When a nursing home resident is receiving Medicaid long-term care benefits, most of their income must be paid to the nursing home each month and applied to the cost of their care. This is sometimes referred to as the resident’s “patient pay liability.”
But, if the nursing home resident is married, this patient pay liability may be impacted by community spouse income protections found in federal and state law.
The community spouse is entitled to retain a certain minimum level of income called the Monthly Maintenance Needs Allowance (MMNA). If the community spouse’s own income is insufficient to provide this allowance, income can be diverted to the community spouse from the institutionalized spouse.
The MMNA is set at 150% of the federal poverty level for a family of two plus an excess shelter allowance, if applicable. The Pennsylvania MMNA is adjusted on July 1st of each year to keep up with inflation adjustments to the poverty level. For the period July 1, 2014 until June 30, 2015 the minimum allowance has been $1,967 per month.
In January 2015 the Department of Health and Human Services announced that the 2015 federal poverty guideline for a family of two is $15,930. (It’s higher if you live in Hawaii or Alaska). This means that effective July 1, 2015 Pennsylvania should increase the community spouse minimum MMNA to $1,991.25 per month.
Pennsylvania usually “rounds up” amounts under one dollar so the working allowance will likely be set at $1,992 per month.
A standard monthly shelter allowance is built into the minimum MMNA. The actual MMNA allowance can be higher than the minimum if the community spouse has high housing cost and is entitled to an “excess shelter allowance.”
The MMNA can also be increased in situations where the community spouse can show “exceptional circumstances resulting in significant financial duress.” 42 U.S.C. § 1396r-5(d)(2)(B). Several Pennsylvania appellate court cases have dealt with the issue of whether a community spouse has such exceptional circumstances. See Davis v. DPW (776 A.2nd 1026 (Pa.Cmwlth. 2001) and Kuznick v. DPW (5A.3d 832) (Pa.Cmwlth. 2010).
The MMNA can also be increased by judicial court-ordered support under 42 U.S.C. § 1396r-5(d)(5). An increase in the MMNA via judicial order does not require a showing of “exceptional circumstances resulting in significant financial duress.”
The minimum income allowance rules are part of the federally mandated “spousal impoverishment” protections that were enacted in 1988 to limit the potential for impoverishment of spouses of nursing home residents.