Medicaid provides special protections for the healthy spouses of Medicaid applicants. Regulations are designed to ensure the healthy spouse has the minimum support needed to continue to live in the community while their counterpart receives long-term care benefits, usually in a nursing home.
Here is how the so-called “spousal protections” work: if the Medicaid applicant is married, the countable assets of both the community spouse and the institutionalized spouse are totaled as of the day the ill spouse enters the facility in which he or she then stays for at least 30 days.
Generally speaking, in order to be eligible for Medicaid benefits, a nursing home resident may have no more than $2,400 in assets (this amount may be somewhat higher for residents with low income). In Pennsylvania, the community spouse may keep one-half of the couple’s total “countable” assets up to a maximum of $137,400 (in 2022). This figure is called the “community spouse resource allowance.” The minimum amount that must be preserved for the benefit of the community spouse is $27,480 (in 2022).
The income of the community spouse is not counted in determining the Medicaid applicant’s eligibility. Only income of the institutionalized spouse is counted. Thus, if the community spouse is still working and earning $5,000 a month, the community spouse will not have to contribute to the cost of caring for her spouse.
But what if most of the couple’s income is in the name of the institutionalized spouse and the community spouse’s income is not enough to live on? In such cases, the community spouse is entitled to some or all of the monthly income of the institutionalized spouse. How much the community spouse is entitled to depends on what the Medicaid agency determines to be a minimum income level for the community spouse. This figure, known as the minimum monthly maintenance needs allowance or MMMNA, is calculated for each community spouse according to a complicated formula based on his or her housing costs. The MMMNA may range from a low of $2,289 to a high of $3,435 a month (in 2022). If the community spouse’s own income falls below his or her MMMNA, the shortfall is made up from the nursing home spouse’s income.
Contact a qualified Medicaid Planner to find out what you can do to make sure the healthy spouse residing in the community has enough income to support themselves. Call 570-784-4654 to meet with one of our Certified Medicaid Planners.