The Medicaid law provides special protections for the spouse of a nursing home resident to make sure he/she has the minimum support needed to continue to live in the community.
The so-called “spousal protections” work this way: if the Medicaid applicant is married, the countable assets of the community spouse and the institutionalized spouse are totaled as of the date of “institutionalization,” the day on which the ill spouse enters a hospital or a long-term care facility in which he or she then stays for at least 30 days.
In general, the community spouse may keep one-half of the couple's total “countable” assets up to a maximum of $104,400.00 (in 2008). Called the "community spouse resource allowance," this is the most that a state may allow a community spouse to retain. A community spouse can retain additional assets if he or she can show “hardship.” In most states the criteria for hardship are very difficult to meet. The least that a state may allow a community spouse to retain is $20,880.00 (in 2008).
Example: If a couple has $100,000.00 in countable assets on the date the applicant enters a nursing home, he or she will be eligible for Medicaid once the couple's assets have been reduced to a combined figure of $52,000.00 - $2,000.00 for the applicant and $50,000.00 for the community spouse.
In nearly all circumstances, the income of the community spouse will continue undisturbed; he or she will not have to use his or her income to support the institutionalized spouse receiving Medicaid benefits. 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 based on his or her housing costs. The MMMNA may range from a low of $1,712.00 to a high of $2,610.00 a month (in 2008). If the community spouse's income falls below his or her MMMNA, the shortfall is made up from the institutionalized spouse's income. (In some states the community spouse is permitted to increase the MMMNA by retaining more resources.)
Example Mr. and Mrs. Smith have a joint income of $2,000.00 a month, $1,500.00 of which is in Mr. Smith's name. Mr. Smith enters a nursing home and applies for Medicaid. The Medicaid agency determines that Mrs. Smith's MMMNA is $1,712.00 (based on her housing costs). Since Mrs. Smith's own income is only $500.00 a month, the Medicaid agency allocates $1,212.00 of Mr. Smith's income to her support. Since Mr. Smith also may keep $45.00 per month for a personal needs allowance, his monthly Medicaid co-pay to the nursing home is only $243.00 per month ($1,500.00 - $1,212.00 - $45.00 = $243.00).
In exceptional circumstances, community spouses may seek an increase in their MMMNA either by appealing to the state Medicaid agency for “hardship” or by obtaining a court order of spousal support.
