Community Spouse

  • By Richard Young
  • 13 Feb, 2019

About half of Americans turning 65 today will develop some condition requiring long-term services and support. These individuals will require assistance with activities of daily living such as feeding, getting dressed, or bathing. Often, nursing home care is needed to provide 24-hour medical care. The inability to gain access to affordable, competent care can be the most significant threat to the physical, emotional, and financial well-being of the afflicted individuals and their families.

The cost of institutional care can quickly impoverish working and middle-class individuals, costing on average $6,832 per month. For individuals who qualify, Medicaid will help cover those costs. The institutionalized individuals are required to pay all but a very small portion of their income each month for their care with Medicaid covering the rest. That can leave a spouse still living at home (the “Community Spouse”) without enough money to cover basic living expenses.

Congress recognizes the need for balance in the Medicaid program between providing long-term care based on medical necessity and preventing the impoverishment of the spouse at home. When determining Medicaid eligibility, all of a married couple’s assets are totaled regardless of who acquired it. To prevent complete impoverishment of the Community Spouse, Congress enacted some spousal protections:

•      While the Institutionalized Spouse may have no more than $4,000 in assets in order to qualify for Medicaid, the Community Spouse may retain some assets. In 2019, the combined value of assets of the Institutionalized Spouse and the Community Spouse allowed is $126,420.

•      If the Community Spouse’s income is below $3,160.50 per month, then some or all of the Institutionalized Spouse’s income can be given to the Community Spouse to bring the Community Spouse’s monthly income up to $3,160.50.

 

•      Medicaid does not count the Community Spouse’s income when determining whether the Institutionalized Spouse is eligible for Medicaid. The Institutionalized Spouse’s income is limited to $2,313 per month.

Many do not realize that the spouse at home can have some assets and also possibly access to the Institutionalized Spouse’s income to help pay the bills.

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