may have thought they were not eligible for the program because either their assets or incomes were too high. For an older couple to be eligible for Medi-cal, generally their “countable” assets cannot exceed $3,000, and their combined incomes must fall below a certain threshold to avoid a monthly share of cost deductible. (Countable assets do not include the home they live in, one household car, and specified arrangements related to IRAS, work-related pensions, nonwork related annuities, and burial.)
Previously if the couple didn’t meet these restrictions, the only possibility for care support may have been outside the home; the frail spouse could enter a Skilled Nursing Facility with payment supports under Medi-cal’s Spousal Impoverishment Protection Rule which was designed to prevent the impoverishment of one spouse when the other spouse enrolls in Medi-cal payment for care. But things have changed and Medi-cal’s Spousal Impoverishment Protection Rule was expanded to include Home and Community Based (HCBS) supports like IHSS. This opens the opportunity for more spouses to receive the needed assistance to keep their loved ones at home.
We mentioned the asset limits for a couple to be Medi-cal eligible, but if only one member of the couple is frail and requires care, then those asset and income limits increase significantly under the Spousal Impoverishment Protection Rule where only the frail spouse applies for Medi-cal. Here, the spouse who isn’t receiving MediCal (the “well spouse”) may retain additional income and assets without jeopardizing the eligibility of the Medi-cal spouse. Currently, the well spouse is permitted to retain a “Community Spouse Resource Allowance” of $128,640 in countable assets in addition to the $2,000 in countable assets the Medi-cal spouse may retain. Combined monthly incomes may well exceed $3,216 before the couple has to contribute toward the cost of care. These limits typically increase each April.
When applying for this program with the local Medi-cal office, it’s important to specify that you are applying for an “HCBS Waiver.” A doctor will need to complete a form verifying the level of need to be at the skilled nursing level.
For more information on this or other resources for older adults in Lake and Mendocino Counties, contact Senior Information & Assistance at Community Care at (707) 468-5132 , or visit www.seniorresourceDirectory.org.