Someone who qualifies for Medicaid to cover the cost of nursing home care mut pay his or her income over to the nursing home. The government picks up the rest of the cost. When most of a couple’s income is in the name of the spouse who is receiving Medicaid, the spouse remaining in the community may wonder what he or she will live on. Medicaid has created some protections for the community spouse.
When a married person applies for Medicaid, the assets of both spouses are counted, regardless of how titled as between each of them. Those assets must shrink down to a modest amount in order to qualify for Medicaid. But the income of the “community spouse” is not counted in determining the Medicaid applicant’s eligibility. Only income in the applicant’s name is counted. Thus, even if the community spouse is still working and earning, say, $5,000 a month, or has substantial Social Security and pension income, he or she will not have to contribute to the cost of caring for a spouse in a nursing home if the spouse is covered by Medicaid.
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 local 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 $2,178 to a high of $3,259.50 a month (in 2021). 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.
Example: Joe and Sally Smith have a joint income of $2,600 a month, $1,900 of which is in Mr. Smith’s name and $700 is in Ms. Smith’s name. Mr. Smith enters a nursing home and applies for Medicaid. The Medicaid agency determines that Ms. Smith’s MMMNA is $2,200 (based on her housing costs). Since Ms. Smith’s own income is only $700 a month, the Medicaid agency allocates $1,500 of Mr. Smith’s income to her support. Since Mr. Smith also may keep a $60-a-month personal needs allowance, his obligation to pay the nursing home is only $340 a month ($1,900 – $1,500 – $45 personal needs allowance = $355).
In exceptional circumstances, community spouses may seek an increase in their MMMNAs by pursuing an administrative appeal with the Pennsylvania Department of Human Services. Contact VASILIADIS PAPPAS ASSOCIATES to find out about these options.