Protecting the Community Spouse
The Community Spouse is the spouse of the individual that is institutionalized in a nursing home and is seeking Medicaid eligibility to pay for long-term care. Before the community spouse resource allowances were provided for, divorce was often necessary to protect the resources of the community spouse. Unless the combined countable assets are less than the minimum resource standard of $21,912 (for 2009), some significant financial data must evaluated to determine Medicaid eligibility for the institutionalized spouse. As a general rule, the spouse of a married applicant is permitted to keep one-half of the couple's combined assets (as of the date of institutionalization) up to $109,560 (the Community Spouse Resource Allowance). Additionally, the minimum resource allowance for the community spouse is $21,912. These numbers are effective January 1, 2009. Medicaid Manual § M1480.231.
Illustration of the CRSA Rules
- Combined Assets in Excess of Twice the Maximum Allowance. Let's assume a hypothetical couple has the following assets: A house assessed at $200,000 (the wife resides in the home), one automobile worth $12,000, $100,000 in financial accounts in the husband's name, $100,000 in financial accounts in wife's name, and $50,000 in jointly-titled assets, for a total of $250,000 in countable assets. The husband has dementia and resides in a nursing home. We are seeking Medicaid eligibility for the husband.
We divide the countable assets by two: $250,000 ÷ 2 = $125,000. Since this number is over the maximum resource allowance of $109,560, the wife gets to keep the maximum allowance of $109,560. Therefore, the wife has excessive resources of $140,440, and the husband will not be eligible for Medicaid until the wife has reduced her countable assets to less than $109,560 and no outstanding penalty periods remain.
- Combined Assets Less than Twice the Maximum Allowance, But More Than the Twice the Minimum Allowance. Let's assume a hypothetical couple has the same assets as above, but the countable assets total $150,000 (rather than $250,000). We divide the countable assets by two, for a total of $75,000. Because $75,000 is between the minimum and maximum allowances, the wife can keep $75,000 and the remaining $75,000 must otherwise be disposed of before the husband can be eligible for Medicaid.
- Combined Assets Less Than Twice the Minimum Allowance. Let's assume the same hypothetical couple has the same assets as indicated above, but only has countable assets of $33,000. Because $33,000 is less than twice the minimum standard of $21,912, the husband will be eligible for Medicaid once the wife's assets have been reduced to no more than $21,912, resulting in excessive resources of $11,088.
Determination Date for Calculating Countable Resources
The determination of the level of the couple's assets is made as of the first day of the month of continuous institutionalization of the institutionalized spouse (the “snap shot date”). It is advantageous for the couple to have as much money as possible in their names on the snap shot date up to $219,120 ($109,560 x 2) so that the amount the community spouse is allowed to keep will be as high as possible. Medicaid Manual § M1480.000 B.2.
Disregarding Assets Post-Eligibility
After the institutionalized spouse qualifies for Medicaid long-term care assistance, the community spouse's resources are no longer deemed available to the institutionalized spouse. Medicaid Manual § M1480.230.
Minimum Monthly Maintenance Needs Allowance
Income Allowances for Community Spouses
The income allowances for married couples with one spouse applying for Medicaid is treated quite differently from an unmarried individual. An unmarried Medicaid applicant can only keep $40 per month of income; the rest of the Medicaid recipient's income is paid to the nursing home as the patient pay. For married Medicaid recipients, except as described in the following paragraph, the income of the community spouse will continue undisturbed; he or she will not have to use his or her income to support the nursing home spouse receiving Medicaid benefits. In some cases, the community spouse is also entitled to share in all or a portion of the monthly income of the nursing home spouse. The DSS determines an income floor for the community spouse, known as the Minimum Monthly Maintenance Needs Allowance (MMMNA).
- MMMNA Calculation. The MMMNA is calculated as follows:
$1,750 plus an excess shelter allowance equal to the amount by which the following expenses exceed $525, to include rent, mortgage payments, taxes, insurance and utility standard of $252.
- The MMMNA cannot exceed $2,610.00 unless a court orders a greater amount.
- The MMMNA may range from a low of $1,750 per month to a high of $2,610.00 per month. If the community spouse's own income falls below his or her MMMNA, then the shortfall can be made up from the nursing home spouse's income. Medicaid Manual § 1480.410 et seq.
- Under Virginia law, a spouse is legally obligated to support his or her needy spouse. Based on this requirement, the DSS is required to inform a community spouse of his or her legal obligation to provide support. If the community spouse's monthly gross income exceeds $1,900, the DSS is required to pursue a contribution toward the cost of the institutionalization from the community spouse.
Excess Income Contributions
If the community spouse's gross monthly income exceeds $1,900, he or she will be expected to contribute $15 per month to the cost of the institutionalized spouse's nursing home care if the community spouse's monthly income equals or exceeds $2,000. This scale of expectancy increases by $10 for each additional $100 of the community spouse's gross monthly income over $2,000. For example, if the community spouse's gross monthly income is $2,300, he or she will be expected to contribute $45 per month toward the cost of care [($10 x 3) + $15 = $45]. If the community spouse's income is $2,500 per month, he or she will be expected to contribute $65 per month[($10 x 8) + $15 = $65]. Medicaid Manual § M1480, Appendix 6.