Individuals or couples who plan to apply for Massachusetts found that the federal statute allows the income-first rule, but the state legislature stopped the Medicaid agency in Massachusetts from using the income-first rule. The community There are two ways to go about providing the needed income: increase the CSRA, or let the community spouse use income of the institutionalized spouse instead of requiring it all to go to the nursing home. Due to the high cost of nursing home care, and the limitations of the Medicare and long If they live in a state that allows the community spouse to keep the first $50,000, all of the assets will be attributed to the community spouse. In addition, income may be given to the community spouse or to dependent children, if their separate income is not considered sufficient to meet their needs. If you are married and seeking coverage from Medicaid Long-Term Care, you may be in one of two situations. After adding together all countable marital assets, the state Medicaid agency then determines what share of those assets the community spouse will be allowed to keep while the other receives Medicaid nursing home benefits. Disclaimer: Grandfolk strives to keep its information accurate and up to date. Pregnant … Medicaid eligibility is incredibly complex, especially in the case of married couples. This is known as the "income-first" rule, which has been adopted in some states. He or she immediately will qualify for Medicaid as an applicant having less than $2,000 in resources. As explained below, there are provisions for using income of the institutionalized spouse to support the community spouse, but not vice versa. It is important to file a request The community spouse always keeps the first few thousand dollars. Advertiser Disclosure: We receive compensation from our partners when someone applies or gets approved for a product through 
our site. Medicaid law changes often. a nursing home almost all of a couple's assets had to be spend in order to establish Medicaid eligibility for the institutionalized spouse, leaving the remaining spouse (the Shore Elder Services, Inc. Massachusetts Legal Assistance Corporation. Specific planning must be done to protect your home. countable assets. INFORMATION MARRIED COUPLES SHOULD KNOW ABOUT MEDICAID ELIGIBILITY AND COVERAGE OF NURSING HOME CARE . effective for nursing home admissions which occur on or after September 30, 1989, to allow For this reason, the assessment often is referred to as a "snapshot" of the couple’s assets on the date of admission to the nursing home. Have a net household income of less than $834 if single or less than $1129 if married. However, this page is specifically focused on Medicaid eligibility for Florida residents who are 65 years of age and older. Here’s an example to show you how Medicaid eligibility would be determined. Ohio found that the income-first rule violates the federal Medicaid statute. Pays for covered services, subject to deductibles and Pays entire Certain assets are disregarded (i.e., not counted when calculating the applicant’s assets), including one car per household, certain burial expenses, home property, and certain life insurance policies. Most married couples own a home, and unless planning is done to protect it, it can be lost to Medicaid “estate recovery,” which enables the State to recover Medicaid benefits paid to someone when that person later dies. The Medicaid program provides special eligibility rules where the applicant is married and requires care in a nursing home. For married couples with one spouse applying for Aged, Blind and Disabled Medicaid, income is calculated jointly. The first principal is that spouses are financially responsible for one another. The assets may have to be spent, or the couple can request a revised (increased) CSRA, which is explained below. INFORMATION MARRIED COUPLES SHOULD KNOW ABOUT MEDICAID ELIGIBILITY AND COVERAGE OF NURSING HOME CARE. that they have the right to request that the Division of Medical Assistance conduct an Both are provided for in the federal Medicaid statute, as explained below. monthly needs allowance, based on his or he r income and housing costs. When all but $2,000 has been spent, the institutionalized spouse will qualify for Medicaid. spent down. There has been a considerable amount of litigation over the income-first rule, with mixed results. Greater Boston Legal Services is supported by, among others, the following sources: United Way of Massachusetts Bay, Inc. The institutionalized spouse has 90 days after obtaining eligibility to transfer to the community spouse enough assets to satisfy her CSRA. But the community spouse may be able to benefit from the revised CSRA procedure under appropriate circumstances. If you are married, and only one of you needs long-term care you may be concerned how the Medicaid rules will affect the other spouse. Readers should be aware the maximum income limits change dependent on the marital status of the applicant, whether a spouse is also applying for Medicaid and the type of Medicaid for which they are applying. Furthermore, assets are defined as countable or non-countable or exempt assets under the Medicaid … Concern about this phenomenon is acute in nursing home cases, where the cost of care can consume the couple’s entire life savings in a matter of months. This provision is set at one-and-one-half times the Federal Poverty Level for a single person living alone. Only by allowing the community spouse a revised CSRA before using income of the institutionalized spouse can those assets be preserved as permanent protection for the community spouse. the couple how their assets can be divided, establishing the amount of assets which can be To get answers to all of the questions you might have about your particular case, contact us. Unfortunately, the income-first rule does not allow the community spouse to go back and recover assets that were spent on the nursing home after the institutionalized spouse dies. These transfers incur no penalty. Medicaid eligibility is determined at many levels, and each state has its own requirements, which change every year. Here's an example of how an immediate annuity works: John and Mary are a married couple living in Boston, Massachusetts, with total countable assets of $270,000. Some states allow the community spouse to keep all countable assets up to the federal maximum. Medical Assistance will notify the couple regarding the amount of assets which must be To learn more about the rules in your state, check with your local agency. MAGI is used to determine financial eligibility for CHIP, Medicaid, and the health insurance marketplace.