When a person applies for Medicaid to pay for long-term care in a skilled nursing facility, there is a financial qualification component based upon the single individual’s resources or the couple’s resources on the date of admission. There are separate rules that relate to income of the Medicaid recipient and his/her spouse.
If the Medicaid recipient is in a skilled nursing facility, the Medicaid recipient’s income is considered his/her contribution toward care costs. A Medicaid recipient may keep a $45.00 monthly personal needs allowance and the money to pay for the supplemental insurance premium. The rest of the Medicaid recipient’s income is considered the recipient’s contribution toward care costs. If the recipient is married, that could leave the spouse at home with insufficient monies to pay for day to day expenses. The situation could be even more dire if the non-Medicaid spouse is in a personal care home and has higher monthly costs.
The law has income protections for the spouse at home or in a personal care home, often referred to as the “community spouse.” Effective July 1, 2020, a community spouse is entitled to a minimum monthly maintenance needs allowance (“MMMNA”) of $2,155.00 (up from $2,114.00 previously) and a maximum monthly maintenance needs allowance (“MaxMMNA”) of $3,216.00.
Let’s look at an example: Bob is in the nursing home on Medicaid. His total net income, after deducting his $45.00 monthly personal needs allowance and supplemental insurance premium, is $3,250.00. Bob’s wife, Sue, is healthy and living at home with a modest gross monthly income of $800.00. The Medicaid law permits a diversion of $1,355.00 of Bob’s income to Sue to bring her up to the $2,155.00 MMMNA. The remaining $1,895.00 of Bob’s income is considered his contribution toward his care, and Medicaid will pay the rest of the skilled nursing home’s Medicaid reimbursement rate.
There are other factors that may allow the County Assistance Office (“CAO”) processing Bob’s Medicaid application to increase the diversion to more than $1,355.00 of Bob’s income. However, the largest increase that can be made by the CAO from Bob’s income is $2,416.00, as adding this to Sue’s income of $800.00 would result in the MaxMMNA of $3,216.00. There are circumstances where more than the MaxMMNA can be diverted; however, they are case specific and cannot be approved solely by the CAO.
The laws, considerations and consequences involved in paying for long-term care are complicated. No matter how well-meaning “friends who’ve been through it,” facility business offices and agencies intend to be, the laws change often, and misconceptions abound. If your spouse is in a nursing home or you are assessing options of admission and Medicaid application for care, consult with a certified elder law attorney.