The expense of nursing home care, which ranges from $4,000 to $6,000 a month or more, can rapidly deplete the lifetime savings of elderly couples. In 1988, Congress enacted provisions to prevent what has come to be called “spousal impoverishment,” which can leave the spouse who is still living at home in the community with little or no income or resources. These provisions help ensure that this situation will not occur and that community spouses are able to live out their lives with independence and dignity.
Resource Eligibility
The spousal impoverishment provisions apply when one member of a couple enters a nursing facility or other medical institution and is expected to remain there for at least 30 days. When the couple applies for Medicaid, an assessment of their resources is made. The couple’s resources, regardless of ownership, are combined. The couple’s home, household goods, an automobile, and burial funds are not included in the couple’s combined resources. The result is the couple’s combined countable resources. This amount is then used to determine the Spousal Share, which is one-half of the couple’s combined resources.
To determine whether the spouse residing in a medical facility meets the state’s resource standard for Medicaid, the following procedure is used: From the couple’s combined countable resources, a Protected Resource Amount (PRA) is subtracted. The PRA is the greatest of:
* The Spousal Share, up to a maximum of $109,560 in 2009;
* The state spousal resource standard, which a state can set at any amount between $21,912 and $109,560 in 2009;
* An amount transferred to the community spouse for her/his support as directed by a court order; or
* An amount designated by a state hearing officer to raise the community spouse’s protected resources up to the minimum monthly maintenance needs standard.
After the PRA is subtracted from the couple’s combined countable resources, the remainder is considered available to the spouse residing in the medical institution as countable resources. If the amount of countable resources is below the State’s resource standard, the individual is eligible for Medicaid. Once resource eligibility is determined, any resources belonging to the community spouse are no longer considered available to the spouse in the medical facility.
Income Eligibility
The community spouse’s income is not considered available to the spouse who is in the medical facility, and the two individuals are not considered a couple for income eligibility purposes. The state uses the income eligibility standard for one person rather than two, and the standard income eligibility process for Medicaid is used.
Post-Eligibility Treatment of Income
This process is followed after an individual in a nursing facility/medical institution is determined to be eligible for Medicaid. The post-eligibility process is used to determine how much the spouse in the medical facility must contribute toward his/her cost of nursing facility/institutional care. This process also determines how much of the income of the spouse who is in the medical facility is actually protected for use by the community spouse.
The process starts by determining the total income of the spouse in the medical facility. From that spouse’s total income, the following items are deducted:
* A personal needs allowance of at least $30;
* A community spouse’s monthly income allowance (between $1,750 and $2,739 for 2009), as long as the income is actually made available to her/him;
* A family monthly income allowance, if there are other family members living in the household;
* An amount for medical expenses incurred by the spouse who is in the medical facility.
The community spouse’s monthly income allowance is the amount of the institutionalized spouse’s income that is actually made available to the community spouse. If the community spouse has income of his or her own, the amount of that income is deducted from the community spouse’s monthly income allowance. Similarly, any income of family members, such as dependent children, is deducted from the family monthly income allowance.
Once the above items are deducted from the institutionalized spouse’s income, any remaining income is contributed toward the cost of his or her care in the institution.
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Hi! Haven’t communicated with you for some time. I used to hang out at the old ‘listserve’ long ago.
We may have to sell home because mortgage payments are too high. Once we sell then equity is exposed? As long as I were to live in the home it would not be counted? But if we sell the house then the equity is divided if ill spouse were to need medicaid?
We are 56 and 57 years old. Spouse has RA, Fibro, damaged back. House is too big and we cannot maintain it anymore.
Thanks for Caring Bill
Hi Bill! I’m so glad to hear from you! I hope you’ve been doing okay. How’s your daughter?
I believe you are correct; the proceeds from your home, should you sell, would be considered “countable resources.”
I’ll see if I can find an elderlaw attorney who can shed more light.
.-= Denise´s last blog ..Finding, Then Keeping, the Happiness =-.
In college! Yikes! Time Flies! She has an eye condition, in one eye, called central serous retinopathy. It’s like macular degeneration, not good and only 19!
Regarding your 6 principles. Under the second principle it is mentioned how much income caregivers lose if they have to quit work to care. There is another figure that is equally important. The amount of income a caregiver loses even if they remain employed. People only have so much time and energy. Caregivers often cannot spend the time required to build a professional career nor work the hours if they are hourly workers. Salaried caregivers can’t compete with their coworkers for advancement because caregivers can’t work the longer hours and miss more workdays than noncare givers. Raising a family at the same time being a caregiver restricts earning power even more. This loss of income accumulates over workers’ careers destroying the ability to save for retirement.
We must make our plight known.
One solution, for those patients who qualify for social security disability, would be to allow additional funds to be automatically provided to the principle caregiver. State could also set up funds to provide assistence to those caregivers need even more help, possibly low interest refinancing for principle residences.
Hi Bill–Excellent point! The EEOC does have guidelines which prevent unfair treatment of employees with caregiving responsibilities; the guidelines are here.
Of course, the guidelines don’t help when you feel you have to change your career goals because of caregiving responsibilities. Hmm… I’m going to explore this more. You’ve given me a great idea!
I also wanted to mention that we have a spousal support group now; you can learn more about it here.
Here is my answer to Bill:
If you sell the home the proceeds will become an available resource to the extent they are not otherwise excluded.
However, you can invest the funds in another home thereby continuing to obtain the home exemption, which can protect up to $500,000 in equity in most states.
Even if you do not reinvest the proceeds in a new home, there may be other ways to protect the proceeds. This will depend on the laws in your state. Consult a certified elder law attorney (CELA)in your state. There is a national list of all certified elder law attorneys at http://www.nelf.org. You shouldn’t wait to do so. Delay is your enemy – get good advice now.
My name is Susan I have my husband that is handicapped and in a wheelchair I have lost my job a few months after this happen to my husband Iam now his full time care giver.I am looking for work to do from our home but as now no luck. We do live in Canada is there a spouse care giver allowance for me ? I do not know where to go can you help us in any way ? Thank You Susan
Hi Susan–Check with the Canadian Caregiver Coalition–they can direct you to resources. Here’s the website for the coalition: http://www.ccc-ccan.ca/index.php